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Your guide to medication Lithium

Lithium is a mood stabiliser used to treat mania and bipolar disorder.

Medication name: Lithium ("LITH-ee-um")
Brand names: Priadel® ("PRI--a-del"), Liskonum® ("LIS-ko-num”), Camcolit® ("CAM-col-it")
Medication type: Mood stabiliser

Ways to take lithium
Tablets: Lithium carbonate is the ingredient in tablets under the brands Priadel™, Liskonum™ or Camcolit™
Liquids: Lithium citrate is the ingredient in liquids under the brands Priadel™ or Li-Liquid™

There is a good and clear patient information booklet from the National Patient Safety Agency (NPSA) that will help you with the practical bits of taking lithium. This booklet should be given to you by your doctor or someone from your care team, but is also available to download and print off.

What can it be used for?
If you are 18 or over, the doctor can prescribe lithium carbonate or lithium citrate for you as a licensed medicine for mania, bipolar disorder, as an extra treatment for low mood (depression) that has been difficult to treat, or for aggression and self-harming behaviour.

In younger people, specialists might prescribe it ‘off-label’ if they believe it is the best medicine for you, and the liquid form may suit you better as lithium tablets are very bitter if chewed.

Find out more about mania and hypomania

About lithium

How lithium works

Lithium helps to keep your mood from becoming too low or too high, which is why it is classed as a mood stabiliser.

In bipolar disorder, lithium can reduce both the number and severity of relapses (it is a little better at preventing manic relapses than depressive relapses).

Lithium can also be added to an antidepressant to boost the antidepressant effect.

It’s very important to have a good relationship with your doctor and care team to get the best from taking lithium.

A lithium treatment pack should be available from your doctor or pharmacist.

Lithium comes in the form of two salts – lithium carbonate and lithium citrate. Each lithium salt works equally well, but the dose of lithium depends on which salt is prescribed

It is best to stick to the same brand when you are on lithium, so that the amount in your body remains stable.

Find out more about mania and hypomania

Lithium and everyday life

Frequently asked questions

Make sure you do not make big changes to the amount of sodium (salt) in your diet without consulting your doctor first.

Having more salt in your diet than usual can make the lithium level become too low.

However, you must not go on a low-salt diet without close monitoring because this could make the lithium level become too high.

Another side effect of lithium can be weight gain. It is hard to know how this will affect each person.

It is important to keep to your normal diet of food and drink while you take lithium. This is because the level of lithium in your body can rise if you reduce your salt intake and have less to drink. This can be dangerous.

Talk to your doctor if you would like to make changes to your diet while on lithium, or if you are gaining too much weight.

You may want to let your family and friends know you are taking lithium so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Alcohol

You can continue to drink some alcohol while taking lithium, but you must not become dehydrated. If this happens, the lithium level may rise in your body and reach a toxic level.

If you decide to drink any alcohol, you must make sure that you drink lots of water as well.

Do not drink a lot of alcohol, to keep the risk of dehydration down.

If you want to drink alcohol, remember that you might also get sleepy, so make sure you can get home safely.

Street drugs

A person taking lithium needs to be as steady as possible in their diet and other things they put in their body.

Erratic use of street drugs might affect the level of lithium in the body.

Taking ecstasy can make a person dehydrated, which can lead to lithium toxicity.

Taking some other medicines at the same time as lithium can make the level of lithium in your body become too high. This is because they affect the way your kidneys deal with lithium.

When you see a doctor or any other healthcare professional, you should tell or remind them that you are taking lithium.

Whenever you are prescribed a new medicine, or the dose of one of your medicines is changed, always ask whether this will affect your lithium.

If you buy medicines from a pharmacy or from another shop, you should check with a pharmacist whether they are safe with your lithium before you take them.

Do not take anti-inflammatory painkillers such as ibuprofen while you are taking lithium. This is because ibuprofen and related medicines (e.g. naproxen, diclofenac) can make the lithium level become too high.

Diuretics (‘water tablets’) and certain types of blood-pressure medicine can also make the lithium level become too high.

A few people who take lithium will, on their doctor’s advice, need to take one of these interacting medicines at the same time. If this is the case, then the lithium dose will be adjusted to take the interacting medicine into account, and you may need more frequent blood tests to check your lithium level.

Some people will need to take antidepressant medicine while they are taking lithium. This is usually safe, but there is a chance of a rare reaction called serotonin syndrome. Symptoms include high temperature (fever), shivering, excessive sweating, agitation, confusion, trembling, and weird muscle movements. If you get these symptoms, you must seek medical attention straight away.

