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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Lithium

PATIENT INFORMATION ON LITHIUM

Lithium is classified as a mood stabilizer. It is a simple element, found in nature in some mineral waters, and is also present in small amounts in the human body.

Uses

Lithium is used primarily in the treatment of acute mania and in the long-term control or prophylaxis of Manic Depressive Illness (Bipolar Disorder).

Though not approved for these indications, lithium has also been found to augment the effects of antidepressants in depression and obsessive compulsive disorder, and is useful in the treatment of cluster headaches, as well as chronic aggression or impulsivity. 

How does the doctor decide what dose (how many milligrams) to prescribe?

The dose of lithium is different for every patient and is based on how much lithium is in the blood, as well as the response to treatment. The doctor will measure the lithium level in the blood on a regular basis during the first few months. The lithium level that is usually found to be effective for most patients is between 0.6 and 1.2 mmol/L (mEq/L).

You may initially take your medication several times a day (2 or3); after several weeks, the doctor may decide to prescribe the drug once daily. It is important to drink 8-12 cups of fluid daily when on lithium (e. g., water, juice, milk, broth, etc.)

On the morning of your lithium blood test, take the morning dose of lithium after the test to avoid inaccurate results.

How quickly will the drug start working?

Control of manic symptoms may require up to 14 days of treatment. Because lithium takes time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor.

Improvement in symptoms of depression, obsessive compulsive disorder, cluster headaches, as well as aggression/ impulsivity also occur gradually.

How long should you take this medication?

Following the first episode of mania it is recommended that lithium be continued for a minimum of one year ; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms; if none occur, the drug can gradually be stopped.

For individuals who have had several episodes of mania or depression, lithium should be continued indefinitely.

Long-term treatment is generally recommended for recurring depression, obsessive-compulsive disorder, cluster headaches or aggression/impulsivity.

Side effects 

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Lethargy, difficulty concentrating-This problem usually goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Nausea or heartburn-If this happens, take the medications with food. If vomiting or diarrhea occur and persist for more than 24 hours, call your doctor.
  • Muscle tremor, weakness, shakiness, stiffness-Speak to your doctor as this may require an adjustment in your dosage.
  • Changes in sex drive or sexual performance-Discuss this with your doctor.
  • Weight changes-Monitor your food intake; avoid foods with high fat content (e. g., cakes and pastry).
  • Increased thirst and increase in frequency of urination-Discuss this with your doctor.
  • Skin changes, e.g., dry skin, acne, rashes.

Side effects you should report IMMEDIATELY, as they may indicate the amount of lithium in the body is higher than it should be, include:

  • Loss of balance
  • Slurred speech
  • Visual disturbances (e. f., double-vision)
  • Nausea, vomiting, stomach ache
  • Watery stools, diarrhea (more than twice a day)
  • Abnormal general weakness or drowsiness
  • Marked trembling (e. g., shaking that interferes with holding a cup), muscle twitches, jaw shaking

IF THESE OCCUR CALL YOUR DOCTOR RIGHT AWAY. If you cannot reach your doctor, stop taking the lithium until you get in touch with him. Drink plenty of fluids and snack on salty foods (e. g., chips, crackers). If symptoms continue to get worse, or if they do not clear within 12 hours , go to the Emergency Department of the nearest hospital. A clinical check-up and a blood test will show the cause of the problem.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Soreness of the mouth, gums or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Swelling of the neck (goiter)
  • Abnormally frequent urination and increased thirst (e. g., having to get up in the night several times to pass urine)

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of lithium in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because lithium can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor any doctor or dentist that you see that you are taking lithium.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. This drug may impair the mental and physical abilities and reaction time required for driving a car or operating other machinery. Avoid activities if you feel drowsy or slowed down.
  3. Do not stop your drug suddenly as this may result in withdrawal symptoms such as anxiety, irritability and emotional liability.
  4. Report any changes in mood or behavior to your physician.
  5. It is important to drink 8-12 cups of fluids daily ( e. g., water , juice, milk, broth, etc.)
  6. Do not change your salt intake during your treatment, without first speaking to your doctor ( e. g., avoid no-salt or low-salt diets).
  7. If you have the flu, especially if vomiting or diarrhea occur, check with your doctor regarding your lithium dose.
  8. Use extra care in hot weather and during activities that cause you to sweat heavily (e. g., hot baths, saunas, exercising). The loss of too much water and salt from your body may lead to changes in the level of lithium in your body.
  9. Tablets or capsules of lithium should be swallowed whole; do not crush them.
  10. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children. 

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse