LITHIUM

OTHER NAME(S):

Atomic number 3, Carbonate de Lithium, Citrate de Lithium, Li, Lithium Carbonate, Lithium Citrate, Lithium Orotate, Litio, Numéro Atomique 3, Orotate de Lithium.

Overview

Overview Information

Lithium is an element. It gets its name from "lithos," the Greek word for stone, because it is present in trace amounts in virtually all rocks. Lithium is approved the US Food and Drug Administration (FDA) as a prescription medication for use in bipolar disorder. People also sometimes use lithium supplements as medicine, but these supplements contain much lower doses of lithium.

Lithium is used for mental illnesses, including bipolar disorder, depression, and schizophrenia. Lithium supplements may also be used for other conditions, but there is limited scientific evidence to support these uses.

How does it work?

Exactly how lithium works is unknown, but it might help mental disorders by increasing the activity of chemical messengers in the brain. Lithium might also be needed for other functions in the body, like the development of blood cells.

Uses

Uses & Effectiveness?

Effective for

  • Bipolar disorder. Lithium is approved by the US Food and Drug Administration (FDA) as a prescription medication for bipolar disorder. It helps stabilize patients quickly. It is also used in lower amounts to prevent another episode. No research has evaluated the use of lithium supplements for bipolar disorder. Do not use lithium supplements to treat bipolar disorder.

Likely Effective for

  • Depression. Lithium is helpful for some people with depression. However, other, more common, drugs are used first to help with depression. No research has evaluated the use of lithium supplements for depression. Do not use lithium supplements to treat depression.

Possibly Effective for

  • Schizophrenia. Lithium is sometimes used in combination with antipsychotic drugs for schizophrenia. But no research has evaluated the use of lithium supplements for schizophrenia. Do not use lithium supplements to treat schizophrenia.
  • Attention-deficit hyperactivity disorder (ADHD). Lithium is sometimes used for patients with aggression and ADHD. However, other drugs are usually tried first. No research has evaluated the use of lithium supplements for ADHD. Do not use lithium supplements to treat ADHD.

Insufficient Evidence for

More evidence is needed to rate the effectiveness of lithium for these uses.

Side Effects

Side Effects & Safety

When taken by mouth: Lithium is LIKELY SAFE for most people when taken appropriately with monitoring by a healthcare provider. Lithium carbonate and lithium citrate have been approved by the U.S. Food and Drug Administration (FDA) as prescription medications. But there isn't enough information to know if lithium supplements are safe to use.

Lithium can cause nausea, diarrhea, dizziness, change in heart rhythm, muscle weakness, fatigue, and a dazed feeling. These unwanted side effects often improve with continued use. Fine tremor, frequent urination, and thirst can occur and may persist with continued use. Weight gain and swelling from excess fluid can also occur. Lithium can also cause or worsen skin disorders such as acne, psoriasis, and rashes. It can also cause problems with the thyroid gland. The amount of lithium in the body must be carefully controlled and monitored with blood tests.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Lithium is POSSIBLY UNSAFE when taken during pregnancy. It can poison a developing baby (fetus) and can increase the risk of birth defects, including heart problems. However, lithium use may be monitored by a healthcare provider when the benefits of giving lithium to the mother outweigh the risks to the fetus.

Lithium treatment is LIKELY UNSAFE in women who are breast-feeding. Lithium can enter breast milk and cause unwanted side effects in a nursing infant. It should only used in very rare circumstances with close monitoring by a healthcare provider.

Children: Lithium citrate and lithium carbonate are POSSIBLY SAFE when used appropriately under the supervision of a healthcare professional in children 7 years and older. There isn't enough information available to know if lithium supplements are safe to use in children or what the side effects might be.

Brugada syndrome: Brugada syndrome is a type of heart disease that increases the risk of the heart suddenly stopping. Lithium should not be used in people who have Brugada syndrome or those who have a history of abnormal ECG readings. Also, stop taking lithium and contact your doctor if you start feeling faint or have changes in heartbeat.

Dehydration: Fever, sweating, and diarrhea can increase the risk of dehydration and salt loss. Lithium can make dehydration worse. If you are dehydrated or have low salt levels you might need to change your lithium dose. Talk to your doctor.

Elderly individuals: As people get older, lithium can build up in the body. Also, older people tend to have other illnesses and are more likely to use many different medications. Older age, other illnesses, and use of many medications makes it more likely that someone will have lithium side effects, and some can be quite serious.

Heart disease: Lithium may cause irregular heart rhythms. This may be a problem, especially for people who have heart disease.

