Experiences with

Lithium

Lithium is a type of medicine known as a mood stabiliser. It's used to treat mood disorders such as:

• mania (feeling highly excited, overactive or distracted)
• hypo-mania (similar to mania, but less severe)
• regular periods of depression, where treatment with other medicines has not worked
• bipolar disorder, where your mood changes between feeling very high (mania) and very low (depression)

Lithium can also help reduce aggressive or self-harming behaviour.

Lithium is available on prescription.

It comes as regular tablets or slow-release tablets (lithium carbonate). Brand names for the tablets include Priadel, Camcolit and Liskonum. It also comes as a liquid that you swallow (lithium citrate). Common brands of lithium liquid are Priadel and Li-liquid.

Dosage

There are 2 different types of lithium – lithium carbonate and lithium citrate. It's important not to change to a different type unless your doctor has recommended it. This is because different types are absorbed differently in the body.

Lithium carbonate comes as standard tablets and slow-release tablets (the medicine is released into your body more slowly).

Standard tablets come as 250mg strength tablets. Slow-release tablets come as 200mg, 400mg and 450mg strength tablets.

Lithium citrate comes as a liquid. This is usually only prescribed for people who have trouble swallowing tablets.

Starting doses vary depending on your age, why you're taking it and the type of lithium your doctor recommends.

If you have kidney problems your doctor will monitor the level of lithium in your blood even more closely and change your dose if necessary.

Changes to your dose

When you start your treatment, you'll need to have a blood test every week to make sure the level of lithium in your blood is not too high or too low. Your doctor may change your dose depending on the results of your blood test.

Once the doctor is happy, you'll have a blood test every 3 to 6 months to check your levels are stable.

Once you find a dose that suits you, it usually stays the same, unless your condition changes, or your doctor prescribes another medicine that may affect the way lithium works.

How to take it

Swallow tablets whole with a drink of water or juice. Do not chew them.

You can take lithium with or without food.

If you're taking liquid, use the plastic syringe or spoon that comes with your medicine to measure the correct dose. If you do not have one, ask your pharmacist. Do not use a kitchen teaspoon as it will not measure the right amount.

You'll usually take your lithium once a day, at night. This is because when you have your regular blood test, you need to have it 12 hours after taking your medicine. You can choose when you take your lithium – just try to keep to the same time every day.

How long to take it for

As long as it's working well to control your condition, you'll generally take lithium for a long time. Some people need to take it for many years.

Do not stop taking lithium suddenly or change your dose without speaking to your doctor first. It's important to keep taking it, even if you feel better. If you suddenly stop, it you could become unwell again very quickly.

If you or your doctor decide to stop your lithium, it must be reduced gradually over a number of weeks or months.

Do not stop taking lithium suddenly even if you feel better, or because you think the dose is too little or too much. The symptoms of your condition are likely to come back.

However, you must stop taking it if you have symptoms such as loss of appetite, problems with your eyesight or feeling very thirsty. These could be signs of lithium toxicity or an allergic reaction. If this happens it's important to stop taking lithium straight away and get medical help.

If you have an infection or illness

If you feel unwell or become unwell while you're taking lithium, it can affect your medicine.

• have an illness that causes severe diarrhoea, vomiting, a high temperature or sweating
• have a urinary tract infection (UTI)
• are not eating and drinking much

Get help from 111 online or call 111

Infections and illnesses like colds and flu can also make you dehydrated. This can affect the levels of lithium in your blood.

Information about your lithium treatment

When you start taking lithium, you'll get a lithium treatment pack (usually a purple folder or book) with a record booklet. You need to show your record booklet every time you see your doctor, go to hospital, or collect your prescription.

When you go to the doctor for blood tests, you or your doctor will write in the record booklet:

• your dose of lithium
• your lithium blood levels
• any other blood test results
• your weight

The treatment pack also has a lithium alert card. You'll need to carry this card with you all the time. It tells healthcare professionals that you're taking lithium. This can be useful for them to know in an emergency.

Tell your doctor or pharmacist if you've lost your treatment pack or did not get one.

If you forget to take it

If you usually take tablets or slow-release tablets and it's less than 6 hours since you were supposed to take your medicine, take it as soon as you remember. If it's more than 6 hours, just skip the missed dose and take your next one at the usual time.

If you forget to take a dose of lithium liquid, just skip the missed dose and take your next one at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much lithium can be dangerous. This is because very high amounts of lithium can cause problems with your kidneys and other organs. It can cause symptoms such as:

• feeling or being sick
• problems with your eyesight (blurred vision)
• increased need to pee, lack of control over pee or poo
• feeling faint, lightheaded or sleepy
• confusion and blackouts
• shaking or muscle weakness, muscle twitches, jerks or spasms affecting the face, tongue, eyes or neck

you take more than your prescribed dose of lithium, even if you do not feel any different

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the lithium packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

Common side effects of lithium are usually mild and go away by themselves. They're more likely to happen when you start taking lithium. There are things you can do to help cope with them:

Keep taking the medicine but talk to your doctor or pharmacist if any of these side effects get worse or do not go away after a few days.

