About Lithium
Lithium is an antidepressant that appears to work by altering sodium
transfer in nerve and muscle cells. But the exact reason for its
effectiveness in treating mood disorders is unknown.
This drug treats bipolar disorder by correcting mania and reducing
depressive mood swings. It reduces the highs and lows of manic depression,
allowing a more stable mood. It may be used to treat or control
mania when this condition appears on its own. Other conditions for
which this medication may be prescribed include aplastic anemia
(additional therapy), chronic hair-pulling, cluster headache prevention,
mood disorders that affect the sex drive, reducing aggressive behavior.
The effects of this medication should be fully understood before
taking it. Regular blood tests every two months, and a thyroid test
2-4 times per year are important to making sure that you're using
appropriate doses. Be aware of the signs of toxicity, so that you
know when to seek medical attention.
Lithium is only available by prescription. Do not take other
mood-altering substances while taking Lithium unless directed
to do so by your doctor. Lithium works best when used regularly,
and should only be stopped under the management of your doctor
to avoid withdrawal or recurrence of symptoms.
Lithium Side Effects
Common Side Effects: Drowsiness, heart block, increased
thirst, increased white blood cells, lethargy, tremor (slight),
weight gain.
Adverse Side Effects: These side effects require varying
levels of medical attention. With mild symptoms, contact your doctor
as soon as possible to notify them of the situation. If your symptoms
are severe or troublesome, seek medical attention immediately. Call
emergency services if you are unable to reach a treatment facility
on your own.
Mild: Allergy (itching, skin rash), blurred vision, diarrhea,
dizziness, edema (water retention and swelling), hair loss, inhibited
erection, joint pain, male infertility, metallic taste, nausea or
vomiting, ringing in the ears, skin dryness, stiff limbs, troubled
breathing during exertion, unsteadiness, weakness.
Severe: Altered (high or low) thyroid function, blackouts,
blue color and pain in extremities, brain disease (very rare), changes
in heart rate or rhythm, confusion, depression, excessive urine,
fixed eye position, heart inflammation, loss of sphincter control,
lupus (very rare), myasthenia gravis (muscle weakness), porphyria,
seizure, sensitivity to cold, slurred speech, spasmodic movement,
stupor, unusual movements.
Toxicity: Diarrhea, drowsiness, lethargy, muscle twitching,
tremor, unsteadiness, or vomiting. It's important to recognize these
signs so that you will know when it's appropriate to contact your
doctor and/or seek medical attention. If you experience these symptoms,
do not take any further doses of Lithium until, and unless, your
doctor instructs you to do so.
Toxicity may be caused by accidental overdose (blood level checks
are necessary to prevent this), childbirth, decreased kidney function,
dehydration, diuretic use, illness, iodides (additional antithyroid
effect, found in some salts and cough syrups), low blood sodium,
new medication.
Cautions: This medication is not suitable for everyone.
To ensure that your treatment is safe and effective, speak with
your doctor if you have any of the following conditions, or a history
of them.
- Allergy: If you have an allergic reaction to Lithium,
you should not use it. An allergic reaction in the past is a contraindication
for future treatment.
- Brain Disease: You may be particularly sensitive to Lithium,
and may be more likely to experience confusion or other mental
effects.
- Diabetes: Speak to your doctor regarding safe treatment.
If your diabetes is untreated through medication and/or diet,
you should not take Lithium.
- Difficult Urination: Condition may be worsened.
- Epilepsy: Condition may be worsened.
- Heart Disease: Condition may be worsened.
- Hypothyroidism: Lithium depresses thyroid function, which
is why regular tests are encouraged throughout treatment. If you
already have a low thyroid condition, you will require closer
monitoring. If your low thyroid is untreated, you should not use
Lithium.
- Kidney Disorder: If you have impaired kidney function,
you will be given a lower dose of this medication according to
your doctor's determination. Individuals with kidney failure should
not use Lithium.
- Leukemia: If you've had this disease in the past, Lithium
treatment may cause it to recur.
- Other Drugs: If you take, or plan to take, any other
prescription or over the counter medication you should speak to
your doctor about its safety. Of particular concern and diuretics
and cortisone treatments.
- Parkinson's Disease: Conditon may be worsened.
- Porphyria: Lithium is not a safe treatment for porphyria.
- Pregnancy: This treatment is not generally considered
safe for pregnancy (esp. first trimester), and decreased clearance
after childbirth may result in toxicity. If you are planning to
get pregnant, you should either stop treatment, or avoid starting.
Lithium should not be mixed with breastfeeding.
- Psoriasis: This condition may be worsened.
- Schizophrenia: You may be particularly sensitive to Lithium,
and may be more likely to experience confusion or other mental
effects.
- Sodium: If your blood sodium is low, or if you are on
a restricted salt diet, caution is advised. This medication may
not be right for you. Serious side effects could occur if your
salt levels are too low.
