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.
It comes as regular tablets or slow-release tablets (lithium carbonate). It also comes as a liquid that you swallow (lithium citrate).
Lithium is available on prescription.
- The most common side effects of lithium are feeling or being sick, diarrhoea, a dry mouth and a metallic taste in the mouth.
- Your doctor will carry out regular blood tests to check how much lithium is in your blood. The results will be recorded in your lithium record book.
- Lithium carbonate is available as regular tablets and modified release (brand names include Priadel, Camcolit and Liskonium).
- Lithium citrate comes as a liquid and common brands include Priadel and Li-Liquid.
Who can and cannot take lithium
Lithium can be taken by adults and children over the age of 12 years.
Lithium may not be suitable for some people. Tell your doctor if:
- you have ever had an allergic reaction to lithium or other medicines in the past
- you have heart disease
- you have severe kidney problems
- have an underactive thyroid gland (hypothyroidism) that is not being treated
- you 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
- you have Addison's disease, a rare disorder of the adrenal glands
- you have, or someone in your family has, a rare condition called Brugada syndrome – a condition that affects your heart
- you need to have surgery in hospital
- you are trying to get pregnant, are pregnant or breastfeeding
Before prescribing lithium, your doctor will do some blood tests to check your kidney and thyroid are OK. The doctor will also check your weight (and check this 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).
How and when to take lithium
It's important to take lithium as recommended by your doctor.
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 regular tablets and slow-release tablets – where the medicine is released slowly over time.
Lithium citrate comes as a liquid. This is usually only prescribed for people who have trouble swallowing tablets .
Doses vary from person to person. Your starting dose will depend on your age, what you're being treated for 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.
You will 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 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 you will not get the right amount.
Information about your lithium treatment
When you start taking lithium, you will 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.
Will my dose go up or down?
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 the level remains steady.
Once you find a dose that suits you, it will usually stay the same – unless your condition changes, or your doctor prescribes another medicine that may interfere with lithium.
Do not stop taking lithium suddenly or change your dose without speaking to your doctor first. It's important you keep taking it, even if you feel better. If you stop taking it suddenly you could become unwell again very quickly.
What if I'm ill while taking lithium?
Infections and illnesses like colds and flu can make you dehydrated, this can affect the level of lithium in your blood.
Talk to your doctor or pharmacist if you:
- 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
What if I forget to take it?
If you usually take:
- tablets or slow-release tablets – if it's less than 6 hours since you were supposed to take your lithium, take it as soon as you remember. If it is more than 6 hours, just skip the missed dose and take your next one at the usual time
- liquid – if you forget to take a dose, 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.
What if I take too much?
If you need to go to A&E, take the lithium packet or the leaflet inside it, plus any remaining medicine, with you.
If you're on the right dose and the level of lithium in your blood is right, you may not have any problems taking this medicine.
However, some people find lithium slows down their thinking or makes them feel a bit "numb".
Common side effects
These are usually mild and go away by themselves. They are more likely to happen when you start taking lithium.
Keep taking the medicine but talk to your doctor or pharmacist if any of the following side effects get worse or do not go away after a few days:
- feeling sick (nausea)
- a dry mouth and/or a metallic taste in the mouth
- feeling thirsty and needing to drink more and pee more than usual
- slight shaking of the hands (mild tremor)
- feeling tired or sleepy
- weight gain (this is likely to be very gradual)
Serious side effects:
The level of lithium in your blood is checked regularly. But rarely, you may get side effects because there's too much lithium in your blood.
How to avoid high lithium levels in your blood
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 are doing intense exercise or in hot weather when you will 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 will sweat more.
Always tell any doctor or pharmacist that you are taking lithium before you take any new medicines.
Serious allergic reaction:
In rare cases, lithium may cause a serious allergic reaction (anaphylaxis).
These are not all the side effects of lithium. For a full list, see the leaflet inside your medicine packet.
You can report any suspected side effect to the UK safety scheme.
How to cope with side effects
What to do about:
- feeling or being sick – take lithium with or after a meal or snack. It may also help if you do not eat rich or spicy food. If you are being sick, take sips of water to avoid dehydration.
- diarrhoea – drink plenty of fluids to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
- a dry mouth and/or a metallic taste in the mouth – try sugar-free gum or sweets, or sipping cold drinks. If this does not help, talk to your pharmacist or doctor. Try not to have drinks with a lot of calories in as this might also mean you put on weight.
- slight shaking of the hands (mild tremor) – talk to your doctor if this is bothering you or does not go away after a few days. These symptoms can be a sign that the dose is too high for you. Your doctor may change your dose or recommend taking your medicine at a different time of day.
- feeling tired or sleepy – as your body gets used to lithium, these side effects should wear off. If these symptoms do not get better within a week or two, your doctor may either reduce your dose or increase it more slowly. If that does not work you may need to switch to a different medicine.
- weight gain – try to eat well without increasing your portion sizes so you do not gain too much weight. Regular exercise will help to keep your weight stable and help you feel better.
Pregnancy and breastfeeding
Lithium and pregnancy
Lithium is not usually recommended in pregnancy, especially during the first 12 weeks (first trimester) where the risk of problems to the baby is highest. However, you may need to take lithium during pregnancy to remain well. Your doctor may advise you to take it in pregnancy if the benefits of the medicine outweigh the risks.
If you become pregnant while taking lithium, speak to your doctor. It could be dangerous to you and your unborn baby if you stop taking it suddenly. Do not stop taking it or make any change to your dose unless your doctor tells you to.
Talk to your doctor before taking this medicine if you plan to get pregnant, or think you may be pregnant. Your doctor can explain the risks and the benefits and will help you decide which treatment is best for you and your baby.
Lithium and breastfeeding
If your doctor or health visitor says your baby is healthy, you can take lithium while breastfeeding.
Lithium passes into breast milk in small amounts. However, it has been linked with side effects in very few breastfed babies.
It's important to continue taking lithium to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.
For more information about how lithium can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.
Cautions with other medicines
This are some medicines that may interfere with how lithium works and this can affect the levels of lithium in your blood.
Check with your doctor or pharmacist if you're taking (or before you start taking):
- tablets that make you pee (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, 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 or supplements
It's not possible to say whether complementary medicines and herbal 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.
For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
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