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Lithium Side Effects

For the Consumer

Applies to lithium: oral capsule, oral solution, oral syrup, oral tablet, oral tablet extended release

In addition to its needed effects, some unwanted effects may be caused by lithium. In the event that any of these side effects do occur, they may require medical attention.

Severity: Major

You should check with your doctor immediately if any of these side effects occur when taking lithium:

Less common:
  • Confusion, poor memory, or lack of awareness
  • fainting
  • 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
Rare:
  • Blue color and pain in the fingers and toes
  • coldness of the arms and legs
  • dizziness
  • eye pain
  • headache
  • noise in the ears
  • vision problems
Incidence not known:
  • Dry, rough skin
  • fast, irregular, pounding, or racing heartbeat or pulse
  • hair loss
  • hoarseness
  • lightheadedness
  • mental depression
  • sensitivity to cold
  • shortness of breath
  • swelling of the feet or lower legs
  • swelling of the neck
  • unusual excitement

If any of the following symptoms of overdose occur while taking lithium, get emergency help immediately:

Symptoms of overdose:
  • Blurred vision
  • clumsiness or unsteadiness
  • convulsions (seizures)
  • diarrhea
  • drowsiness
  • 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)

Severity: Minor

Some of the side effects that can occur with lithium may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

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

Nervous system

Frequency not reported: Headache, drowsiness, lethargy, tendency to sleep, impaired consciousness, lack of coordination, ataxia, giddiness, fine hand tremor, tremor, coarse tremor of the extremities and lower jaw, dysarthria, myoclonus, clonic movements of whole limbs, choreoathetotic movements, hyperactive deep tendon reflexes, abnormal reflexes, hypertonicity, blackout spells, epileptiform seizures, convulsions, slurred speech/speech disorder, dizziness, vertigo, somnolence, metallic/salty taste, dysgeusia/taste distortion, peripheral neuropathy, psychomotor retardation, restlessness, stupor, coma, acute dystonia, extrapyramidal syndrome, cogwheel rigidity, downbeat nystagmus, tongue movements, poor memory, slowed intellectual functioning, startle response, benign intracranial hypertension, pseudotumor cerebri (increased intracranial pressure and papilledema), encephalopathy, transient electroencephalogram (EEG), diffuse slowing of EEG, widening of EEG frequency spectrum, potentiation and disorganization of EEG background rhythm[Ref]

Drowsiness and lack of coordination may be early signs of lithium toxicity, and may occur at lithium levels below 2 mEq/L.

Ataxia and giddiness occurred at levels above 2 mEq/L.

Fine hand tremor may occur during initial therapy for the acute manic phase, and may persist during therapy.

The development of transient EEG changes, headache, dysgeusia/taste distortion, and metallic taste were unrelated to dosage.

Peripheral neuropathy may occur in patients on long-term treatment, but is usually reversible after discontinuation of therapy.[Ref]

Cardiovascular

The development of transient ECG changes, chest tightness, and edematous swelling of ankles/wrists were unrelated to dosage.

Painful discoloration of the fingers/toes and coldness of extremities (resembling Raynaud's syndrome) occurred within one day of initiation; the patient recovered after discontinuation. The exact mechanism for this side effect is unknown.[Ref]

Frequency not reported: Cardiac arrhythmia, hypotension, peripheral circulatory collapse, sinus node dysfunction with severe bradycardia (may result in syncope), bradycardia, unmasking of Brugada syndrome, transient ECG changes, reversible flattening of ECG, isoelectricity of ECG, inversion of T-waves, QT prolongation, Raynaud's syndrome, chest tightness, atrioventricular block, cardiomyopathy, peripheral edema/edematous swelling of ankles or wrists[Ref]

Gastrointestinal

Frequency not reported: Diarrhea, vomiting, nausea, flatulence, constipation, indigestion, incontinence of feces, gastritis, salivary gland swelling, dry mouth, excessive salivation, abdominal pain/discomfort, swollen lips, dental caries[Ref]

Diarrhea and vomiting may be early signs of lithium toxicity, and may occur at lithium levels below 2 mEq/L.

Transient and mild nausea may occur within the first few days of therapy.

