Lithium is used for the treatment of the manic episodes of manic-depressive illness, also called bipolar disorder. It helps to control the symptoms of mania, which may include reduced need for sleep, poor judgment, hyperactivity, feelings of grandiosity, aggressiveness, and sometimes hostility. Lithium takes about one to three weeks before it has an effect on these symptoms.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

The usual starting dose for treatment of mania is 900 mg to 1,800 mg daily divided into three equal doses. The dose may be started at a lower level depending on the circumstances of the person taking the medication. The dose of lithium is usually aimed at keeping a certain level of lithium in the bloodstream. This is why lab tests are needed to monitor the levels. Once the best dose is reached, the medication may usually be taken in a single daily dose. This dose may be lower than the total of the initial three daily divided doses.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue on with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one.

Lithium should not be taken by people who:

• are allergic to lithium or to any ingredients of the medication
• have significant kidney or heart disease
• are severely debilitated
• are severely dehydrated
• have low blood levels of sodium
• are taking diuretics (water pills)

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your health professional. They may be able to help you to deal with some of the effects.

The following side effects may go away as your body becomes used to the medicine; check with your doctor if they continue or become bothersome.

More common:
• increased frequency of urination or loss of bladder control (more common for women than for men, usually begins 2 to 7 years after start of treatment)
• increased thirst
• nausea (mild)
• trembling of hands (slight)

Less common:
• acne or skin rash
• bloated feeling or pressure in the stomach
• muscle twitching (slight)

Check with your doctor as soon as possible if any of the following side effects occur:

Less common:
• confusion, poor memory, or lack of awareness
• difficulty breathing (especially during hard work or exercise)
• fainting
• fast or slow heartbeat
• frequent urination
• irregular pulse
• increased thirst
• stiffness of arms or legs
• slurred speech
• unusual tiredness or weakness
• weight gain

Rare:
• blue colour and pain in fingers and toes
• coldness of arms and legs
• dizziness
• eye pain
• headache
• noises in the ears
• vision problems

Stop taking this medication and check with your doctor immediately if any of the following symptoms occur:

Early symptoms of overdose or toxicity:
• diarrhea
• drowsiness
• lack of coordination
• loss of appetite
• muscle weakness
• nausea or vomiting
• slurred speech
• trembling

Late symptoms of overdose or toxicity:
• blurred vision
• clumsiness or unsteadiness
• confusion
• convulsions (seizures)
• dizziness
• increase in amount of urine
• ringing in the ears
• trembling (severe)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Fluid intake and diet: It is important to maintain a normal diet, including salt, as well as an adequate fluid intake (2,500 mL to 3,000 mL), at least during the initial period of taking this medication. Side effects have been reported to follow after large amounts of sweating or diarrhea. If this occurs, extra fluids and salt should be taken. Talk to your doctor about the appropriate amounts of fluid and salt to take. If you develop a fever, check with your doctor to see if you should reduce your dose or temporarily stop taking the medication.

Lab tests: Lithium toxicity is closely related to the level of lithium in the blood, and can occur at doses that are close to normal. People taking this medication will need to have lab tests (as ordered by their doctor) so that the blood levels of lithium can be monitored.

Kidney disease: Chronic lithium treatment is frequently associated with a decrease in kidney function as well as symptoms of thirst, excess urination, and weight gain. Contact your doctor if you experience these symptoms.

Drowsiness/reduced alertness:: Since lithium may reduce mental or physical abilities, people taking this medication should avoid activities requiring alertness (e.g., operating vehicles or machinery) until they know how the medication affects them.

Stopping the medication: Do not stop taking this medication suddenly without checking with your doctor first. Stopping the medication suddenly may cause withdrawal symptoms.

Pregnancy: Lithium should not be used during pregnancy or by women of childbearing potential unless no other appropriate therapy exists, and, in the opinion of the doctor, the expected benefits outweigh the possible risks.

Breast-feeding: Lithium passes into breast milk. Women should not breast-feed while taking lithium except in rare circumstances where, in the opinion of the doctor, the potential benefits to the mother outweigh possible risks to the child.

Children: The safety and effectiveness of this medication have not been established for children under 12 years of age. Therefore, the use of lithium is not recommended for this age group.

The following medications may affect how lithium works or increase the risk of side effects:

If you are taking any medications containing this drug, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription) and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or illegal drugs can affect the action of many medications, you should let your prescriber know if you use them.