- Surgery: If you will be having any type of surgical or
dental procedure performed which requires general anesthesia,
be sure to inform your doctor beforehand. This treatment may interact
with some drugs used in surgery.
- Testing: If you can't get the regular testing for blood
levels and thyroid function, you should not use this medication.
The risk of toxicity is too high.
Lithium Interactions
This treatment should not be mixed with all prescription or over the counter drugs. In some cases, your doctor may have you take medications that may interact anyway, but usually with dosage adjustments, and possibly more frequent monitoring.
- ACE (Angiotensin-Converting Enzyme) Inhibitors - Medications
like Accupril (quinapril),
Aceon (perindopril), Altace
(ramipril), Capoten
(captopril), Lotensin
(benazepril), Mavik (trandolapril), Monopril
(fosinopril), Prinivil or Zestril (lisinopril),
Univasc (moexipril), and Vasotec
(enalapril) may triple Lithium levels.
- Alcohol - Use moderately according to your doctor's guidelines.
Your alcohol tolerance may drop during treatment.
- Aldomet (methyldopa) - This combination usually works
well, but in some individuals neurotoxicity may result.
Combined treatment is advised with extreme caution, until
you doctor is certain that you won't react this way.
- Angiotensin II receptor antagonists - Medications like
Cozaar (losartan) and
Diovan (valsartan) may
lead to lithium toxicity.
- Aspirin - Increased risk of toxicity.
- Benzodiazepines (a class of antidepressants, anti-panic
agents, sleep medications, and muscle relaxants) such as
Valium (diazepam),
Halcion (triazolam),
Restoril (temazepam),
Librium (chlordiazepoxide),
Tranxene-SD (clorazepate), Klonopin
(clonazepam), Paxipam (halazepam), Ativan
(lorazepam), ProSom (estazolam), Xanax
(alprazolam), or Versed (midazolam) - May lead to hypothermia.
- Bronchodilators of the xanthine (thioxanthine) class (Aminophylline,
Dyphylline, Oxtriphylline, Somophyllin, Theo-Dur,
etc...) - Treatment may be less effective.
- Bumex (bumetanide) - Lithium effects may be increased.
- Calcitonin - Treatment may be less effective.
- Calcium channel blockers - Medications like Bepadin (bepridil),
Calan (verapamil), Cardene
(nicardipine), Cardizem
(diltiazem), DynaCirc (isradipine), Nimotop (nimodipine),
Plendil (felodipine), Procardia
(nifedipine), or Sibelium (flunarizine) may lead to
toxicity or mania.
- Cisplatin - Check blood levels more often.
- Clozaril (clozapine) - Agranulocytosis, delirium, or neuroleptic
malignant syndrom may result. Do not combine.
- Cox II inhibitors like Celebrex
(celecoxib) and Vioxx (rofecoxib)
increase the risk of toxicity.
- Diamox (acetazolamide) - Treatment may be less effective.
- Diuretics - Serious side effects may occur. Dehydration
poses a significant risk of Lithium toxicity.
- Edecrin (ethacrynic acid) - Lithium effects may be increased.
- Flagyl (metronidazole) - Lithium toxicity may result.
- Florinef (fludrocortisone) - This treatment may be less
effective when used with Lithium.
- Lasix (furosemide) - Lithium effects may be increased.
- MAO inhibitors - Lithium must never be mixed with MAO
(monoamine oxidase) inhibitors, a class of antidepressants
and antisenility drugs, such as Eldepryl (selegiline), Furoxone
(furazolidone), Nardil (phenelzine), Marplan (isocarboxazid),
or Parnate (tranylcypromine). Never use Lithium within
2 weeks of starting or stopping an MAO inhibitor. This
drug combination could cause convulsions, delirium, fever,
and possibly death.
- Meridia (sibutramine)
- Do not combine.
- Neupogen (filgrastim) - White blood cells may increase.
- Nicotine - Hypersensitivity to nicotine may result.
- Non-Steroidal Anti-Inflammatories, or NSAIDs, such as
Butazolidine (phenylbutazone), Clinoril
(sulindac), Ibuprofen (Motrin), Indocin (indomethacin),
Feldene (piroxicam), Naprosyn (naproxen), Toradol
(ketorolac), and others may increase risk of Lithium
toxicity.
- Pain medication - Any non-narcotic pain treatment will
increase the risk of toxicity. Narcotic analgesics are safe
to use by themselves, but many of them are prescribed as
combination products with ibuprofen or acetaminophen. Consult
your doctor about pain treatment options.
- Selective serotonin reuptake inhibitors (SSRIs) like Celexa
(citalopram), Paxil
(paroxetine), Prozac
(fluoxetine), Luvox (fluvoxamine), or Zoloft
(sertraline) may lead to serotonin syndrome or Lithium
toxicity.
- Sodium bicarbonate (baking soda) - Treatment may be less
effective.
