Lithium Carbonate. Clinical.
Side Effects.
Drowsiness, dizziness, tiredness, increased thirst, increased frequency of urination, weight gain, and mildly shaking hands (fine tremor) may occur. These should go away as your body adjusts to the medication. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: diarrhea, vomiting, unsteady walk, confusion, slurred speech, blurred vision, severe hand trembling (coarse tremor), vision changes (such as growing blind spot, vision loss), joint swelling/pain, pain/discoloration of finger/toes, cold hands/feet.
Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, slow/fast/irregular heartbeat, shortness of breath, seizures.
This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin (Antidepressants), so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Precautions.
Before taking lithium, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart disease, kidney disease, urinary problems (such as difficulty urinating), underactive thyroid (hypothyroidism), seizures, Parkinson’s disease, leukemia, severe dehydration (severe loss of body water), any infection with high fever, a certain skin disorder (psoriasis).
Lithium treatment may rarely reveal an existing condition that affects the heart rhythm (Brugada syndrome). Brugada syndrome is an inherited, life-threatening heart problem that some people may have without knowing it. It can cause a serious (possibly fatal) abnormal heartbeat and other symptoms (such as severe dizziness, fainting, shortness of breath) that need medical attention right away. Brugada syndrome may cause death suddenly. Before starting lithium treatment, tell your doctor if you have any of the following risk factors: Brugada syndrome, unexplained fainting, family history of certain heart problems (Brugada syndrome, sudden unexplained death before 45 years old).
This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.
If heavy sweating or severe diarrhea occurs, check with your doctor right away how to best continue taking lithium. Take care in hot weather or during activities that cause you to sweat heavily such as during hot baths, saunas, or exercise.
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
This medication is not recommended for use during pregnancy. It may harm an unborn baby. However, since untreated mental/mood problems (such as bipolar disorder) can harm a pregnant woman and her unborn baby, do not stop taking this medication unless directed by your doctor. Instead, ask your doctor if a different medication would be right for you. If you are planning pregnancy, become pregnant, or think you may be pregnant, tell your doctor right away.
Lithium passes into breast milk and may have undesirable effects on a nursing infant. Therefore, breast-feeding is not recommended while using this drug. Consult your doctor before breast-feeding.
Interactions.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Other medications can affect the removal of lithium from your body, which may affect how lithium works. Examples include ACE inhibitors(such as captopril, enalapril), ARBs (such as losartan, valsartan), NSAIDs(such as celecoxib, ibuprofen), “water pills” (diuretics such as hydrochlorothiazide, furosemide), other drugs for mental/mood conditions (such as chlorpromazine, haloperidol, thiothixene), among others. Your doctor may need to adjust your dose of lithium if you are on these medications.
The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Some examples are street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (such as SSRIs like fluoxetine/paroxetine, SNRIs like duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
Symptoms of overdose may include: diarrhea, vomiting, ringing in the ears, blurred vision, trouble walking, unusual drowsiness, seizures, shaking, loss of consciousness.
Notes.
Do not share this medication with others.
Laboratory and/or medical tests (such as kidney function, thyroid function, lithium and calcium blood levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
Missed Dose.
If you miss a dose, take it as soon as you remember unless your next scheduled dose is within 6 hours. In that case, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
How much is enough? — “low-dose lithium”
Low doses can often be of benefit for depression, either bipolar or plain depression. Lithium treats the entire Mood Spectrum. In very low doses it can still be useful as an “adjunct”, and add-on to another mood stabilizer or an antidepressant.
A simple blood test can show exactly how much of the medication is in the blood. When you are first starting this medication there may be several such tests done, because high levels of lithium can be dangerous and your doctor will be working to make sure you will not get that high a level in your bloodstream.
Recommended dosage.
Depending on the patient’s medical needs, age, weight, and kidney function, doses of lithium can range from 600 to 2,400 mg per day, although most patients will be stabilized on 600 to 1,200 mg per day. Patients who require large amounts of lithium often benefit from the addition of another anti-manic drug, which may allow the dose of lithium to be lowered.
Generally, lithium is taken two or three times daily. However, the entire dose may be taken at once if the physician believes that a single daily-dose program will increase patient compliance . The single dose schedule is especially helpful for people who are forgetful and may skip doses on a multiple dose schedule. Additionally, evidence indicates that once-daily doses are associated with fewer side effects.
More than with any other drug used in the treatment of mental disorders, it is essential to maintain lithium blood levels within a certain narrow range to derive the maximum therapeutic benefit while minimizing serious negative side effects. It is important that people taking lithium have their blood levels of lithium measured at regular intervals.
NOTE.
IN MY CLINICAL EXPERIENCE, I HAVE SEEN PATIENTS STABILIZED AT DOSES AS LOW AS 450 MG LITHIUM CARBONATE PER DAY. SO IT IS ALWAYS GOOD TO START FROM THE LOWEST DOSE POSSIBLE. ASK YOUR DOCTOR.