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Lithium

  • Medication name

    Lithium ("LITH-ee-um")

  • Brand names

    Priadel® ("PRI--a-del")

    Liskonum® ("LIS-ko-num”)

    Camcolit® ("CAM-col-it")

  • Medication type

    Mood stabiliser

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™

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.

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.

If you are 12 or over, the doctor can prescribe lithium carbonate for you as a licensed medicine for mania and bipolar disorder, to prevent future episodes of mania, hypomania or depression. Only Liskonum® is licensed from 12 years of age.

If you are under 18, a specialist doctor may still consider this as a treatment option for mania and bipolar disorder. They may also consider this as a treatment option for low mood (depression) in combination with another antidepressant.

If your doctor prescribes you lithium, you’ll be given a lithium treatment booklet. This provides important information about your medicine as well as space to record the results of monitoring. It also contains a lithium treatment card which you can show to a pharmacist if you are buying medicine, or to other healthcare professionals, so that they know you are taking lithium and can give you the correct advice.

Read more about mania and hypomania

About lithium

Lithium helps keep your mood from becoming too low or too high.

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.

We do not fully understand how lithium works as a mood stabiliser although it is thought to be very complex. It can alter the metabolism of chemical messengers in the brain (neurotransmitters) and have an effect on signalling within and between cells in the brain. Lithium might also be involved in triggering neurogenesis in parts of the brain. This is a process where new nerve cells are formed and may contribute towards improving mood.

Lithium and everyday life

You may start to notice some positive effects within the first week, but it usually takes several weeks to start to work. If you respond to treatment the beneficial effects will then continue to increase over the next few months and can continue to increase over the next six to 12 months.

Your doctor will start your lithium with a low dose and then increase it gradually to a dose that is right for you.

A side effect of lithium can be weight gain. This can affect people differently and it is not possible to predict the effects until you start taking it. Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking lithium.

Making sure you do enough exercise and eat a healthy diet (with vegetables and fibre) can help you to avoid putting on too much weight. Exercise is also good at helping with your mood.

Mental health conditions like bipolar disorder can make being active and eating healthily more of a challenge. Talk to your doctor, pharmacist and specialist healthcare team for lifestyle advice and where to get support if this would be helpful.

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.

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

A side effect of lithium is a dry mouth and a metallic taste. Over a long time, a dry mouth can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well, have regular dental check-ups, and try to drink water or low-calorie drinks. Speak to your dentist, doctor or pharmacist about things you can do to help.

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.

You can feel drowsy in the first few days of taking lithium, or if the dose is increased. This should get better after a week or two. If it makes you feel drowsy, try taking it just before you go to bed.

If you have been taking lithium for more than a month and you continue to feel very tired, sleepy or struggle to function during the day, you should go back to your doctor and discuss what changes could be made to help.

Alcohol

It may be possible to drink some alcohol in moderation while taking lithium but having the two together might make you very sleepy and unsteady on your feet.

During the first few weeks of treatment, it might be best to stop drinking alcohol until you see how the medicine affects you.

Drinking alcohol can dehydrate your body. This can be dangerous if you are taking lithium because it can result in the lithium levels in your body increasing and they could reach a toxic level.

If you drink alcohol, always make sure you drink water or another soft drink as well to prevent yourself becoming dehydrated.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

The use of street drugs may change your behaviour which could include the amount of food you eat and drink and affect the level of lithium in your body. If it increases, this could be dangerous.

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

Lithium may reduce the effects of amfetamines, and taking amfetamines with lithium may increase the risk of serotonin syndrome. Watch out for symptoms such as fever, tremors, diarrhoea and agitation.

There are many different street drugs, but we don’t know what effect taking them with lithium will have, so it’s best to be cautious. Taking these together could result in the risk of toxicity as well as other dangers like blacking out and not remembering what you have done.

There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on drugs and alcohol.

Lithium does not mix well with some other medicines, including herbal remedies. It may affect how they work, could cause more side effects or may change the lithium level in your body. If the level of lithium becomes too high this could be dangerous.

Before you start taking lithium, tell your doctor if you are taking any other medications including things you have bought from a pharmacy (or other shop) for common illnesses like colds and flu. This includes medications that you put on your skin. You can also show them the lithium treatment card you were given when you started lithium.
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.