There is also a risk of serotonin syndrome if you take a type of anti-migraine medicine called a ‘triptan’ while taking lithium.

Some people will need to take an antipsychotic medicine while they are taking lithium. This is usually safe, but there is a chance of a rare reaction called neuroleptic malignant syndrome (NMS). Symptoms of this include confusion, disorientation, agitation, tiredness, shaking, excessive sweating, rigid muscles, muscle cramps, weird muscle movements, and high temperature (fever). If you get these symptoms, then you must seek medical attention straight away.

Antipsychotic medicines and some other medicines may affect your heart rhythm if taken with lithium, and you may need to have a test called an electrocardiogram (ECG) to check on your heart.

If you drink a lot of coffee, cola drinks or caffeine drinks while taking lithium, it can reduce the level of lithium in your body, which means it might not work as well for you.

If you suddenly stop drinking caffeine, it could make the level rise.

Do not make any big changes to your diet before talking to your doctor, so they can watch your lithium levels more closely. This might mean having an extra blood test after a change has been made to check the lithium in your blood is still at the right level.

Taking lithium may affect your reaction time, give you blurred vision, make you feel dizzy, and make your hands shake when you start taking it.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days, until you know how it affects you.

Do not worry - most people do these things as normal while taking lithium.

Pregnancy

Lithium can affect the development of a baby in the womb.

The first trimester (the first three months of pregnancy) is thought to be the time when the greatest risk is posed to the baby from taking lithium. For this reason, some women stop taking the medication in the first trimester and re-start it in the second trimester.

The main worry is a rare heart condition called Ebstein’s Anomaly where one of your baby’s heart valves becomes faulty. On lithium, the risk of this happening is increased from one in 20,000 babies to three in 20,000 babies, so it’s still very rare at 0.015%.  Early screening at 18-20 weeks can detect heart problems in your baby.

Women taking lithium should use good contraception so that they do not become pregnant by accident.

Hormone contraceptive pills are not affected by lithium.

If you want to get pregnant, then talk to your doctor about whether you should change medications. 

It is important not to suddenly stop taking the lithium, even if you discover that you are pregnant, because if you do, you can become unwell quite quickly. Talk to your doctor if you would like to stop taking lithium.

You will need more frequent blood tests to check the lithium level during pregnancy because it can change as the pregnancy progresses. Expect your lithium dose to go up from month four onwards to keep your body levels in the right range.

Post-natal

Lithium is usually stopped around 12 hours before delivery to avoid levels going high during the delivery period.

Breastfeeding

Lithium gets into the breast milk in quite variable amounts, but in most cases, this does not mean you can’t breastfeed if you have a healthy full-term baby.

If your baby was premature, then breastfeeding is not recommended as your baby may not be able to get rid of the lithium safely.

If you would like to breastfeed your baby rather than bottle-feed, then do discuss this with the doctor or midwife.

If your baby becomes restless, very sleepy or has feeding problems then stop breastfeeding and seek medical advice straight away.

Sex

Lithium can have side effects that may affect your sex life. These include:

  • difficulty getting an erection (getting hard) or difficulty ejaculating (coming)  
  • difficulty reaching orgasm (coming)

These effects should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to the doctor and see what else you could try.

The good effects of lithium may have a positive impact on your sex life as your symptoms settle, and you can concentrate on your relationships.

Fertility

No effects on fertility have been reported in people taking lithium.

If you are trying for a baby, then talk to your doctor about your medicines because there are risks associated with taking lithium during pregnancy.

Hormone contraceptive pills are not affected by lithium.

Lithium is not a banned substance in sport.

It might, however, affect your reaction times or make your hands shake, so think about this if your sport needs a steady hand or quick reactions.

Do not worry - most people play sports as normal while taking lithium.

Try not to take lithium for the first time just before your exams.

Lithium can affect your memory, your eyesight, and make your hands shake when you start taking it.

You should talk to your doctor about any future exams if you are starting lithium.

You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start lithium to improve your motivation to study.

Do not worry - most people can take exams as normal while taking lithium.

Monitoring your health on lithium

  • You need to have regular blood tests when you take lithium so that the amount of the medication in your blood is kept at the right level. If the level is too low, lithium will not work properly. If the level is too high, you will feel very unwell. This is called lithium toxicity.