Serious side effects

The level of lithium in your blood will be checked regularly. Although it's rare, having too much lithium in your blood can cause side effects. This is because very high amounts of lithium can cause problems with your kidneys and other organs.

you have any of these symptoms:

• stomach ache, feeling sick (nausea) and having diarrhoea
• problems with your eyesight (blurred vision)
• feeling very thirsty, needing to pee more than normal, and lack of control over pee or poo
• feeling lightheaded or drowsy
• confusion and blackouts
• shaking, muscle weakness, muscle twitches, jerks or spasms affecting the face, tongue, eyes or neck
• difficulty speaking

These are signs of lithium toxicity, which is an emergency. Stop taking lithium straight away.

• Make sure that you go for the blood tests arranged by your doctor.
• It's important not to reduce your salt intake suddenly. Talk to your doctor if you want to reduce the amount of salt in your diet.
• Drink plenty of fluids, especially if you’re doing intense exercise or in hot weather when you’ll sweat more.
• Drinking alcohol causes your body to lose water. It's best not to drink too much as it's likely to make you dehydrated, especially in hot weather when you’ll sweat more.
• Always tell any doctor or pharmacist that you’re taking lithium before you take any new medicines.

Serious allergic reaction

In rare cases, lithium may cause a serious allergic reaction (anaphylaxis).

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Long-term side effects

If you've been taking lithium for a long time, it can cause weight gain.

If you find you're putting on weight after taking lithium for a while, try to have a healthy balanced diet. Regular exercise will also help you keep your weight stable. Your doctor will usually monitor your weight while you're taking this medicine.

Taking lithium for a long time can also cause problems with your kidneys or thyroid gland.

Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed. Signs of kidney problems include swollen hands or ankles, feeling tired and short of breath, changes in your pee and feeling sick.

Tell your doctor if you get any these symptoms. Your doctor will arrange blood tests to check for any changes in your thyroid and kidneys.

Other side effects

These are not all the side effects of lithium. For a full list, see the leaflet inside your medicine packet.

Who can take lithium

Most adults and children aged 12 years old and over can take lithium.

Who may not be able to take lithium

Lithium may not be suitable for some people. To make sure it's safe for you, tell your doctor before starting to take it if you:

• have ever had an allergic reaction to lithium or other medicine
• have heart disease
• have severe kidney problems
• have an underactive thyroid gland (hypothyroidism) that is not being treated
• have low levels of sodium in your body – this can happen if you're dehydrated or if you're on a low-sodium (low-salt) diet
• have Addison's disease, a rare disorder of the adrenal glands
• have a rare heart condition called Brugada syndrome, or someone in your family has this condition
• need to have surgery
• are trying to get pregnant, or are already pregnant or breastfeeding

Before prescribing lithium, your doctor will do some blood tests to check your kidneys and thyroid are OK. They'll also check your weight and continue to check it throughout your treatment.

If you have a heart condition, the doctor may also do a test that measures the electrical activity of your heart (electrocardiogram).

Lithium and pregnancy

Lithium may be taken in pregnancy if needed. However, there's a small chance that it may affect how your baby's heart develops in the early stages of pregnancy (the first 12 weeks). After 12 weeks, there is less risk.

You may need to continue taking lithium or change to a different medicine during pregnancy, to remain well.

Speak to your doctor or specialist if you're planning a pregnancy or become pregnant. They'll want to review your medicine to check that it's the best treatment option for you and your baby.

Do not stop taking your medicine unless your doctor tells you to as this may affect your mental health.

Lithium and breastfeeding

If your doctor, midwife or health visitor says your baby is healthy, you can take lithium while breastfeeding, but this is usually after specialist advice.

Speak to your doctor or specialist if you are planning to breastfeed. They'll help you decide the best option for you and your baby. Your lithium dose may need to be reduced after giving birth and your baby may need extra blood tests.

Do not stop taking your medicine unless you're told to do so as this may affect your mental health. Breastfeeding will also benefit both you and your baby.

The amount of lithium that passes into breast milk can range from small to quite large amounts. Lithium is not generally linked with side effects in breastfed babies, although it has caused side effects in a few babies.

It's important to look out for any side effects in your baby. They are more likely if your baby has an infection or becomes dehydrated.

• is not feeding as well as usual or putting on weight as you would expect
• seems unusually sleepy or tired
• has diarrhoea or is being sick
• is showing other signs of an infection (for example is irritable, has a high temperature or seems clammy or sweaty)
• is showing signs of dehydration (not drinking as much or producing as many wet nappies)

There is no evidence that lithium affects female fertility. However, there’s a small chance it can reduce sperm count in men.

Speak to your doctor if you're trying for a baby.

Cautions with other medicines

There are some medicines that may affect the way lithium works and this can change the levels of lithium in your blood.

Speak to your doctor or pharmacist before starting to take lithium if you take:

• tablets that make you pee more (diuretics) such as furosemide or bendroflumethiazide
• non-steroidal anti-inflammatory drugs (NSAIDs) – used for pain relief and swelling such as aspirin, ibuprofen, celecoxib or diclofenac
• medicines used for heart problems or high blood pressure such as enalapril, lisinopril or ramipril (ACE inhibitors)
• some medicines used for depression such as fluvoxamine, paroxetine or fluoxetine
• antibiotics such as oxytetracycline, metronidazole, co-trimoxazole or trimethoprim
• medicines for epilepsy such as carbamazepine or phenytoin

These are not all the medicines that can affect the way lithium works. Always check with your doctor before you start or stop taking any medicine.

Mixing lithium with herbal remedies and supplements

There’s not enough information to say that complementary medicines, herbal remedies and supplements are safe to take with lithium. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

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