Lithium carbonate (or lithium) is a medication used to treat bipolar disorder and manic episodes. It's taken by mouth, typically 2 to 3 times a day. Lithium is available as instant-release pills and oral liquid as well as an extended-release tablet (brand name Lithobid). All lithium products are available as lower-cost generics. Lithium works well for treating bipolar disorder, but it can also cause side effects, such as shakiness, thirst, and nausea. To prevent lithium toxicity, your provider will check your blood lithium levels to make sure you're on a safe dose of the medication.
Treatment of manic episodes of bipolar disorder
Long-term maintenance treatment of bipolar disorder
Lithium is a mood stabilizer. It's not known exactly how lithium works, but it's thought to affect the levels of certain chemicals in the brain that regulate mood.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Confusion, poor memory, or lack of awareness
fainting
fast, pounding, or irregular heartbeat or pulse
increased thirst
slow heartbeat
stiffness of the arms or legs
troubled breathing (especially during hard work or exercise)
unusual tiredness or weakness
Rare
Blue color and pain in the fingers and toes
coldness of the arms and legs
dizziness
headache
noise in the ears
vision problems
Incidence not known
Blurred vision
burning feeling in the chest or stomach
chills
cloudy urine
decreased urination
difficulty in speaking
eyeballs bulge out of the eye sockets
flushed, dry skin
fruit-like breath odor
general feeling of illness
increase in heart rate
increased hunger
increased urination
indigestion
irregular heartbeat, recurrent
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
lightheadedness
loss of balance control
loss of strength or energy
muscle pain or weakness
muscle trembling, jerking, or stiffness
paleness or cold feeling in the fingertips and toes
rapid breathing
restlessness or agitation
shakiness and unsteady walk
shuffling walk
stomach pain or upset
sugar in the urine
sunken eyes
swelling of the ankles or wrists
tenderness in the stomach area
tingling or pain in the fingers or toes when exposed to the cold
twisting movements of the bod
twitching
uncontrolled jerking or twisting movements of the hands, arms, or legs
uncontrolled movements, especially of the face, neck, and back
unexplained weight loss
unsteadiness, trembling, or other problems with muscle control or coordination
unusual drowsiness, dullness, or feeling of sluggishness
unusually strong reflexes
wrinkled skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Acne or skin rash
bloated feeling or pressure in the stomach
change in or loss of taste
decreased interest in sexual intercourse
drying and thinning of hair
excess air or gas in the stomach or bowels
full feeling
inability to have or keep an erection
increased watering of the mouth
loss in sexual ability, desire, drive, or performance
passing gas
salivary gland swelling
tooth pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Works well for bipolar disorder
Starts to work in about 1 to 3 weeks
Available as a lower-cost generic
Available as oral pills and oral liquid for those having trouble swallowing pills
Can have a lot of side effects, including lithium toxicity if lithium levels are too high
Requires routine blood tests to check the medication levels and how the medication is affecting your body
Not the best option for people with severe kidney problems
Interacts with a lot of medications such as non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, and ACE-inhibitors
You can take lithium with or without food, but nausea and vomiting are common side effects of lithium. Taking it with food can help. But if it doesn't and these effects are bothersome, let your provider know because you might need to have your dose lowered, your nausea treated, or switched to lithium (Lithobid) extended-release tablets.
Lithium can make you sleepy and dizzy. Don't drive or do anything requiring concentration until you know how this medication affects you. Also, drinking alcohol isn't recommended while taking lithium because it can worsen sleepiness and dizziness.
Stomach upset that won’t go away, shakiness, slurred speech, and extreme drowsiness can be signs that your lithium dose is too high. If you experience these symptoms, call your provider or get medical help right away.
The amount of fluids and salt in your diet can affect your lithium blood levels. Avoid becoming overheated or dehydrated in hot weather or during exercise, and keep your salt intake consistent. Also, make sure to stay well-hydrated and drink fluids when you feel thirsty. Changing the amount of salt in your diet can change the lithium levels in your blood and cause more side effects. Too little salt can cause higher blood lithium levels, while too much salt can cause your lithium levels to fall. Talk to your healthcare provider about how much fluids you should drink when taking lithium.
