What You Need to Know to Safely Take Lithium

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Side Effects

Toxicity

Interactions

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Lithium is a mood stabilizer used to prevent and treatmanic episodes in people with bipolar disorder. If you’ve been prescribed this drug, it’s important to know how to use it safely. This involves being aware of its potential side effects, as well as recognizing why it is critical to follow through with regular testing at lithium monitoring labs.

Most Important Information to Know About LithiumSerious side effects can occur when taking lithium, and taking even a little too much can be dangerous to your health.Regularly monitoring your lithium level is extremely important for taking this drug safely.

Most Important Information to Know About Lithium

Serious side effects can occur when taking lithium, and taking even a little too much can be dangerous to your health.Regularly monitoring your lithium level is extremely important for taking this drug safely.

Possible Side Effects of Lithium

As with most any medication, lithium can come with a number of side effects. Some lithium side effects are common and mild. Others don’t happen as often but can be serious, requiring medical attention.

Common Side Effects

The most common side effects of lithium tend to be more annoying than dangerous. They include:

Another common side effect of lithium is weight gain. This effect tends to occur in the first two years of taking the drug and is associated with many factors, such as being onother medications that also cause weight gain, increased thirst leading to high-calorie drink consumption, and hypothyroidism or edema.

A 2016 study found that the medication Metformin may help reduce or prevent weight gain for some people onlithium therapy.

If any of these common effects are bothersome or don’t go away, talk with your healthcare provider. They may modify your dosage or change medications to help ease these effects.

Serious Side Effects

Other lithium side effects are more serious, often requiring immediate medical attention. Serious lithium side effects include:

If any of these side effects are experienced when taking lithium, contact your healthcare provider immediately or seek emergency medical attention.

Lithium Toxicity

If lithium levels get too high, it can result in toxicity.Lithium toxicity, also sometimes referred to as lithium poisoning, can appear in one of three forms:

Mild cases of lithium toxicity can result in symptoms such as weakness, tremors, poor concentration, and diarrhea. In severe cases, it can lead to vomiting, more noticeable tremors, slurred speech, lethargy, and confusion.

While lithium toxicity is generally not fatal, it does require treatment. It may also require an extended hospital stay due to mobility and cognitive complications.

If you suspect lithium toxicity, call the Poison Help hotline at 800-222-1222 or seek immediate medical attention.

Drug Interactions With Lithium

There are several drugs that can interact with lithium, resulting in increased lithium levels in the blood. These include:

In contrast, other substances have been found to lower lithium levels, potentially reducing this drug’s therapeutic effects. They include caffeine, table salt, and theophylline, a medication sometimes prescribed for breathing issues.

Due to caffeine and table salt being on this list, the prescribing physician may provide special dietary instructions to follow when taking lithium. This could involve avoiding low-sodium diets,drinking enough fluids, and limiting caffeine intake.

This is not a comprehensive list of substances that may interact with lithium. Therefore, it’s important to tell your healthcare provider about any drugs, prescription medications, supplements, or herbal remedies you are taking to help verify that they won’t impact your treatment.

Monitoring Tests During Lithium Therapy

If lithium levels get too high, it can be problematic for the kidneys, parathyroid, and thyroid glands.This makes regular testing at lithium monitoring labs important for taking this drug safely.

For example, almost half of patients experience some degree of excessive urination after starting lithium, with 15% to 20% of these individuals developing nephrogenic diabetes insipidus (NDI).NDI is a condition in which the kidneys are unable to concentrate the urine resulting in excess urination (polyuria) and excess thirst (polydipsia).

Process of Monitoring Lithium Levels

Blood lithium levels are then analyzed regularly during treatment. For instance, they are often checked five days after a dosage change, as the drug’s levels begin to stabilize. Levels should also be checked if any new medications are added or discontinued since many medications interact with lithium.

Tests used to monitor lithium levels and this drug’s effects may include:

Additional tests, such as blood chemistries and an EKG, may also be used to help monitor safe lithium levels.

Therapeutic Lithium Levels

Lithium has a narrow safety window.This means that there is a fine line between the level of the drug needed to have a therapeutic effect and that which causes toxicity.

The therapeutic level of lithium is usually between 0.8 mmol/L and 1.1 mmol/L at the beginning of treatment, with maintenance levels between 0.6 mmol/L and 0.8 mmol/L.Although, target ranges may be slightly lower for elderly patients.

The dosage of lithium prescribed is usually between 600 milligrams (mg) and 1200 mg per day.However, some people require a higher daily dose to obtain relief frombipolar symptoms.

Coping With Lithium Side Effects and Toxicity

There are several ways in which lithium’s side effects and toxicity risk can be reduced. They include keeping the dose low enough so that blood levels are on the lower side of the therapeutic window. The timing of the dose may also be helpful.