Kidney disease: Lithium is removed from the body by the kidneys. In people with kidney disease, the amount of lithium that is given might need to be reduced.

Low sodium levels: Lithium can lower the level of salt in the blood. If you already have low levels of salt in the blood, use lithium with caution.

Surgery: Lithium might change levels of serotonin, a chemical that affects the central nervous system. There is some concern that lithium might interfere with surgical procedures that often involve anesthesia and other drugs that affect the central nervous system. Lithium use should be stopped, with the approval of a healthcare provider, at least two weeks before a scheduled surgery.

Thyroid disease: Lithium might make thyroid problems worse. Make sure to have your thyroid function tested regularly.

Interactions

Interactions?

Major Interaction

Do not take this combination

!

  • Medications for depression (Antidepressant drugs) interacts with LITHIUM

    Lithium increases a brain chemical called serotonin. Some medications for depression also increase the brain chemical serotonin. Taking lithium along with these medications for depression might increase serotonin too much and cause serious side effects including heart problems, shivering, and anxiety. Do not take lithium if you are taking medications for depression.
    Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.

  • Medications for depression (MAOIs) interacts with LITHIUM

    Lithium increases a chemical in the brain. This chemical is called serotonin. Some medications used for depression also increase serotonin. Taking lithium with these medications used for depression might cause there to be too much serotonin. This could cause serious side effects including heart problems, shivering, and anxiety.
    Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.

Moderate Interaction

Be cautious with this combination

!

  • Dextromethorphan (Robitussin DM, and others) interacts with LITHIUM

    Lithium can affect a brain chemical called serotonin. Dextromethorphan (Robitussin DM, others) can also affect serotonin. Taking lithium along with dextromethorphan (Robitussin DM, others) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety could result. Do not take lithium if you are taking dextromethorphan (Robitussin DM, and others).

  • Medications for high blood pressure (ACE inhibitors) interacts with LITHIUM

    Some medications for high blood pressure can increase lithium levels in the body. Taking lithium along with some medications for high blood pressure might cause too much lithium to be in the body.
    Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others.

  • Medications for high blood pressure (Calcium channel blockers) interacts with LITHIUM

    Lithium is commonly used to help fix chemical imbalances in the brain. Some medications for high blood pressure might increase the side effects of lithium, and decrease the amount of lithium in the body.
    Some medications for high blood pressure include nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin, Verelan), diltiazem (Cardizem), isradipine (DynaCirc), felodipine (Plendil), amlodipine (Norvasc), and others.

  • Medications used to prevent seizures (Anticonvulsants) interacts with LITHIUM

    Medications used to prevent seizures affect chemicals in the brain. Lithium is commonly used to help fix chemical imbalances in the brain. Taking lithium along with some medications used for seizures might increase the side effects of lithium.
    Some medications used to prevent seizures include phenobarbital, primidone (Mysoline), valproic acid (Depakene), gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin), and others.

  • Meperidine (Demerol) interacts with LITHIUM

    Lithium increases a chemical in the brain called serotonin. Meperidine (Demerol) can also increase serotonin in the brain. Taking lithium along with meperidine (Demerol) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety.

  • Methyldopa (Aldomet) interacts with LITHIUM

    Taking methyldopa might increase the effects and side effects of lithium. Do not take lithium if you are taking methyldopa unless prescribed by your healthcare professional.

  • Methylxanthines interacts with LITHIUM

    Taking methylxanthines can increase how quickly the body gets rid of lithium. This could decrease how well lithium works.
    Methylxanthines include aminophylline, caffeine, and theophylline.

  • Muscle relaxants interacts with LITHIUM

    Lithium might increase how long muscle relaxants work. Taking lithium along with muscle relaxants might increase the effects and side effects of muscle relaxants.
    Some of these muscle relaxants include carisoprodol (Soma), pipecuronium (Arduan), orphenadrine (Banflex, Disipal), cyclobenzaprine, gallamine (Flaxedil), atracurium (Tracrium), pancuronium (Pavulon), succinylcholine (Anectine), and others.

  • NSAIDs (Nonsteroidal anti-inflammatory drugs) interacts with LITHIUM

    NSAIDs are anti-inflammatory medications used for decreasing pain and swelling. NSAIDs might increase lithium levels in the body. Taking lithium along with NSAIDs might increase the risk of lithium side effects. Avoid taking lithium supplements and NSAIDs at the same time.
    Some NSAIDs include ibuprofen (Advil, Motrin, Nuprin, others), indomethacin (Indocin), naproxen (Aleve, Anaprox, Naprelan, Naprosyn), piroxicam (Feldene), aspirin, and others.