Lithium can interact with a lot of commonly used medications. such as NSAIDs like ibuprofen (Advil, Motrin) or naproxen (Aleve), blood pressure medications, and diuretics (water pills). Make sure to tell your provider and pharmacist about all of the medications you're taking before starting lithium. Also, don't start any new medications while taking lithium without talking to your provider first.
Swallow the extended-release tablets whole. Don't crush or chew them as too much medication might get released at once, which can cause side effects.
If you're taking the liquid form of lithium, be sure to use the measuring device that your pharmacy provides with the medication. Don't use household spoons to measure out your dose because they might not be accurate and you can give yourself the wrong dose.
Don't change your dose or suddenly stop taking lithium without talking to your provider first. If you're interested in stopping the medication, contact your provider. They'll give you specific instructions on how to lower your dose slowly over a period of time before completely stopping the medication.
Lithium can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Body fluids or electrolyte levels not in balance | Current fever or illness | Kidney problems | Heart problems
If your blood lithium levels are too high, you can experience lithium toxicity, which can cause serious side effects. Your risk is higher if you're taking medications that can raise the levels of lithium in your body. To prevent lithium toxicity, your provider will measure lithium levels regularly to see if you're within a safe range, and adjust the dose of your medication as needed. Get medical help right away if you're experiencing symptoms of having too much lithium in your body, such as diarrhea, vomiting, abnormal eye movements, shaking, muscle weakness, impaired speech, loss of balance or coordination, confusion, and trouble breathing.
Risk factors: Long-term use | Kidney problems
Lithium can directly damage your kidneys, which could potentially be reversed if you stop taking lithium. Lithium can also affect your kidneys' ability to balance salt and water in your body. When first starting treatment or after long-term use, you might experience more frequent urination and more thirst. It is important that you keep your fluid and salt intake relatively the same each day. You should also avoid dehydration and becoming overheated in hot weather and exercise. Your provider will monitor your kidney health before and during treatment and will adjust or stop your dose of lithium if there's evidence the medication is damaging your kidneys. Contact your provider if you notice bloody or foamy urine, lower back pain, or fatigue, because these could be signs of damaged kidneys.
Risk factors: Taking other medications that raise serotonin levels in your brain
Some people taking lithium have developed a rare, but potentially life-threatening condition called serotonin syndrome. This condition happens where there's too much serotonin in the brain. Your risk for serotonin syndrome is higher if you use lithium with other medications that can raise your serotonin levels, such as certain antidepressants, mental health medications, pain medications, and migraine medications. Let your provider know about all the medications you take before starting lithium. Also, don't start any new medications without talking to your provider first. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Get medical help right away if you have any of these symptoms.
Risk factors: Long-term use | Thyroid problems
Lithium can build up in the thyroid and lead to thyroid problems such as hypothyroidism (low thyroid hormone) or hyperthyroidism (overactive thyroid). Your provider will monitor your thyroid health before and during treatment to make sure your thyroid gland is working properly and your thyroid hormone levels are normal. If you get symptoms of hypothyroidism (e.g., tiredness, weight gain, and feeling cold, contact your provider right away) or hyperthyroidism (e.g., weight loss, feeling hot, irritable, sweating), contact your provider.
Risk factors: Personal or family history of Brugada syndrome | Family history of sudden death before the age of 45 | Unexplained fainting
Lithium can worsen the symptoms of a rare but life-threatening heart rhythm condition called Brugada syndrome. Lithium should be avoided in patients with Brugada syndrome or those suspected of having Brugada syndrome. People with a family history of Brugada syndrome or sudden death before the age of 45 years should consult with a heart specialist (cardiologist) to discuss the benefits and risks of starting lithium treatment.
Risk factors: Older adults | Taking a water pill | Not enough body fluids | Currently sick with illness | Drinking alcohol regularly
Lithium can cause low sodium levels in your blood. Your provider might closely monitor your blood sodium levels before and during treatment with lithium. Get medical help right away if you experience weakness, confusion, difficulty concentrating, headache, or memory problems because these could be signs of low blood sodium levels, which is a medical emergency.
