When I was first prescribed lithium, my psychiatrist told me to take it once daily
just before bed, and to get a blood test measuring the trough serum level 12 hours
after the previous dose. I was troubled by these instructions. Firstly, I did not
understand why my psychiatrist was using the term trough to apply to a lithium serum
concentration about halfway between peak and trough serum concentrations. Secondly,
I did not understand why my dosing regimen was not twice daily (every 12 hours). Since
the therapeutic window of lithium is very small, splitting the dose would have produced
a narrower peak-to-trough serum lithium level. Thirdly, I did not know why a peak
lithium level blood test was not asked for. I was under the impression acute toxicity
was the danger when starting lithium.
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