Lithium

Brand names

• Carbolith
• Cibalith-S
• Duralith
• Eskalith
• Eskalith CR
• Lithane
• Lithizine
• Lithobid,
• Lithonate
• Lithotabs

Usage

To treat the manic phase of bipolar disorder (also known as manic-depression) and to enhance the effect of other antidepressant medications in patients with recurrent depression.

Side effects

Serious

Sedation, pronounced muscle weakness, confusion or disorientation, muscle twitching, vomiting, increased urination, slow heartbeat, fatigue, weight gain, dizziness, cold arms and legs, dry and rough skin, hoarseness, sensitivity to cold, swollen feet or legs, swollen neck. Call your physician immediately.

Common

Increased thirst, increased urination, nausea, loss of appetite, diarrhea, a slight tremor in the hands, fatigue, unexpected weight gain, metallic taste in mouth.

Less common

Skin rash, acne, hair loss.

Possible interactions

Other medicaments:

Lithium may increase the effects of:

• tricyclic antidepressants.

Lithium taken concurrently with:

• ACE inhibitors such as captopril (Capoten) may increase lithium levels by as much as three times the level prior to combination therapy.
• calcium channel blockers, such as diltiazem, may cause neurotoxicity or mania.
• carbamazepine (Tegretol) may result in neurotoxicity.
• chlorpromazine (Thorazine, etc.) and other phenothiazines may decrease lithium or phenothiazine therapeutic effects.
• cisplatin may cause changes in lithium levels; level checks are prudent.
• citalopram (Celexa) may enhance the effect of citalopram on serotonin.
• clozapine (Clozaril) may result in serious agranulocytosis, delirium and neuroleptic malignant syndrome; do not combine these medicines.
• diazepam (Valium) may cause hypothermia.
• diuretics may lead to lithium toxicity.
• filgrastim (Neupogen) may result in a greater than expected increase in white blood cell numbers.
• fludrocortisone (Florinef) may result in loss of the mineralocorticoid benefits of fludrocortisone.
• fluoxetine (Prozac) may result in neurotoxicity.
• fluvoxamine (Luvox) may result in increased lithium levels and toxicity.
• haloperidol (Haldol) or with other neuroleptics may result in decreased beneficial effects from both medicines.
• methyldopa (Aldomet, etc.) is usually well tolerated; however, it may cause a severe neurotoxic reaction in susceptible individuals. These combinations should be used very cautiously.
• metronidazole (Flagyl) may lead to lithium toxicity.
• monoamine oxidase (MAO) inhibitors may result in the serotonin syndrome and potential fatality.
• nicotine (various brands) may cause super sensitivity to nicotine.
• sibutramine (Meridia) may cause an increased risk of serotonin syndrome.
• verapamil (Calan, Isoptin) may cause unpredictable effects; both lithium toxicity and decreased lithium blood levels have been reported.

The following medicaments may increase the effects of lithium:

• aspirin (various).
• bumetanide (Bumex).
• celecoxib (Celebrex) or rofecoxib (VIOXX).
• ethacrynic acid (Edecrin).
• fluoxetine (Prozac).
• furosemide (Lasix, etc.).
• indomethacin (Indocin).
• losartan (Cozaar, Hyzaar) and perhaps other angiotensin II inhibitors.
• piroxicam (Feldene) or any nonsteroidal anti-inflammatory medicament.
• thiazide diuretics.

The following medicaments may decrease the effects of lithium:

• acetazolamide (Diamox, etc.).
• calcitonin (various).
• sodium bicarbonate.
• theophylline (Theo-Dur, etc.) and related medicaments.

Foods:

Maintain a normal diet; do not restrict your use of salt.

Herbal medicines or minerals:

This medicament may cause increased calcium. Talk to your doctor before taking any calcium supplements. Herbs that have a diuretic or potassium losing effect may lead to lithium toxicity.

Alcohol:

May have an increased intoxicating effect. Avoid alcohol completely if any symptoms of lithium toxicity develop.

Tobacco smoking:

Lithium may increase sensitivity to nicotine.

Marijuana smoking:

Possible increase in apathy, lethargy, drowsiness or sluggishness; accentuation of lithium-induced tremor; possible increased risk of precipitating psychotic behavior.

Exposure to heat:

Excessive sweating can cause significant depletion of salt and water and resultant lithium toxicity. Avoid sauna baths.

Occurrence of unrelated illness:

Fever, sweating, vomiting or diarrhea can result in significant alterations of blood and tissue lithium concentrations. Close monitoring of your physical condition and blood lithium levels is needed to prevent serious toxicity.

Discontinuation:

Sudden discontinuation does not cause withdrawal symptoms. Avoid premature discontinuation; some individuals may require continual treatment for up to a year to achieve maximal response. Discontinuation by "responders" may result in recurrence of either mania or depression. Lithium should be discontinued if symptoms of brain toxicity appear or if an uncorrectable diabetes insipidus-like syndrome develops.

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