How does this medication work? What will it do for me?
Lithium is used to treat manic episodes of bipolar disorder. It helps to control the symptoms of mania, which may include reduced need for sleep, poor judgment, hyperactivity, feelings of grandiosity, aggressiveness, and sometimes hostility. Lithium takes about 1 to 3 weeks before it has an effect on these symptoms. Lithium may also reduce the frequency of manic episodes if it is taken regularly.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each hard gelatin capsule with a yellow opaque body and an orange cap, with "pms" and "150" printed on the cap in blue ink, and "LITH" imprinted on the body in blue ink, containing a fine white to off-white powder, contains 150 mg of lithium carbonate. Nonmedicinal ingredients: talc; capsule shell: D&C Red No. 28, D&C Yellow No. 10, FD&C Blue No. 1, FD&C Red No. 40, gelatin, titanium dioxide, and yellow iron oxide.
Each hard gelatin capsule with a white body and flesh-coloured cap, with "pms" and "300" printed on the cap in black ink, and "LITH" imprinted on the body in black ink, containing a fine white to off-white powder, contains 300 mg of lithium carbonate. Nonmedicinal ingredients: talc; capsule shell: gelatin, red iron oxide, and titanium dioxide.
Each hard gelatin capsule with a white body and aqua blue cap, with "pms" and "600" printed on the cap, and "LITH" imprinted on the body in black ink, containing a fine white to off-white powder, contains 600 mg of lithium carbonate. Nonmedicinal ingredients: talc; capsule shell: FD&C Blue No. 1, gelatin, and titanium dioxide.
How should I use this medication?
The usual starting dose for treatment of mania is 900 mg to 1,800 mg daily divided into 3 equal doses. The dose may be started at a lower level depending on the circumstances of the person taking the medication. The dose of lithium is usually aimed at keeping a certain level of lithium in the bloodstream. This is why lab tests are needed to monitor the levels. Once the best dose is reached, the medication may usually be taken in a single daily dose. This dose may be lower than the total of the initial 3 daily divided doses.
After the manic episode is controlled, it may be necessary to decrease the dose of lithium to avoid unwanted effects. At this point, the daily dose of lithium is between 500 mg and 1200 mg, divided into three doses.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
Lithium should be taken with food. Swallow the capsules whole with some water, do not crush or chew the capsules.
It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take lithium carbonate if you:
- are allergic to lithium carbonate or any ingredients of the medication
- are severely debilitated
- are severely dehydrated
- are taking diuretics (water pills)
- have low blood levels of sodium
- have significant kidney disease
- have significant heart disease
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- abdominal pain
- increased frequency of urination or loss of bladder control (more common for women than for men, usually begins 2 to 7 years after start of treatment)
- increased thirst
- nausea (mild)
- sensation of spinning (vertigo)
- trembling of hands (slight)
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- confusion, poor memory, or lack of awareness
- difficulty breathing (especially during hard work or exercise)
- fast or slow heartbeat
- frequent urination
- increased thirst
- irregular pulse
- stiffness of arms or legs
- slurred speech
- symptoms of too much calcium in the blood (e.g., fatigue, confusion, excessive thirst, increased urination, muscle weakness)
- unusual tiredness or weakness
- weight gain
Stop taking the medication and seek immediate medical attention if any of the following occur:
- lack of coordination
- loss of appetite
- muscle weakness
- nausea or vomiting
- slurred speech
- blurred vision
- clumsiness or unsteadiness
- convulsions (seizures)
- increase in amount of urine
- ringing in the ears
- trembling (severe)
Early symptoms of overdose or toxicity:
Late symptoms of overdose or toxicity:
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
HEALTH CANADA ADVISORY
February 5, 2014
Health Canada has issued new restrictions concerning the use of lithium. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Drowsiness/reduced alertness: Lithium may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.
Fluid intake and diet: It is important to maintain a normal diet, including salt, as well as an adequate fluid intake (2,500 mL to 3,000 mL) at least during the initial period of taking this medication. Side effects have been reported to follow after large amounts of sweating or diarrhea. If this occurs, extra fluids and salt should be taken. Talk to your doctor about the appropriate amounts of fluid and salt to take. If you develop a fever, check with your doctor to see if you should reduce your dose or temporarily stop taking the medication.
Heart disease: If you have heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severe heart disease should not take lithium (see "Who should NOT take this medication?").
Hypercalcemia: Lithium can cause increases in the level of calcium in the blood (hypercalcemia). This may be linked to changes in the function of the parathyroid gland, but sometimes it is not. Tell your doctor if you experience symptoms of hypercalcemia, which include: fatigue, depression, mental confusion, nausea, vomiting, excessive thirst, appetite loss, abdominal pain, frequent urination, muscle and joint aches, and muscle weakness.
Your doctor will order blood tests as part of your treatment with lithium. Calcium may be included in these tests to monitor for changes in the amount of calcium in your blood.
Kidney function: Decreased kidney function may cause this medication to build up in the body, causing unwanted effects. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Long term lithium treatment often leads to a decrease in kidney function as well as symptoms of thirst, excess urination, and weight gain. Contact your doctor if you experience these symptoms.
Lab tests: Lithium toxicity is closely related to the level of lithium in the blood, and can occur at doses that are close to normal. Your doctor will order regular blood tests so that the blood levels of lithium can be monitored.
Stopping the medication: Do not stop taking this medication suddenly without checking with your doctor first. Stopping the medication suddenly may cause withdrawal symptoms.
Thyroid disease: If you have thyroid disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Long-term lithium treatment is sometimes associated with the development of growths in the thyroid gland. Contact your doctor if you develop a swelling in the neck.
Pregnancy: Lithium appears to cause an increase in heart, kidney and thyroid problems in the infants born to mothers who took lithium during pregnancy. Lithium should not be used during pregnancy or by women of childbearing potential unless no other appropriate therapy exists, and, in the opinion of the doctor, the expected benefits outweigh the possible risks.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking lithium, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of this medication have not been established for children less than 12 years of age. The use of lithium is not recommended for this age group.
What other drugs could interact with this medication?
There may be an interaction between lithium carbonate and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.