Monitoring of blood levels is important on a regular basis, as well as if any new symptoms should arise. In some cases, medications can be used to reduce certain side effects.

Summary

Lithium can be an effective drug for people with bipolar disorder. In some cases, it can even be a lifesaver as this drug has been found to decrease the rate of suicide, which is a significant risk among people with this condition.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

That said, careful monitoring of lithium levels is critical to reducing the potential for toxicity and its consequences. While some side effects are common, many of these effects are more annoying than dangerous.

Lab tests must be conducted regularly when taking lithium to minimize the risk of kidney and thyroid dysfunction. With monitoring, however, and a careful understanding of the early symptoms of toxicity, you can enjoy the benefits of this medication without significant risks.

Treating Bipolar Disorder

13 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Alliance on Mental Illness.Lithium.Gitlin M.Lithium side effects and toxicity: prevalence and management strategies.Int J Bipolar Disord. 2016;4(1):27. doi:10.1186/s40345-016-0068-yPraharaj SK.Metformin for lithium-induced weight gain: a case report.Clin Psychopharmacol Neurosci. 2016;14(1):101–103. doi:10.9758/cpn.2016.14.1.101National Library of Medicine.Lithium.National Library of Medicine.Lithium toxicity.Baird-Gunning J, Lea-Henry T, Hoegberg L, Gosselin S, Roberts D.Lithium poisoning.J Intens Care Med. 2017;32(4):249-263. doi:10.1177/0885066616651582Finley P.Drug interactions with lithium: an update.Clin Pharmacokinetics. 2016;55(8):925-41. doi:10.1007/s40262-016-0370-yGong R, Wang P, Dworkin L.What we need to know about the effect of lithium on the kidney.Am J Physiol Renal Physiol. 2016;311(6):F1168-F1171. doi:10.1152/ajprenal.00145.2016Azab AN, Shnaider A, Osher Y, Wang D, Bersudsky Y, Belmaker RH.Lithium nephrotoxicity.Int J Bipolar Disord. 2015;3(1):28. doi:10.1186/s40345-015-0028-yNederlof M, Heerdink ER, Egberts ACG, et al.Monitoring of patients treated with lithium for bipolar disorder: an international survey.Int J Bipolar Disord. 2018;6(1):12. doi:10.1186/s40345-018-0120-1Jakobsson E, Argüello-Miranda O, Chiu SW, et al.Towards a unified understanding of lithium action in basic biology and its significance for applied biology.J Membrane Biol. 2017;250:587-604. doi:10.1007/s00232-017-9998-2Zhao S, Zhang X, Zhou Y, et al.Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder.BMC Endocr Disord. 2021;21:210. doi:10.1186/s12902-021-00869-5Del Matto L, Muscas M, Murru A, et al.Lithium and suicide prevention in mood disorders and in the general population: A systematic review.Neurosci Biobehav Rev. 2020;116:142-153. doi:10.1016/j.neubiorev.2020.06.017

13 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Alliance on Mental Illness.Lithium.Gitlin M.Lithium side effects and toxicity: prevalence and management strategies.Int J Bipolar Disord. 2016;4(1):27. doi:10.1186/s40345-016-0068-yPraharaj SK.Metformin for lithium-induced weight gain: a case report.Clin Psychopharmacol Neurosci. 2016;14(1):101–103. doi:10.9758/cpn.2016.14.1.101National Library of Medicine.Lithium.National Library of Medicine.Lithium toxicity.Baird-Gunning J, Lea-Henry T, Hoegberg L, Gosselin S, Roberts D.Lithium poisoning.J Intens Care Med. 2017;32(4):249-263. doi:10.1177/0885066616651582Finley P.Drug interactions with lithium: an update.Clin Pharmacokinetics. 2016;55(8):925-41. doi:10.1007/s40262-016-0370-yGong R, Wang P, Dworkin L.What we need to know about the effect of lithium on the kidney.Am J Physiol Renal Physiol. 2016;311(6):F1168-F1171. doi:10.1152/ajprenal.00145.2016Azab AN, Shnaider A, Osher Y, Wang D, Bersudsky Y, Belmaker RH.Lithium nephrotoxicity.Int J Bipolar Disord. 2015;3(1):28. doi:10.1186/s40345-015-0028-yNederlof M, Heerdink ER, Egberts ACG, et al.Monitoring of patients treated with lithium for bipolar disorder: an international survey.Int J Bipolar Disord. 2018;6(1):12. doi:10.1186/s40345-018-0120-1Jakobsson E, Argüello-Miranda O, Chiu SW, et al.Towards a unified understanding of lithium action in basic biology and its significance for applied biology.J Membrane Biol. 2017;250:587-604. doi:10.1007/s00232-017-9998-2Zhao S, Zhang X, Zhou Y, et al.Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder.BMC Endocr Disord. 2021;21:210. doi:10.1186/s12902-021-00869-5Del Matto L, Muscas M, Murru A, et al.Lithium and suicide prevention in mood disorders and in the general population: A systematic review.Neurosci Biobehav Rev. 2020;116:142-153. doi:10.1016/j.neubiorev.2020.06.017

