Lithium carbonate is about twice the elemental lithium per gram, it seems after further googling. So, it's like I'm taking half the lithium carbonate dose. So if I take 4 then that would be like taking 240 of lithium carbonate, which is a pretty low dose. Also, I read about a lithium orotate overdose of 18 pills that only had minor effects. I don't plan to go into any really high dose but if I experience nausea or tremors then I will back the dose down.
Here is the study you mention:
J Med Toxicol. 2007 Jun;3(2):61-2.
Lithium toxicity from an Internet dietary supplement.
Pauzé DK, Brooks DE.
Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. pauzedk@upmc.edu
INTRODUCTION: The widespread availability of medications and herbal products on the Internet has increased the potential for poisonings. We are reporting a case of mild, acute lithium toxicity occurring after the intentional misuse of a lithium-containing "dietary supplement" (Find Serenity Now) obtained over the Internet. CASE REPORT: An 18-year-old woman presented to our emergency department (ED) after ingesting 18 tablets of Find Serenity Now; each tablet contained, according to the listing, 120 mg of lithium orotate [3.83 mg of elemental lithium per 100 mg of (organic) lithium orotate compared to 18.8 mg of elemental lithium per 100 mg of (inorganic) lithium carbonate]. The patient complained of nausea and reported one episode of emesis. Her examination revealed normal vital signs. The only finding was a mild tremor without rigidity. Almost 90 minutes after the ingestion, her serum lithium level was 0.31 mEq/L, a urine drug screen was negative, and an electrocardiogram (ECG) showed a normal sinus rhythm. The patient received intravenous fluids and an anti-emetic; one hour later, her repeat serum lithium level was 0.40 mEq/L. After 3 hours of observation, nausea and tremor were resolved, and she was subsequently transferred to a psychiatric hospital for further care. Prior human and animal data have shown similar pharmacokinetics and shared clinical effects of these lithium salts. DISCUSSION: Over-the-Internet dietary supplements may contain ingredients capable of causing toxicity in overdose. Chronic lithium toxicity from ingestion of this product is also of theoretical concern.
PMID: 18072162
Note their concern about chronic lithium toxicity -- lithium has a half-life of approximately 20 hours. You won't reach steady concentrations of lithium until you've taken a given dose for five to seven days. If the data suggesting typical dietary intake of lithium to be 1mg daily is correct, 5mg already represents a high level of supplementation, and the 20mg you're taking can only be described as pharmacological self-medication with lithium. And if you are thinking 20mg of elemental lithium is not that much compared to typical lithium carbonate therapy, consider that there may be differences in bioavailability and elimination that make lithium orotate more potent (the word toxic could be substituted depending on your perspective):
An animal study by Smith and Schou suggests that the kidneys clear lithium orotate significantly less effectively than lithium carbonate, and that this accounts for the higher serum levels of lithum when lithium orotate is taken compared to the equivalent amount of lithium carbonate. They conclude: "The higher lithium concentrations could be accounted for by the lower kidney function. It seems inadvisable to use lithium orotate for the treatment of patients."[3] Proponents of lithium orotate therapy argue that this study was flawed because equal amounts of each compound of lithium was employed, whereas the point of using lithium orotate is to consume less elemental lithium than with lithium carbonate therapy.[4]
The study which concluded that lithium orotate was inadvisable for treatment of patients was done as a direct follow-up study to one performed by Kling, Manowitz and Pollack in 1978. Their study suggested that lithium orotate could be used in lower amounts than the amounts required when using lithium carbonate, while achieving therapeutic results.[5] However, an earlier study did not find a difference in the uptake, distribution and elimination of the orotate salt, as compared to carbonate or chloride salts of lithium.[6]
Self-treatment of a psychiatric disorder with these supplements is potentially dangerous, since lithium is toxic in high doses.[7] The active principle in these salts is the lithium ion Li+, which interacts with the normal function of sodium ions to produce numerous changes in the neurotransmitter activity of the brain. Therapeutically useful amounts of lithium are only slightly lower than toxic amounts when lithium carbonate or lithium citrate are used, so the blood levels of lithium must be carefully monitored during treatment.
3 ^ Smith DF, Schou M. Kidney function and lithium concentrations of rats given an injection of lithium orotate or lithium carbonate. J Pharm Pharmacol. 1979 Mar;31(3):161-3. Retrieved 18 April 2007
4 ^ Lithium Orotate - Herbal Miracle or Internet Snake Oil?. Retrieved February 22, 2008.
5 ^ Kling MA, Manowitz P, Pollack IW. Rat brain and serum lithium concentrations after acute injections of lithium carbonate and orotate. J Pharm Pharmacol. 1978 Jun;30(6):368-70.
6 ^ Smith, DF (April 1976). "Lithium orotate, carbonate and chloride: pharmacokinetics, polyuria in rats". Br J Pharmacol. 56 (4): 399–402. PMID 1260219, http://www.pubmedcen...ubmedid=1260219.
7 ^ Pauzé DK, Brooks DE (June 2007). "Lithium toxicity from an Internet dietary supplement". J Med Toxicol 3 (2): 61–2. PMID 18072162, http://jmt.pennpress...302_061_062.pdf.
At a dose of 150mg lithium orotate daily, less than a third of your dose, 20% of the patients in this study developed side effects including muscle weakness, loss of appetite and apathy. Side effects resolved with less frequent dosing.
Alcohol. 1986 Mar-Apr;3(2):97-100.
Lithium orotate in the treatment of alcoholism and related conditions.
Sartori HE.
The subjects were 42 alcoholic patients (33 males and 9 females) who were treated with lithium orotate during an alcohol rehabilitation program in a private clinical setting for at least six months. They derive from a total number of 105 patients who received this treatment initially, while the remainder discontinued the treatment within six months. The data were collected from a private practice record and the follow-up varied between six months and 10 years. The 42 patients studied displayed a multitude of complaints in addition to chronic alcoholism. These included liver dysfunction, seizure disorders, headaches, hyperthyroidism, affective disorders. Meniere's syndrome, liver and lung cancers. Thirty-six of the 42 patients studied had been hospitalized at least once for the management of their alcoholism. Lithium orotate was given, 150 mg daily, with a diet low in simple carbohydrates and containing moderate amounts of protein and fat. In addition, calcium orotate (for hepatic involvement), magnesium orotate, bromelaine, and essential phospholipids (for cardiac problems), and supportive measures were instituted, if required. Lithium orotate proved useful as the main pharmacologic agent for the treatment of alcoholism. Ten of the patients had no relapse for over three and up to 10 years, 13 patients remained without relapse for 1 to 3 years, and the remaining 12 had relapses between 6 to 12 months. Lithium orotate therapy was safe and the adverse side effects noted were minor, i.e., eight patients developed muscle weakness, loss of appetite or mild apathy. For these patients, the symptoms subsided when the daily dose was given 4 to 5 times weekly.
Edited by FunkOdyssey, 16 December 2008 - 05:21 PM.