How does this medication work? What will it do for me?

Lithium citrate belongs to the class of medications called antimanics. Lithium is used to treat the manic episodes of bipolar disorder. It is also used to prevent or to reduce the frequency of manic episodes for people with bipolar disorder. It works by affecting the balance of chemicals that occur naturally in the brain.

Lithium starts to work within 5 to 7 days but it may take up to 3 weeks before it controls the symptoms of mania (e.g., reduced need for sleep, poor judgment, hyperactivity, feelings of grandiosity, aggressiveness, and sometimes hostility).

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. 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?

July 13, 2015

Lithium citrate is no longer being manufactured for sale in Canada. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The usual starting dose for treatment of mania is 600 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.

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.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue on with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on 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 freeze this medication.

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?

Lithium should not be taken by anyone who:

  • is allergic to lithium or to any of the ingredients of the medication
  • is severely debilitated
  • is severely dehydrated
  • has brain damage
  • has low blood levels of sodium or have conditions that require a low intake of sodium
  • has significant kidney or 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.

  • dizziness
  • dry mouth
  • fatigue
  • hair loss
  • increased frequency of urination or loss of bladder control
  • increased thirst
  • mild disorientation
  • mild nausea
  • muscle weakness
  • slight trembling of hands
  • thinning hair
  • weight loss

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:

  • blurred vision
  • confusion, poor memory, or lack of awareness
  • difficulty breathing (especially during hard work or exercise)
  • exaggerated reflexes
  • fainting
  • fast or slow heartbeat
  • increasing disorientation
  • increasing drowsiness
  • irregular pulse
  • low blood pressure
  • muscle twitching
  • problems with muscle control or coordination
  • ringing in the ears
  • stiffness of arms or legs
  • unusual tiredness or weakness
  • weight gain

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • convulsions (seizures)
  • diarrhea
  • eye pain
  • involuntary rapid eye movement
  • muscle weakness
  • slurred speech
  • vomiting

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?

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.

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.

Drowsiness/reduced alertness: Lithium may reduce mental or physical abilities. Avoid activities that require alertness, such as operating vehicles or machinery, until you know how the medication affects you.

Fluid intake and diet: The level of lithium in the blood is directly affected by the intake of fluid and salt, so it is important to maintain a normal diet, including adequate salt and fluid intake (2,500 mL to 3,000 mL). You should try to avoid making large changes to your diet that would affect your salt and fluid intake. Talk to your doctor about the appropriate amounts of fluid and salt to take.

Heart disease: People with heart disease should discuss with their doctor how this medication may affect their medical condition, how their 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 citrate (see "Who should NOT take this medication?")

Kidney disease: People with kidney disease should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Long-term lithium treatment is frequently associated with a decrease in kidney function as well as symptoms of thirst, excess urination, and weight gain. If you experience any of these symptoms, contact your doctor.

Lab tests: Side effects resulting from lithium are closely related to the level of lithium in the blood. The side effects can occur at doses that are close to the normal dose required for your body to respond. You will probably need to have regular blood tests while taking this medication, so your doctor can monitor the blood levels of lithium.

Stopping the medication: Do not stop taking this medication suddenly without checking with your doctor first. Stopping the medication suddenly may cause a manic episode or other withdrawal symptoms.

Thyroid disease: People with thyroid disease should discuss with their doctor how this medication may affect their medical condition, how their 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: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking lithium citrate, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children under 12 years of age.

Seniors: Seniors appear to be more likely to experience side effects when taking lithium, even if the blood levels are appropriate. Lower doses may be necessary to avoid these effects.

What other drugs could interact with this medication?

There may be an interaction between lithium citrate and any of the following:

  • ACE inhibitors (e.g., enalapril, ramipril)
  • acetazolamide
  • angiotensin II receptor blockers (e.g., losartan, telmisartan)
  • calcium channel blockers (e.g., diltiazem, verapamil)
  • carbamazepine
  • celecoxib
  • diuretics (e.g., hydrochlorothiazide)
  • diazepam
  • haloperidol
  • iodide salts (e.g., iodine, potassium iodide)
  • MAO inhibitors (e.g., phenelzine)
  • methyldopa
  • metronidazole
  • nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., naproxen, ibuprofen)
  • phenothiazines (e.g., chlorpromazine)
  • phenytoin
  • propranolol
  • selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine, fluvoxamine, sertraline)
  • sodium bicarbonate
  • sodium chloride
  • tetracyclines (e.g., doxycycline, tetracycline)
  • theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine, nortriptyline)

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.