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Lithium Patient Tips

Written by C. Fookes, BPharm on Nov 04, 2016

How it works

  • Experts are not sure exactly how lithium works but believe it alters sodium transport in nerve and muscle cells which adjusts the metabolism of neurotransmitters within the cell.

Upsides

  • Used to treat manic episodes of manic-depressive (bipolar) disorder.
  • Long-term therapy with lithium prevents or diminishes the intensity of subsequent episodes of mania.

Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Fine hand tremor, frequent urination and mild thirst commonly occur during lithium initiation. Sometimes these effects may persist throughout treatment.
  • Nausea during initiation is common but usually subsides with continued administration.
  • Diarrhea, vomiting, drowsiness, muscular weakness, loss of appetite and coordination difficulties may be an early sign of lithium toxicity. Dizziness, blurred vision, ringing in the ears and excessive production of dilute urine may occur with higher (toxic) lithium levels. Seek urgent medical advice.
  • Lithium may also cause irregular heartbeat, drying and thinning of hair, alopecia, dry mouth, weight gain, itchiness, and other side effects. Long-term use may lead to hypothyroidism or other thyroid problems.
  • Monitoring is required, particularly during therapy initiation but also long-term.
  • Not suitable for people with significant renal or cardiovascular disease, in those who are frail, dehydrated, taking diuretics or with low levels of sodium. Not recommended for children aged less than 12.
  • Full effects of lithium in pregnancy have not been fully determined so advice is to avoid lithium particularly in the first trimester.
  • May interact with several other medications including diuretics (water pills), NSAIDs and ACE inhibitors.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

Bottom Line

Lithium is useful for treating manic episodes of bipolar disorder; however, there is a fine line between too much and too little and ongoing monitoring is needed to prevent lithium toxicity.

Tips

  • Lithium is usually taken two to three times daily with food.
  • Do not crush or chew extended-release tablets; swallow whole.
  • Too much caffeine may decrease the amount of lithium in your body.
  • Lithium may affect your mental alertness or make you drowsy. Do not drive until you know how lithium will affect you. Avoid alcohol.
  • Ensure you keep adequately hydrated while taking lithium. The risk of side effects of lithium is increased if you are dehydrated, or if you are excessively hydrated. Excessive sweating or diarrhea may also upset the balance of lithium in the blood.
  • Contact your doctor if you become ill or have an infection as your dosage of lithium may need to be altered or temporarily discontinued.
  • There is a fine line between too much and too little lithium. Always take lithium exactly as directed and go to your scheduled appointments. Never take any herbal supplements or over the counter remedies without consulting your doctor or pharmacist first as many drugs may affect blood levels of lithium.
  • Seek urgent medical attention if symptoms similar to diabetes (such as excessive thirst or excessive urine production) occur.
  • Stop lithium and contact your doctor urgently if symptoms of lithium toxicity such as diarrhea, vomiting, tremor, drowsiness, muscle weakness or confusion occur.
  • May affect your mental and physical abilities so be careful driving or operating machinery until you know how lithium affects you.
  • If you miss a dose of lithium, take it as soon as you remember. If it is close to your next dose, do not double up on the dose.

Response and Effectiveness

  • A reduction in manic symptoms should be noticed within one to three weeks. Your doctor will determine if your symptoms have improved enough to warrant lithium long-term.

References

Lithium [Package Insert] Revised 06/2006. Miles Pharmaceuticals. https://www.drugs.com/pro/lithane.html

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use lithium only for the indication prescribed.

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