  • Phenothiazines interacts with LITHIUM

    Taking phenothiazines along with lithium might decrease the effectiveness of lithium. Lithium might also decrease the effectiveness of phenothiazines.
    Some phenothiazines include chlorpromazine (Thorazine), fluphenazine (Prolixin), trifluoperazine (Stelazine), thioridazine (Mellaril), and others.

  • Tramadol (Ultram) interacts with LITHIUM

    Tramadol (Ultram) can affect a chemical in the brain called serotonin. Lithium can also affect serotonin. Taking lithium along with tramadol (Ultram) might cause too much serotonin in the brain causing confusion, shivering, stiff muscles and other side effects.

  • Water pills (Loop diuretics) interacts with LITHIUM

    Some "water pills" can increase how much sodium the body gets rid of in the urine. Decreasing sodium in the body can increase lithium levels in the body and increase the effects and side effects of lithium.

  • Water pills (Thiazide diuretics) interacts with LITHIUM

    Taking lithium with some "water pills" can increase the amount of lithium in the body. This can cause serious side effects. Talk to your healthcare provider if you are taking lithium before taking "water pills."
    Some types of "water pills" include chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL, Esidrix), indapamide (Lozol), metolazone (Zaroxolyn), and chlorthalidone (Hygroton).

Minor Interaction

Be watchful with this combination

!

  • Pentazocine (Talwin) interacts with LITHIUM

    Lithium increases a brain chemical called serotonin. Pentazocine (Talwin) also increases serotonin. Taking lithium along with pentazocine (Talwin) might cause too much serotonin in the body. Taking lithium along with pentazocine (Talwin) might cause serious side effects including heart problems, shivering, and anxiety. Do not take lithium supplements if you are taking pentazocine (Talwin).

Dosing

Dosing

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:

  • For acute manic episodesbipolar disorder: 1.8 grams or 20-30 mg/kg of lithium carbonate per day in 2-3 divided doses is used for episodes of mania or severe depression. To prevent another episode, the usual adult dose is 900 mg to 1200 mg per day in 2-4 divided doses. 24-32 mEq of lithium citrate solution, given in 2-4 divided doses daily, has also been used. Doses usually should not exceed 2.4 grams of lithium carbonate or 65 mEq lithium citrate daily. Stopping lithium therapy suddenly increases the chance that symptoms of bipolar disorder will return. The dose of lithium should be reduced gradually over at least 14 days.
CHILDREN

BY MOUTH:
  • For bipolar disorder: 15-60 mg/kg (0.4-1.6 mEq/kg) per day in divided doses has been used.

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View References

REFERENCES:

  • Foulser P, Abbasi Y, Mathilakath A, Nilforooshan R. Do not treat the numbers: lithium toxicity. BMJ Case Rep. 2017;2017. pii: bcr-2017-220079. View abstract.
  • Girlanda F, Cipriani A, Agrimi E, et al. Effectiveness of lithium in subjects with treatment-resistant depression and suicide risk: results and lessons of an underpowered randomised clinical trial. BMC Res Notes. 2014;7:731. View abstract.
  • https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/017812s028,018421s027lbl.pdf. Accessed Nov. 21, 2018
  • Perlis RH, Sachs GS, Lafer B, et al. Effect of abrupt change from standard to low serum levels of lithium: a reanalysis of double-blind lithium maintenance data. Am J Psychiatry 2002;159:1155-9.. View abstract.
  • Riblet NBV, Shiner B, Young-Xu Y, Watts BV. Strategies to prevent death by suicide: meta-analysis of randomised controlled trials. Br J Psychiatry. 2017;210(6):396-402. View abstract.
  • Sawagashira R, Sasagawa Y, Matsukura M, Takamaru Y. Case of myxedema coma induced by lithium carbonate in a patient with schizophrenia. Psychiatry Clin Neurosci. 2018;72(2):131. View abstract.
  • Schrauzer GN. Lithium: occurrence, dietary intakes, nutritional essentiality. J Am Coll Nutr 2002;21:14-21.. View abstract.
  • Singhal AB, Caviness VS, Begleiter AF, et al. Cerebral vasoconstriction and stroke after use of serotonergic drugs. Neurology 2002;58:130-3. View abstract.
  • Smith DF, Schou M. Kidney function and lithium concentrations of rats given an injection of lithium orotate or lithium carbonate. J Pharm Pharmacol 1979;31:161-3.. View abstract.
  • Sun M, Herrmann N, Shulman KI. Lithium toxicity in older adults: A systematic review of case reports. Clin Drug Investig. 2018;38(3):201-209. View abstract.

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