Lithium: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Dec 29, 2019.
1. How it works
- Lithium may be used to treat mania associated with bipolar disorder. 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. Lithium is an element found naturally in the environment and in our bodies.
- Lithium belongs to the class of medicines known as antimanic agents.
- May be 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.
- Non-habit forming and not abusable.
- Generic lithium is available.
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 kidney disease, high blood calcium levels, hyperparathyroidism, hypothyroidism or other thyroid problems.
- Dosing may be difficult because there is not much of a margin between an adequate dose of lithium and a toxic dose.
- Monitoring is required, particularly during therapy initiation but also long-term.
- Not suitable for people with significant renal or cardiovascular disease, who are frail, dehydrated, taking diuretics or with low levels of sodium. Not recommended for children aged less than 12. Lithium use may cause an unmasking of Brugada syndrome (a heart disorder characterized by abnormal ECG findings and a risk of sudden death).
- The range of effects of lithium in pregnancy have not been fully determined so experts recommend women avoid lithium, particularly in the first trimester.
- May interact with several other medications including diuretics (water pills), NSAIDs and ACE inhibitors.
- Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium]), fast heart rate, dizziness, flushing, muscle tremor or rigidity and stomach symptoms (including nausea, vomiting, and diarrhea).
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.
- Lithium is usually taken two to three times daily with food.
- 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.
- 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.
- 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 and maintain an adequate salt intake (your doctor will discuss this requirement). 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.
- 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.
- Seek urgent medical advice if symptoms consistent with serotonin syndrome (such as agitation, hallucinations, fast heart rate, dizziness, flushing, nausea, diarrhea) develop.
- You will need to go for regular blood tests while you are taking lithium to ensure that the dosage is appropriate for you.
- May affect your mental and physical abilities so be careful driving or operating machinery until you know how lithium affects you.
- Do not take any other medications, including those bought over the counter, without first checking with your doctor or pharmacist that they are compatible with lithium.
6. Response and Effectiveness
- Lithium is completely absorbed in the gastrointestinal tract with peak levels occurring 0.25 to 3 hours after oral administration of immediate-release preparations and two to six hours after sustained-release preparations.
- 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.
Medicines that interact with lithium may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with lithium. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with lithium include:
- antacids containing sodium bicarbonate
- anticonvulsants, such as carbamazepine, fosphenytoin, phenytoin, phenobarbital, or primidone
- antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, fluoxetine, sertraline)
- antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
- any medication that may prolong the QTc interval, such as amiodarone or haloperidol
- calcium channel blockers, such as diltiazem or verapamil
- diuretics, such as furosemide or HCTZ
- heart medications, such as digoxin, ACE inhibitors (such as captopril, enalapril, or lisinopril), angiotensin II receptor antagonists (such as candesartan or irbesartan)
- migraine medications, such as almotriptan, eletriptan, or sumatriptan
- NSAIDs, such as ibuprofen, diclofenac, or naproxen
- opioids (such as codeine, morphine)
- sodium chloride
- other medications that affect serotonin, such as amphetamines, dextromethorphan, fentanyl, ondansetron, tramadol, or St. John's Wort.
Avoid drinking alcohol or taking illegal or recreational drugs while taking lithium.
Note that this list is not all-inclusive and includes only common medications that may interact with lithium. You should refer to the prescribing information for lithium for a complete list of interactions.
Lithium. Revised 08/2019. Drugs.com https://www.drugs.com/ppa/lithium.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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- Drug class: antimanic agents
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