Sometimes lithium is combined with antidepressant medicine if the antidepressant hasn’t worked as well as expected on its own. When these medicines are combined there have been some reports of serotonin syndrome occurring. This is rare, but you need to be aware of the symptoms so you know what to do if you get them. 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.

When these medicines are combined, there have been some reports of neuroleptic malignant syndrome (NMS) occurring. This is rare, but you need to be aware of the symptoms so you know what to do if you get them. Symptoms 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.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with lithium. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

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.

There are multiple companies that manufacture this medicine and the non-active ingredients may vary between products and also between the different strengths of tablets that are available.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

The Priadel liquid contains a small amount of alcohol, but not enough to affect your blood alcohol level.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

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 or weeks until your dose is stable and you know how it affects you.

Most people drive as normal while taking lithium. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

You must tell The DVLA (Driver and Vehicle Licensing Agency) if you have bipolar disorder, schizophrenia, schizoaffective disorder or other mental health conditions that could affect your driving. You can be fined if you do not tell The DVLA about a medical condition that affects your driving and may be prosecuted if you are involved in an accident as a result.

Pregnancy

There is evidence that suggests taking lithium while pregnant can make health problems more likely whilst your baby is developing. Early screenings can help detect if there are any health problems with your baby.

If you become pregnant while you are on lithium, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing lithium and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking lithium during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Untreated depression or bipolar illness can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking lithium while pregnant, you should tell your midwife. If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with lithium.

If you and your doctor agree that you will continue to take lithium during your pregnancy, you will need regular blood tests to monitor your lithium levels. Your body processes lithium differently during pregnancy so your dose might change.

Post-natal

If you have continued to take lithium during pregnancy it is advised that you plan to give birth in hospital. This means you and your baby can be monitored by doctors and your midwife, and you can quickly get any extra support if you need it.

Some new born babies whose mothers take lithium during pregnancy can get withdrawal symptoms at birth and soon after, like restlessness, floppy muscles or being very sleepy.

Tell your midwife if you are taking lithium, so that they can help if the baby has any symptoms after birth.

Breastfeeding

Lithium is passed to the baby in breastmilk in varying amounts.
If your baby was born early, then breastfeeding while you take lithium may not be recommended. Talk to your midwife and doctor about feeding options.

If you breastfeed while taking lithium, seek urgent medical advice if your baby becomes restless, very sleepy or develops feeding problems.

Sex

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

  • problems getting an erection
  • difficulty reaching orgasm

Untreated depression can have a negative effect on your sex life, so if lithium helps you to recover, positive effects can include improving your desire, experience and enjoyment of intermit relationships again.

Fertility

There is no evidence to suggest that lithium will affect your fertility. Talk to your doctor about your lithium if you are trying to get pregnant or planning a family.

Lithium is not a banned substance in sport.

Most people play sports as normal while taking lithium. However, it may affect your ability to play sports that require quick reactions or a steady hand. It might also affect your ability to focus.

If you have any concerns, discuss this with your doctor.

Ideally it is best not to take lithium for the first time just before your exams as it may affect your concentration.

It’s not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking lithium.

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 and ability to study. Bear in mind that depression itself can affect concentration.

Most people take exams as normal while taking lithium, but if you have concerns, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

  • you’re not given a leaflet
  • you don’t understand the information
  • you need it in a different format or language
  • you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking lithium

Your doctor will advise you on how long it is best to keep taking your medication. This may vary depending on what you’re taking it for and how many times you’ve been unwell.

If you are prescribed lithium to treat bipolar disorder, it is recommended that you take lithium for at least two years or more. The full effects may not be reached until six to twelve months after taking this medicine.

If lithium helps you and you are continuing to do well, you and your doctor may decide that it will be beneficial for you to continue for longer. Some people take this medicine for years or even decades.

You will get the best effects from your medicine if you take it every day at the dose prescribed by your doctor.

Lithium is usually taken once a day. Sometimes it may be prescribed twice a day in the morning and evening.

If you take lithium once a day, it is usual to take it in the evening. This is because the blood tests to check the amount of lithium in your body should be taken at least twelve hours after your last dose, so it is easier to arrange an appointment with your surgery at the correct time if you take the dose in the evening.