Risk factors: Long-term use | Taking other medications that raise blood calcium levels
Taking lithium for a long time can raise the calcium levels in your blood due to too much parathyroid hormone. Sometimes, these changes in your parathyroid glands won't go away and the only way to fix it is through surgery. Your provider will monitor your blood calcium levels and parathyroid hormone levels during treatment to make sure your parathyroid gland is working properly and that your calcium levels are normal. Let your provider know if you have symptoms of high calcium levels, such as tiredness, muscle weakness, loss of appetite, nausea, vomiting, constipation, and confusion.
Risk factors: Taking an antipsychotic and lithium together
Taking lithium with antipsychotics such as quetiapine (Seroquel), aripiprazole (Abilify), and olanzapine (Zyprexa) can raise your risk for certain brain side effects, such as weakness, fever, tremors, confusion, and muscle stiffness. If you notice any of these symptoms, get medical help right away.
Though very rare, taking lithium can also raise the pressure in the brain. Let your provider know right away if you notice changes in your vision. If this change is caused by lithium, then they'll need to switch you to a different medication.
Dosage | Quantity | Price as low as | Price per unit |
---|---|---|---|
8meq/5ml | 150 ml | $24.59 | $0.16 |
Lithium is available in different formulations. Your dose can differ depending on which formulation your provider prescribes. Some examples include:
Lithium immediate-release tablets and capsules:
Adults and children above 30 kg (66 lbs): The typical starting dose is 300 mg by mouth 3 times a day. The usual maintenance dose ranges from 300 mg to 600 mg taken 2 to 3 times a day, depending on whether you're taking it for manic episode or long-term treatment.
Children weighing 20 kg to 30 kg (44 lbs to 66 lbs): The typical starting dose is 300 mg by mouth 2 times a day. The usual maintenance dose ranges from 600 mg to 1,500 mg total daily (depending on whether you're taking it for manic episode or long-term treatment), given in divided doses.
Lithium 8 mEq/5 mL oral solution:
Adults and children above 30 kg (66 lbs): The typical starting dose is 8 mEq by mouth 3 times a day. The usual maintenance dose ranges from 8 mEq to 16 mEq taken 2 to 3 times a day, depending on whether you're taking it for manic episode or long-term treatment.
Children weighing 20 kg to 30 kg (44 lbs to 66 lbs): The typical starting dose is 8 mEq by mouth 2 times a day. The usual maintenance dose ranges from 16 mEq to 40 mEq total daily (depending on whether you're taking it for manic episode or long-term treatment), given in divided doses.
Lithium (Lithobid) extended-release tablets
Manic episodes: The typical dose is 900 mg by mouth 2 times a day, or 600 mg 3 times a day. The total daily dose is 1,800 mg.
Long-term control: The typical dose is 600 mg by mouth 2 times a day. The total daily dose is 1,200 mg.
Your provider will adjust your lithium dose based on if you have kidney problems, how well your bipolar symptoms are responding to the medication, if you're having side effects, and your blood lithium level.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Allergy to any lithium-containing product
Treatment of manic episodes of bipolar disorder
Long-term maintenance treatment of bipolar disorder
Bipolar disorder
Seizures (focal impaired awareness seizure, absence seizure)
Migraine prevention
Seizures (partial seizures, tonic-clonic seizures)
Seizures of Lennox-Gastaut syndrome - immediate-release only
Bipolar disorder - immediate-release only
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ANI Pharmaceuticals, Inc. (2022). LITHOBID- lithium carbonate tablet, film coated, extended release. DailyMed.
Centers for Disease Control and Prevention. (2020). Spoons are for soup, milliliters are for medicine.
Chokhawala, K., et al. (2023). Lithium. StatPearls.
Gomes-da-Costa, S., et al. (2022). Lithium therapy and weight change in people with bipolar disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews.
Sayed, M. E., et al. (2022). Brugada syndrome. StatPearls.
You and Your Hormones. (2020). Hyperthyroidism.
You and Your Hormones. (2020). Parathyroid hormone.
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