The development of metallic/salty taste, dental caries, and swollen lips were unrelated to dosage.[Ref]

Dermatologic

Frequency not reported: Drying and thinning of hair, anesthesia of skin, acne/acneform eruptions, chronic folliculitis, xerosis cutis, alopecia, psoriasis exacerbation, cutaneous ulcers, papular skin disorders, generalized pruritus with/without rash[Ref]

The development of generalized pruritus with/without rash and cutaneous ulcers were unrelated to dosage.[Ref]

Endocrine

Frequency not reported: Euthyroid goiter, hypothyroidism (including myxedema), thyrotoxicosis, lower T3 and T4 levels, iodine 131 uptake increased, hyperthyroidism, hyperparathyroidism, diffuse nontoxic goiter with/without hypothyroidism[Ref]

Hyperthyroidism has been rarely reported, and may persist after discontinuation of treatment.

Hyperparathyroidism may persist after discontinuation of treatment.

The development of diffuse nontoxic goiter with/without hypothyroidism and hyperparathyroidism were unrelated to dosage.[Ref]

Musculoskeletal

Muscular weakness develops early in lithium toxicity, and may occur at lithium levels below 2 mEq/L.

Muscle hyperirritability includes fasciculations, twitching, clonic movements of whole limbs.

The development of swollen/painful joints and polyarthralgia were unrelated to dosage.[Ref]

Frequency not reported: Muscular weakness, muscle hyperirritability, twitching, arthralgia/polyarthralgia, myalgia, myasthenia gravis, swollen/painful joints, rhabdomyolysis[Ref]

Renal

Frequency not reported: Oliguria, glycosuria, decreased creatinine clearance, nephrogenic diabetes insipidus, microcysts, nephrotic syndrome, histological renal changes with interstitial fibrosis[Ref]

Diabetes insipidus may persist after discontinuation of treatment.

Histological renal changes with interstitial fibrosis occurred in patients on prolonged treatment, and was usually reversible upon discontinuation. Long-term treatment may cause permanent kidney changes and impairment of renal function; high serum concentrations and/or acute lithium toxicity may worsen these changes.[Ref]

Metabolic

Frequency not reported: Anorexia, dehydration, weight loss, transient hyperglycemia/hyperglycemia, hypercalcemia, hypermagnesemia, excessive weight gain[Ref]

The development of transient hyperglycemia, hypercalcemia, and excessive weight gain were unrelated to dosage.[Ref]

Other

Tinnitus occurred at levels above 2 mEq/L.

Mild thirst may occur during initial therapy for the acute manic phase, and may persist during therapy; in some cases, thirst resembled diabetes insipidus. The development of thirst was unrelated to dosage.

General discomfort may also appear within the first few days of therapy.

The development of fever was unrelated to dosage.[Ref]

Frequency not reported: Tinnitus, thirst, general discomfort, fasciculations, fatigue, feeling dazed, fever[Ref]

Genitourinary

Frequency not reported: Large output of dilute urine, polyuria, incontinence of urine, albuminuria, polyuria, impotence/sexual dysfunction[Ref]

At levels above 2 mEq/L, patients excreted a large output of dilute urine.

Polyuria may occur during initial therapy for the acute manic phase, and may persist during therapy; in some cases, polyuria resembled diabetes insipidus. The development of polyuria was unrelated to dosage.

The development of albuminuria was unrelated to dosage.[Ref]

Psychiatric

Frequency not reported: Confusion, tics, hallucinations, delirium, worsening of organic brain syndromes[Ref]

The worsening of organic brain syndromes was unrelated to dosage.[Ref]

Hypersensitivity

Frequency not reported: Angioedema, allergic rashes[Ref]

Ocular

Frequency not reported: Blurred vision, transient scotomata/scotoma[Ref]

Blurred vision occurred at levels above 2 mEq/L.[Ref]

Oncologic

Frequency not reported: Oncocytoma, collecting duct renal carcinoma[Ref]

Collecting duct renal carcinoma occurred in patients on long-term therapy.[Ref]

Hematologic

Frequency not reported: Leukocytosis[Ref]

The development of leukocytosis was unrelated to dosage.[Ref]

References

1. "Product Information. Eskalith (lithium)." SmithKline Beecham, Philadelphia, PA.

2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

3. Cerner Multum, Inc. "Australian Product Information." O 0

4. "Product Information. Lithobid (lithium)." Ciba Pharmaceuticals, Summit, NJ.

Not all side effects for lithium may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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