    Before you start on lithium, you will need some “baseline” blood tests so that the doctor knows if there are any existing problems with your kidneys or thyroid gland. This is part of making sure that lithium is suitable for you.

    You will have at least one blood test about a week after starting lithium, to check the level is right to start with. You will have another blood test to check your lithium level every three to six months.

    You will also need regular blood tests to check on your kidneys, thyroid gland, and calcium level, because these can sometimes be affected by lithium.

    You will also need a test called an electrocardiogram (ECG) to check your heart rhythm before you start taking lithium. This is also part of making sure that lithium is suitable for you.

Uses, warnings, safety and side effects

Taking lithium

What if I miss a dose?

If you realise that you have forgotten to take a dose, take it as soon as possible (unless it is getting close to your next dose).

If you remember later during the day, take it as soon as possible (as long as it is at least ten hours to your next scheduled dose).

If you forget to take it by the time of the next dose, just take the next dose.

Do not take a double dose.

Stopping the use of lithium

It is very important that you do not stop taking your lithium suddenly. This is because your symptoms may come back. If this happens, they will be harder to get back under control again.

Research shows that if you are taking lithium for bipolar disorder and you stop taking it suddenly (i.e. over the course of less than 14 days), then you have a 50% (one in two) chance of becoming ill again within six months and a 90% (nine in ten) chance of becoming unwell again within three years.

If you need to stop taking lithium, it is best for you to come off it gradually, over at least four weeks, but preferably over three to six months. Gradually reducing the dose will make it less likely that your symptoms come back (compared to stopping the lithium quickly).

If you are thinking of stopping taking lithium, then you should discuss this with your doctor.

If your lithium level is too high, then you may need to stop taking your lithium for a few days, then start taking it again at a lower dose.

Lithium is not addictive. You will not have cravings for lithium if you stop taking it, and you cannot get ‘hooked’ on lithium.

Warnings and safety

Safety headlines

If you have taken more lithium than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

Lithium can cause serious side effects, including allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps) and lithium toxicity (when the level of lithium in your body becomes too high).

Do not take anti-inflammatory medicines like ibuprofen, which you can buy while you are taking lithium. This type of medication should only be taken alongside lithium under medical supervision.

You might feel sleepy or dizzy in the first few days after taking lithium. Do not drive a car, ride a bike or operate machines until you see how this affects you.

Use good contraception while you are taking lithium. If you take lithium while you are pregnant, it may affect the developing baby. It can also cause symptoms in newborn babies if you take it at the end of pregnancy. Talk to your doctor or midwife about this and get their help.

You need regular blood tests while you are on lithium to measure the level of lithium in your blood. If the lithium level is too low, then the lithium may not work. However, if the lithium level becomes too high, then this can result in lithium toxicity, which is dangerous.

Make sure you stay well-hydrated while you are taking lithium. If you become dehydrated while you are taking lithium, then there is a risk of the lithium level becoming too high. If you visit a hot country, play sport or drink any alcohol, you should counter the effects of this by drinking lots of water, to prevent dehydration.

Make sure you do not make big changes to the amount of sodium (salt) in your diet without consulting your doctor first. Having more salt in your diet than usual can make the lithium level become too low. However, you must not go on a low-salt diet without close monitoring because this could make the lithium level become too high.

It is best to avoid drinking more than one or two alcoholic drinks per day while you are on lithium.

Avoid changing your caffeine intake while taking lithium without consulting your doctor first. Having a higher caffeine intake can make your lithium level lower and cutting down your caffeine intake could make the lithium level higher.

You will also need regular blood tests to check on your kidneys, thyroid gland, and calcium level, because these can sometimes be affected by lithium.

When to go to the hospital

If the level of lithium in your blood becomes too high, you could suffer from lithium toxicity (where the level of lithium in your blood rises above 1.5mmol/l).

Symptoms of lithium toxicity include:

  • feeling unusually sleepy
  • severe shaking of the hands (‘tremor’)
  • stomach ache along with feeling sick and having diarrhoea
  • muscle weakness
  • being unsteady on your feet
  • muscle twitches
  • slurring of words – so that it is difficult for others to understand what you are saying
  • blurred vision
  • confusion

If you experience any of these symptoms, visit a hospital or see your doctor immediately.

Side effects

Side effects

Please do not be worried by the side effects listed on this page. Many people take lithium with only a few mild side effects. If you think you might be getting a side effect from lithium, then you should discuss this with your doctor, nurse, or pharmacist.

