Your guide to medication Lithium

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.