Questions re. Switching to Orotate
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Q:  Questions re. Switching to Orotate

Hello Dr.,

I have read so much about Orotate and you have shown excellent  documentation as well. So I am writing to let you know I  have plans to take oratate  as soon as I can, but what the situation is is that I am currently taking Lith Carbonate( 900mg) and I dont want to take them both at the same time yet I dont know what the transition should be like. I really dont want to find out the hard way so I wondered if I should make a transition slowly taking them both and end up taking the Orotate or just switch on point? I am going to take Orotate regardless but I really  pray you might have any advice for what you would  do.


Dear Anthony --

My apologies in advance: my knee is jerking in response to your question.  If you'll pardon the tone, there may be  some information that you will find useful.

Something is making you really want to switch to orotate. I fear that this is a result of some sort of marketing by someone who stands to make money off you.  To my knowledge, there is no rational reason to want to switch.  We have absolutely no basis to think that orotate is safer for your kidney, for example.  Since the risks of orotate are basically unknown, whereas the risks of lithium carbonate have been "available for viewing" for several decades now, to switch from lithium carbonate to use lithium orotate is certainly a case of trading the devil you know for the devil you don't know.

Worse yet, not only are you trading a known risk for an unknown one, you are trading known efficacy for unknown value.  Forgive me for pounding away like this, but I just don't get it.

Nevertheless, to answer your question, and try to remain respectful of the inquiry, I will try to gently point out that if we have no data on efficacy or risks or appropriate doses, then we are unlikely to have any data on which to base a strategy for switching.

Well, that might be overstated, actually. We do know that stopping lithium carbonate suddenly is associated with a much greater likelihood of return of symptoms in the short run, compared to tapering off lithium carbonate.  So presuming that there is a substantial chance that lithium orotate, at whatever dose you choose, may not be effective; and presuming that lithium carbonate is doing something useful now at 900 mg (which may not be the case, I recognize); then you would definitely want to taper off the lithium carbonate.  On that basis, you would probably want to taper up the lithium orotate.

From the way you are asking this question, somehow I find myself doubting that you are going to discuss this with the doctor who is currently prescribing the lithium carbonate.  That could be unfortunate, in that it might well be just that doctor to whom you would turn if symptoms got out of control.  If so, one might reason that you owe it to her or him to provide information about what you're doing before you do it, so the doctor can comment. In my practice, I would listen to your explanation, try to understand what the basis of your interest in orotate actually is, and see if we can address whatever is driving your decision in a fashion that is more informed by accurate information.  I understand that there are doctors out there who would simply dismiss the question outright, and perhaps belittle you in the process (I hope I am not doing too much of that right here).

I so strongly believe that you ought to be talking with your physician about this that I think it would probably be best if I did not give you any further information on how to taper lithium carbonate.  At least I would be internally consistent that way.

In preparation for discussing this issue with your physician, you might try to write out (for yourself, if not for her) exactly what you're trying to achieve with the switch.  That will help her help you best.  Good luck with that --

Dr. Phelps

Published November, 2008


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