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Alliance on Mental Illness.Lithium.Gitlin M.Lithium side effects and toxicity: prevalence and management strategies.Int J Bipolar Disord. 2016;4(1):27. doi:10.1186/s40345-016-0068-yPraharaj SK.Metformin for lithium-induced weight gain: a case report.Clin Psychopharmacol Neurosci. 2016;14(1):101–103. doi:10.9758/cpn.2016.14.1.101National Library of Medicine.Lithium.National Library of Medicine.Lithium toxicity.Baird-Gunning J, Lea-Henry T, Hoegberg L, Gosselin S, Roberts D.Lithium poisoning.J Intens Care Med. 2017;32(4):249-263. doi:10.1177/0885066616651582Finley P.Drug interactions with lithium: an update.Clin Pharmacokinetics. 2016;55(8):925-41. doi:10.1007/s40262-016-0370-yGong R, Wang P, Dworkin L.What we need to know about the effect of lithium on the kidney.Am J Physiol Renal Physiol. 2016;311(6):F1168-F1171. doi:10.1152/ajprenal.00145.2016Azab AN, Shnaider A, Osher Y, Wang D, Bersudsky Y, Belmaker RH.Lithium nephrotoxicity.Int J Bipolar Disord. 2015;3(1):28. doi:10.1186/s40345-015-0028-yNederlof M, Heerdink ER, Egberts ACG, et al.Monitoring of patients treated with lithium for bipolar disorder: an international survey.Int J Bipolar Disord. 2018;6(1):12. doi:10.1186/s40345-018-0120-1Jakobsson E, Argüello-Miranda O, Chiu SW, et al.Towards a unified understanding of lithium action in basic biology and its significance for applied biology.J Membrane Biol. 2017;250:587-604. doi:10.1007/s00232-017-9998-2Zhao S, Zhang X, Zhou Y, et al.Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder.BMC Endocr Disord. 2021;21:210. doi:10.1186/s12902-021-00869-5Del Matto L, Muscas M, Murru A, et al.Lithium and suicide prevention in mood disorders and in the general population: A systematic review.Neurosci Biobehav Rev. 2020;116:142-153. doi:10.1016/j.neubiorev.2020.06.017

National Alliance on Mental Illness.Lithium.

Gitlin M.Lithium side effects and toxicity: prevalence and management strategies.Int J Bipolar Disord. 2016;4(1):27. doi:10.1186/s40345-016-0068-y

Praharaj SK.Metformin for lithium-induced weight gain: a case report.Clin Psychopharmacol Neurosci. 2016;14(1):101–103. doi:10.9758/cpn.2016.14.1.101

National Library of Medicine.Lithium.

National Library of Medicine.Lithium toxicity.

Baird-Gunning J, Lea-Henry T, Hoegberg L, Gosselin S, Roberts D.Lithium poisoning.J Intens Care Med. 2017;32(4):249-263. doi:10.1177/0885066616651582

Finley P.Drug interactions with lithium: an update.Clin Pharmacokinetics. 2016;55(8):925-41. doi:10.1007/s40262-016-0370-y

Gong R, Wang P, Dworkin L.What we need to know about the effect of lithium on the kidney.Am J Physiol Renal Physiol. 2016;311(6):F1168-F1171. doi:10.1152/ajprenal.00145.2016

Azab AN, Shnaider A, Osher Y, Wang D, Bersudsky Y, Belmaker RH.Lithium nephrotoxicity.Int J Bipolar Disord. 2015;3(1):28. doi:10.1186/s40345-015-0028-y

Nederlof M, Heerdink ER, Egberts ACG, et al.Monitoring of patients treated with lithium for bipolar disorder: an international survey.Int J Bipolar Disord. 2018;6(1):12. doi:10.1186/s40345-018-0120-1

Jakobsson E, Argüello-Miranda O, Chiu SW, et al.Towards a unified understanding of lithium action in basic biology and its significance for applied biology.J Membrane Biol. 2017;250:587-604. doi:10.1007/s00232-017-9998-2

Zhao S, Zhang X, Zhou Y, et al.Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder.BMC Endocr Disord. 2021;21:210. doi:10.1186/s12902-021-00869-5

Del Matto L, Muscas M, Murru A, et al.Lithium and suicide prevention in mood disorders and in the general population: A systematic review.Neurosci Biobehav Rev. 2020;116:142-153. doi:10.1016/j.neubiorev.2020.06.017

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