Lithium Side Effects
Some side effects of lithium may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to lithium: oral capsule, oral solution, oral syrup, oral tablet, oral tablet extended release
Along with its needed effects, lithium may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking lithium:Less common
- Confusion, poor memory, or lack of awareness
- fast or slow heartbeat
- frequent urination
- increased thirst
- irregular pulse
- stiffness of the arms or legs
- troubled breathing (especially during hard work or exercise)
- unusual tiredness or weakness
- weight gain
- Blue color and pain in the fingers and toes
- coldness of the arms and legs
- eye pain
- noise in the ears
- vision problems
- Dry, rough skin
- fast, irregular, pounding, or racing heartbeat or pulse
- hair loss
- mental depression
- sensitivity to cold
- shortness of breath
- swelling of the feet or lower legs
- swelling of the neck
- unusual excitement
Get emergency help immediately if any of the following symptoms of overdose occur while taking lithium:Symptoms of overdose
- Blurred vision
- clumsiness or unsteadiness
- convulsions (seizures)
- increase in the amount of urine
- lack of coordination
- loss of appetite
- muscle weakness
- nausea or vomiting
- ringing in the ears
- slurred speech
- trembling (severe)
Some side effects of lithium may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:Less common
- Acne or skin rash
- bloated feeling or pressure in the stomach
- muscle twitching (slight)
For Healthcare Professionals
Applies to lithium: compounding powder, oral capsule, oral syrup, oral tablet, oral tablet extended release
The hand tremor associated with lithium therapy is usually a fine rapid intentional tremor. Coarsening of the tremor or occurrence of tremor in a new part of the body may suggest lithium toxicity.
A wide variety of other nervous system effects have been reported and include ataxia, dysarthria, hyperreflexia, other movement disorders, EEG changes, blackouts, stupor, coma, central incontinence, sleep disturbances, dizziness, vertigo, pseudotumor cerebri, seizures, and worsening of organic brain syndrome.
One study (n=34) has concluded that chronic maintenance treatment with lithium affects the peripheral nerves even if the impairment rarely leads to discontinuation of therapy. This study suggests that monitoring of electroneuronographic results could be useful for the early detection of neurotoxicity of lithium.
Nervous system side effects most commonly have included nervous system effects include tremor, lethargy, lassitude, and muscle weakness. Headache, decreased concentration and confusion also have been reported less frequently. Most of these effects resolve during continuing therapy.
Gastrointestinal side effects including nausea, vomiting, diarrhea, anorexia, abdominal pain, and dry mouth have been reported frequently.
Taking lithium with meals or dividing doses may ameliorate some of the gastrointestinal effects of lithium.
Renal side effects including nephrogenic diabetes insipidus have been reported in as many as 50% of patients started on lithium. As a consequence, many patients experience polydipsia and polyuria. Rarely, some patients may show serum electrolyte abnormalities and clinical evidence of dehydration.
The nephrogenic diabetes insipidus associated with lithium therapy is generally reversible after discontinuation of lithium but may take up to a year or more to resolve.
Some investigators have suggested that indomethacin may be useful in the treatment of lithium-induced nephrogenic diabetes insipidus. The mechanism of action of indomethacin's favorable effects may be related to its antiprostaglandin activity or to the prevention of sodium loss in the ascending loop of Henle. Other investigators have recommended amiloride as a useful drug in the medical management of lithium-induced nephrogenic diabetes insipidus.
Moderate reversible increases in blood urea nitrogen and serum creatinine as well as proteinuria have been observed in patients with lithium toxicity. Rarely the decreases in glomerular filtration have been persistent. A variety of renal effects have been reported and include glomerular sclerosis, interstitial fibrosis, chronic interstitial nephritis, nephrotic syndrome, renal tubular acidosis and tubular atrophy.
Endocrine side effects including clinically evident hypothyroidism (1% to 4%) have been reported. Goiter occurs in approximately 5% of patients. Myxedema coma and hyperglycemia have been reported. A case of silent thyroiditis has also been reported.
Lithium exerts multiple effects on the thyroid gland. Most importantly it inhibits the release of thyroxine and triiodothyronine and can lead to enhanced thyrotropin activity resulting in goiter. Therefore some clinicians recommend baseline thyroid function tests and yearly thyroid function tests while patients are on lithium.
Cardiovascular side effects including a variety of arrhythmias, hypotension, peripheral circulatory collapse and EKG changes have been reported. There have been postmarketing reports of a possible association between treatment with lithium and the unmasking of Brugada Syndrome.
The EKG manifestations of lithium are similar to those seen in hypokalemia and include reversible flattening and inversion of the T wave.
In addition to the effects noted above, interstitial myocarditis has been reported in one patient who experienced lithium overdose.
Cases of sinus node dysfunction have also been reported (often in association with concomitant carbamazepine therapy).
Dermatologic side effects including alopecia have been reported fairly commonly. Folliculitis, maculopapular rash, acneform eruptions, exacerbations of psoriasis, and lower extremity ulcers have also been reported. One case of mycosis fungoides has been reported.
Lithium-induced alopecia has generally been reported to occur within the first six months of treatment. Although the scalp is the most common site for lithium-associated hair loss, rare reports of body hair loss also exist. The alopecia appears to be reversible upon discontinuation of therapy.
Excessive lithium concentration has been determined not to be a contributing factor to hair loss. An increase in the telogen shedding rate has been determined to be the most likely mechanism for lithium-associated hair loss.
Hematologic side effects including reversible leukocytosis (with leukocyte counts in the range of 8,000 to 15,000 cells/mm3) have been reported to occur in most patients on lithium. Erythrocytosis and thrombocytosis have been reported to occur much more rarely.
General side effects including weight gain and, less frequently, weight loss as well as edema have been reported. Metallic taste in the mouth, fever and pruritus have also been reported.
Hypersensitivity side effects including allergic vasculitis have been reported rarely.
Genitourinary side effects may include a significant decrease sperm motility as suggested by one in vitro study.
More about lithium
- Lithium controlled-release and extended-release tablets
- Lithium syrup
- Lithium (Advanced Reading)
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