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Lithium

Brand names:

Eskalith®, Eskalith CR®, Lithobid®
  • Tablets: 300mg, 450mg
  • Capsules: 300mg
  • Generic name: Lithium carbonate (tablets and capsules), Lithium citrate (liquid)
  • Tablets: 300mg
  • Slow-release tablets: 300mg, 450mg
  • Capsules:150mg, 300mg. 600mg
  • Liquid: 300mg/5mL (300mg per teaspoonful)

What is lithium and what does it treat?

Lithium is a medication that works in the brain to treat bipolar disorder. It is approved for the treatment of bipolar disorder and acute mania. Bipolar disorder involves episodes of depression and/or mania.

A depressive episode, or depression, occurs when a person experiences several of the following symptoms at the same time: "low" or depressed mood (e.g., sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/hopeless/helpless, psychomotor agitation or retardation (i.e., thoughts/movements speeding up or slowing down), difficulty concentrating, and thoughts of death (suicidal thinking).

A manic episode, or mania, is when a person experiences several of the following symptoms at the same time: “high” or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, and frequently involved in activities with large risk for bad consequences (e.g., excessive buying sprees).

Bipolar disorder is a brain disorder (mental illness) that exposes people to these mood changes over the course of time. Bipolar disorder affects more than two million Americans each year, but individuals with this disorder can lead fulfilling lives when they receive proper treatment. Unfortunately, many people with this illness do not receive treatment.

What is the most important information I should know about lithium?

Do not stop taking lithium or change your dose without first talking to your healthcare provider.

Lithium is used for long-term treatment of bipolar disorder.

Do not stop taking lithium even when you feel better. Only your healthcare provider can determine the length of lithium treatment that is right for you.

Missing doses of lithium may increase your risk for a relapse in your mood symptoms.

In order for lithium to work properly, it should be taken every day as ordered by your healthcare provider.

Periodically, your healthcare provider may ask you to provide a blood sample to make sure the appropriate level of medication is in your body and to assess for side effects, such as changes in blood counts.

Are there specific concerns about lithiumand pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions. This is a complex decision since untreated bipolar disorder has risks to the fetus as well as the mother. It is important to discuss with your doctor and caregivers.

Exposure to lithium during the first three months of pregnancy is associated with a slightly increased risk of "Ebstein’s Anomaly", a heart valve defect. Even though recent data suggest that the risk of Ebstein’s anomaly from first trimester use of lithium is very low, an ultrasound of the heart is recommended at 16 to 20 weeks of gestation. Serum lithium concentrations should be monitored monthly in early pregnancy and weekly near delivery. Avoidance of sodium depletion and avoidance of a low salt diet are recommended to prevent lithium toxicity.

Breast-feeding is not recommended in women who are taking lithium.

What should I discuss with my healthcare provider before taking lithium?

  • Symptoms that are most bothersome to you about your condition
  • If you have thoughts of suicide
  • Medications you have taken in the past to treat bipolar disorder, whether they were effective or caused any adverse effects
  • Any psychiatric or medical problems you may have
  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
  • Other non-medication treatment you are receiving (such as psychotherapy (i.e., talk therapy) or substance abuse treatment). Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breast-feeding
  • If you smoke, drink alcohol, or use illegal drugs

How should I take lithium?

Lithium is usually taken two to three times per day with food.

If you are taking an extended release form of lithium, it is important to swallow the tablet whole. Do not crush or chew extended release tablets.

While the dose usually ranges from 900–1200 mg/day, your healthcare provider will determine the dose that is right for you based upon your response and your lithium blood level.

What happens if I miss a dose of lithium?

If you miss a dose of lithium, take it as soon as you remember it. If it is close to your next dose, wait until then to take the medication and skip the missed dose. Do not double your next dose or take more than your prescribed dose. Discuss any missed doses with your healthcare provider.

What should I avoid while taking lithium?

Avoid drinking alcohol or using illegal drugs while you are taking lithium. They may decrease the benefits (e.g., worsen your symptoms) and increase adverse effects (e.g., sedation, dizziness).

Avoid excessive intake of caffeinated beverages, such as coffee, tea, cola or energy drinks, since these may decrease levels of lithium and decrease effectiveness of the medication

What happens if I overdose with lithium?

If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1 (800) 222-1222.

Overdosing with lithium may lead to: confusion, difficulty concentrating, sluggishness, vomiting, diarrhea, poor coordination, tremor and muscle weakness or twitching. In severe cases, people can develop abnormal heart rhythm, seizures. Coma and death are possible.

A specific antidote for lithium does not exist.

What are possible side effects of lithium?

Common

Sedation, nausea, loss of appetite, mild diarrhea, dizziness, fine hand tremors, increased production of urine and excessive thirst are common side effects.

Rare

In rare cases, lithium may lead to a reversible condition known as diabetes insipidus. If this occurs you would notice a drastic increase in thirst and how much fluid you drink as well as how much you urinate.

Hypothyroidism and other thyroid conditions may occur with long term lithium use.

Are there any risks for taking lithium for long periods of time?

To date, there are rare kidney problems associated with long term use of lithium. Generally, it is a safe and effective medication when used as directed.

What other medications may interact with lithium?

There are a number of medications which can increase the amount of lithium in the body. These include:

  • Diuretics: hydrocholorothiazide (Microzide), furosemide (Lasix), bumetanide (Bumex), torsemide (Demadex), acetazolamide (Diamox), chlorothiazide (Diuril), and chlorthalidone (Thalitone)
  • Non-steroidal anti-inflammatory medications (NSAIDs) including: ibuprofen (Advil); naproxen (Aleve, Naprosyn); celecoxib (Celebrex); diclofenac (Voltaren); and nabumetone (Relafen)
  • Angiotensin receptor blockers (ARBs): valsartan (Diovan), olmesartan (Benicar), candesartan (Atacand), losartan (Cozaar)
  • Angiotensin converting enzyme (ACE) inhibitors: enalapril (Vasotec), captopril (Capoten), benazepril (Lotensin), fosinopril (Monopril)

Some substances may decrease the amounts of lithium in the body, examples include:

  • Caffeine                            
  • Theo–Dur®, Slo–Bid® (theophylline)

How long does it take for lithium to work?

It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking lithium. It will probably take several weeks to see big enough changes in your symptoms to decide if lithium is the right medication for you.

Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder. Your doctor can best discuss the duration of treatment you need based on your symptoms and course of illness.

Provided by College of Psychiatric and Neurologic Pharmacists, January 2012

Reviewed by Ken Duckworth, M.D., NAMI Medical Director

FDA Warning: Lithium toxicity can occur at therapeutic doses, so serum lithium determinations are required to monitor therapy.

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