To help you to take your tablet regularly, you should choose a time that you will remember. This could be a mealtime or when you brush your teeth.

You will start with a low dose, which will be increased slowly to a dose that is effective for you. This may take several weeks and your doctor will use the results of your blood tests to help find the dose that is right for you.

You can take it with or without food, but taking it with or just after food may help to minimise side effects like feeling sick.

Swallow the tablet whole with a glass of water. Crushing or chewing the tablets can change the way the medicine is released. If you struggle to swallow your tablets whole, talk to your pharmacist for advice.

If you realise that you have forgotten to take a dose, take it as soon as possible, unless it is less than 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 try and catch up by taking a double dose.

If you regularly forget to take it every day, your medicine may not work as well, and it could increase the risk of you becoming unwell again.

It is very important that you do not stop taking lithium suddenly. This is because your symptoms may come back. If this happens, they may 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 over the course of less than 14 days, then you have a 50% chance of becoming ill again within six months and a 90% chance of becoming ill 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.

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

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

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

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

  • feeling drowsy or sleepy
  • feeling or being sick
  • noticing a change in your heart rate or breathing

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

Mood disorders can sometimes cause you to have thoughts about hurting yourself or taking your own life. These may be increased when first starting lithium or changing your dose.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

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

Seek urgent medical help if you experience the following symptoms of lithium toxicity:

  • severe shaking of the hands (‘tremor’)
  • shaking muscles, muscle weakness, twitching, jerks or spasms (affecting the face, tongue, eyes or neck)
  • feeling unusually sleepy, tired and dizzy, confusion and blackouts
  • stomach ache along with feeling sick and having diarrhoea
  • muscle weakness
  • being unsteady on your feet
  • muscle twitches
  • slurring of words or difficulty speaking – so that it is difficult for others to understand what you are saying
  • blurred vision or worsening of eyesight
  • confusion
  • feeling very thirsty and needing to pee more than usual

Rarely, lithium can cause allergic reactions. Seek urgent medical help if you experience these symptoms:

  • difficulty breathing
  • swelling of your face or throat
  • itching skin rashes and lumps

Rarely, lithium can bring on serotonin syndrome. Visit a hospital or see your doctor immediately if you get any combination of the following symptoms:

  • high temperature
  • agitation
  • confusion
  • trembling
  • sweating
  • diarrhoea (loose poo)
  • fast heartbeat
  • weird movements of your muscles

Contact your doctor immediately but don't stop taking lithium, if you get any of the following symptoms:

  • irregular, fast or changes to your heartbeat
  • feeling thirsty and going to the loo a lot to pee
  • developing a hand tremor, shaky movements or tensing or contraction of muscles that you are not able to control
  • development or worsening of skin conditions such as psoriasis or development of rashes and redness of skin
  • feeling tired, dry and scaly skin, weight gain, muscle aches and weakness (these symptoms may mean your thyroid isn’t working as well as it should and your doctor can test this and treat it as necessary)

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking lithium. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

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 (symptoms might include feeling tired, dry and scaly skin, weight gain, muscle aches and weakness)

As well as side effects, the following symptoms might mean the lithium levels in your body are too high. Always seek urgent medical help if you develop these symptoms:

  • feeling unusually sleepy
  • severe shaking of the hands (tremors)
  • 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 or worsening of eyesight
  • confusion

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Before you start lithium, you should have your weight, kidney function and thyroid function checked. Your doctor will also do tests to measure the level of electrolytes and calcium in your blood, as well as checking your blood cells are healthy. A blood test will be needed to check this.

Your doctor might also check your heart with an electrocardiogram (ECG).
Your doctor will recommend a pregnancy test before starting lithium if you think there is any possibility you could be pregnant.

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.

To start with, these tests will be weekly to help find the lithium dose that is right for you. After your dose is stable, they will be checked every three to six months. Your doctor will tell you how often you need to have your blood tests taken. You can record your results in your purple lithium information booklet.

It is very important to go for these checks when you are asked to do so. If you are worried or anxious about the monitoring, or having blood tests, talk to your doctor, care team or practice nurse about this for advice and support.

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About this information

The information on this page was reviewed by the College of Mental Health Pharmacy in September 2024.

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