Lithium can cause side effects at normal levels. These commonly include:

  • upset stomach
  • fine shake/gentle tremor of your hands
  • metallic taste
  • weight gain
  • feeling thirsty and passing lots of urine
  • thyroid problems

Taking lithium

What if I miss a dose?

If you realise that you have forgotten to take a dose, take it as soon as possible (unless it is getting close to your next dose).

If you remember later during the day, take it as soon as possible (as long as it is at least ten hours to your next scheduled dose).

If you forget to take it by the time of the next dose, just take the next dose.

Do not take a double dose.

Stopping the use of lithium

It is very important that you do not stop taking your lithium suddenly. This is because your symptoms may come back. If this happens, they will be harder to get back under control again.

Research shows that if you are taking lithium for bipolar disorder and you stop taking it suddenly (i.e. over the course of less than 14 days), then you have a 50% (one in two) chance of becoming ill again within six months and a 90% (nine in ten) chance of becoming unwell again within three years.

If you need to stop taking lithium, it is best for you to come off it gradually, over at least four weeks, but preferably over three to six months. Gradually reducing the dose will make it less likely that your symptoms come back (compared to stopping the lithium quickly).

If you are thinking of stopping taking lithium, then you should discuss this with your doctor.

If your lithium level is too high, then you may need to stop taking your lithium for a few days, then start taking it again at a lower dose.

Lithium is not addictive. You will not have cravings for lithium if you stop taking it, and you cannot get ‘hooked’ on lithium.

Warnings and safety

Safety headlines

If you have taken more lithium than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

Lithium can cause serious side effects, including allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps) and lithium toxicity (when the level of lithium in your body becomes too high).

Do not take anti-inflammatory medicines like ibuprofen, which you can buy while you are taking lithium. This type of medication should only be taken alongside lithium under medical supervision.

You might feel sleepy or dizzy in the first few days after taking lithium. Do not drive a car, ride a bike or operate machines until you see how this affects you.

Use good contraception while you are taking lithium. If you take lithium while you are pregnant, it may affect the developing baby. It can also cause symptoms in newborn babies if you take it at the end of pregnancy. Talk to your doctor or midwife about this and get their help.

You need regular blood tests while you are on lithium to measure the level of lithium in your blood. If the lithium level is too low, then the lithium may not work. However, if the lithium level becomes too high, then this can result in lithium toxicity, which is dangerous.

Make sure you stay well-hydrated while you are taking lithium. If you become dehydrated while you are taking lithium, then there is a risk of the lithium level becoming too high. If you visit a hot country, play sport or drink any alcohol, you should counter the effects of this by drinking lots of water, to prevent dehydration.

Make sure you do not make big changes to the amount of sodium (salt) in your diet without consulting your doctor first. Having more salt in your diet than usual can make the lithium level become too low. However, you must not go on a low-salt diet without close monitoring because this could make the lithium level become too high.

It is best to avoid drinking more than one or two alcoholic drinks per day while you are on lithium.

Avoid changing your caffeine intake while taking lithium without consulting your doctor first. Having a higher caffeine intake can make your lithium level lower and cutting down your caffeine intake could make the lithium level higher.

You will also need regular blood tests to check on your kidneys, thyroid gland, and calcium level, because these can sometimes be affected by lithium.

When to go to the hospital

If the level of lithium in your blood becomes too high, you could suffer from lithium toxicity (where the level of lithium in your blood rises above 1.5mmol/l).

Symptoms of lithium toxicity include:

  • feeling unusually sleepy
  • severe shaking of the hands (‘tremor’)
  • stomach ache along with feeling sick and having diarrhoea
  • muscle weakness
  • being unsteady on your feet
  • muscle twitches
  • slurring of words – so that it is difficult for others to understand what you are saying
  • blurred vision
  • confusion

If you experience any of these symptoms, visit a hospital or see your doctor immediately.

Side effects

Side effects

Please do not be worried by the side effects listed on this page. Many people take lithium with only a few mild side effects. If you think you might be getting a side effect from lithium, then you should discuss this with your doctor, nurse, or pharmacist.

Lithium can cause side effects at normal levels. These commonly include:

  • upset stomach
  • fine shake/gentle tremor of your hands
  • metallic taste
  • weight gain
  • feeling thirsty and passing lots of urine
  • thyroid problems

About this information

The information on this page was reviewed by the College of Mental Health Pharmacy in March 2020.

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