- Tegretol (carbamazepine)
- Lithium toxicity may result.
- Thiazide diuretics like Anhydron (cyclothiazide), Diuril
(chlorothiazide), Enduron (methyclothiazide), Metahydrin
(trichlormethiazide), Naturetin (bendroflumethiazide), Renese
(polythiazide), and others may increase the risk of serious
side effects and toxicity.
- Tranquilizers like Haldol (haloperidol), Mellaril (thioridazine),
Thorazine (chlorpromazine), or other neuroleptic phenothiazines,
may interact with Lithium in such a way that both treatments
are less effective.
- Tricyclic antidepressants such as Elavil
(amitriptyline), Asendin (amoxapine), Anafranil (clomipramine),
Pertofrane or Norpramin (desipramine), Sinequan
(doxepin), Tofranil (imipramine), Aventyl or Pamelor
(nortriptyline),
Vivactil (protriptyline), and Surmontil (trimipramine),
combination therapy may increase the risk of side effects
from trycyclics.
- Wellbutrin, Zyban (bupropion)
- Increased risk of seizure.
Also, any medication for asthma, bronchitis, cold or flu, cystic
fibrosis, emphysema, or sinusitis should be checked for the following
ingredients which may further depress thyroid function:
- Calcium iodide
- Iodinated glycerol
- Potassium iodide
Lithium Dosages
Lithium is available in the following doses:
- Capsules: 150 mg, 300 mg, 600 mg
- Controlled Release Tablets: 300 mg, 450 mg
- Syrup: 8 mEq/5 ml
- Tablets: 300 mg
Standard dosing for adults is 900 mg - 1,200 mg on the first day,
divided into three doses. After that, dosage can be increased by
an additional 300 mg daily, to a maximum of 3,600 mg daily.
Speak to your doctor about determining a dosage schedule, this
will need to be developed individually for each patient.
Lithium Directions
Do not increase your dose of Lithium without instructions from
your doctor. If you miss a dose, take it as soon as you remember,
unless it is almost time for your next dose. Skip the missed dose
of Lithium and resume your regular schedule. Do not take double
doses of this medication.
Regular Lithium tablets may be crushed, and the capsules opened.
Controlled release forms should be swallowed whole. The medication
should be taken on a full stomach to reduce stomach upset, tremor,
and possible laxative effect.
Drink lots of water. Dehydration can be a major cause of toxicity.
This is also a concern if you come down with a serious infection,
illness, or severe diarrhea, as these can dehydrate the body quickly.
You may become oversensitive to temperature. Be cautious in hot
weather, strenuous activity, jacuzzis, or saunas. Dress warmly in
cold weather, and be cautious about swimming in very cold pools.
Cold sensitivity may be a sign of depressed thyroid function.
Diet changes should not be undertaken without your doctor's approval.
Weight loss dieting can increase the risk of side effects and/or
toxicity.
Do not discontinue treatment without the advice of your doctor.
There are no withdrawal symptoms, but mood disorders can reoccur
if treatment is stopped too soon.
Inform your doctor, dentist, or anesthesiologist that you are taking
Lithium before any kind of surgery or medical test. This medication
may interfere with certain test results. Lithium should not be combined
with certain medications given during surgery.
Store Lithium away from direct light and heat. Store in a dry location;
avoid storing it in the bathroom, near sinks, or other areas where
it may become damp. Do not use after the expiration date. Do not
allow the liquid form of this medication to freeze.
Keep Lithium away from children; both when storing it, and when
discarding any unused medication.
Lithium may cause drowsiness or disorientation. Be cautious if
you plan to drive or operate heavy machinery, avoid these activities
if you find yourself feeling tired or experience slowed reactions.
Lithium and Pregnancy
This drug may cause birth defects if taken during pregnancy, and
floppy baby syndrome at birth. Lithium should absolutely not be
used during the first 3 months of pregnancy, and only if absolutely
necessary in the last 6 months. Blood levels will have to be monitored
carefully if treatment will proceed.
Lithium is unsuitable for use during breastfeeding, as it passes
into milk in large amounts. Either treatment or breastfeeding should
be discontinued.
Lithium and Children
Safety and effectiveness have not been established for children under 12. A dose for each individual must be determined by a doctor.
Lithium and Seniors
Seniors may be more strongly affected by Lithium, and should be
watched carefully for unwanted side effects and toxicity. In addition
to the ordinary effects of toxicity, abnormal walking or movement
patterns, or a risk of sudden coma are higher. A low salt diet and/or
diuretic use increases these risks.
Individuals over the age of 60 years should start with a dose no
greater than 75-150 mg per day.
Eskalith and Eskalith CR are trademarks of GlaxoSmithKline
Generic Lithium is manufactured by Roxane
Lithobid slow-release tablets are a trademark of Solvay
Back to top
This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.
|
