1. About 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.
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.
Priadel 200mg and 400mg tablets are being discontinued by the manufacturer. If you usually take Priadel, you’ll need to have blood tests before changing to a different brand. Your doctor will make a plan to help you find the right dose on your new brand of lithium.
Dated: August 2020
2. Key facts
- 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.
3. 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).
4. 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?
Immediate action required: Call 999 or go to A&E if:
- you take too much lithium, even if you do not feel any different
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
If you need to go to A&E, take the lithium packet or the leaflet inside it, plus any remaining medicine, with you.
5. Side effects
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.
Immediate action required: Call 999 or go to A&E now if:
You have 1 or more of these symptoms:
- loss of appetite, feeling or being sick (vomiting)
- 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. Lithium toxicity is an emergency. Stop taking lithium straight away.
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).
Immediate action required: Call 999 or go to A&E if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
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.
6. 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.
7. 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.
Non-urgent advice: Talk to your doctor if you:
- are trying to get pregnant
- are already pregnant
- would like to breastfeed
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.
8. 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.
9. Common questions
How does lithium work?
Lithium is a metal. Tiny amounts of lithium are found naturally in rocks, and in our food and bodies.
We do not really know exactly how lithium works for mental health conditions, though we do know it's very effective.
There are a number theories about how it works. One is that it works by protecting and helping to create neurons (the cells that pass messages in your brain).
How long does it take to work?
Lithium may take several weeks or months to work.
How will it make me feel?
If the amount of lithium in your blood is right, you probably will not have any problems taking this medicine.
However, some people find it slows down their thinking or makes them feel a bit "numb". Sometimes it's hard to know whether this is because the lithium is doing its work to control your mood (if you have mania).
Talk to your doctor if you're worried that lithium is slowing down your thinking or numbing your emotions. You may need to have your lithium levels checked again.
How long will I take it for?
As long as it is working well to control your condition, you will generally take lithium for a long time.
Some people need to take lithium for many years.
What will happen if I stop taking it?
If you or your doctor decide to stop lithium, it must be reduced gradually over a number of weeks or months. If you stop taking it suddenly the symptoms of your condition are likely to come back.
Do not stop taking lithium suddenly even if you feel better, or because you think the dose is too little or too much.
Your doctor will help you to reduce your medicine and stop completely, if you need to.
However, if you think you have lithium toxicity, or are having an allergic reaction, it's important to stop taking lithium straight away and get medical help.
Immediate action required: Call 999 or go to A&E now (and stop taking lithium) if:
- you’re having an allergic reaction
- you have lithium toxicity
Can I take lithium for a long time?
Lithium is generally safe to take for a long time. Most people take it for years with no problems.
If you've been taking lithium for some time, it can cause weight gain. It 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 test your thyroid and kidneys every 6 months to check for any changes.
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.
Your doctor may discuss topping up levels of the hormone that the thyroid gland normally produces (thyroxine) with a tablet.
Is lithium an antipsychotic?
Lithium is not an antipsychotic medicine, it's known as a mood stabiliser. However, your doctor might prescribe an antipsychotic medicine with lithium.
How well does lithium treat depression?
Usually, if you have depression, you'll be prescribed an antidepressant medicine first as they are considered more effective for depression than lithium.
However, when antidepressants have not worked, your doctor might prescribe lithium as well. This may be more effective and help your symptoms get better.
Can I drink alcohol with it?
Lithium can make you drowsy so it's best to stop drinking alcohol during the first few days of taking lithium, or if your dose is increased.
If you feel OK after this, you can drink alcohol but it's best not to drink too much it's likely to make you dehydrated. This can increase the chance of high levels of lithium in your blood. It's important to remember this, especially in hot weather when you will sweat more and your body loses water.
Will it affect my contraception?
However, if you have severe diarrhoea for more than 24 hours, your combined pill may not protect you from pregnancy. Look on the pill packet to find out what to do.
Will it affect my fertility?
There is no clear evidence that lithium affects female fertility. However, there is small chance that it can reduce sperm count in men.
Speak to your doctor if you're trying for a baby.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking lithium.
However, it's best to avoid a low-sodium (low-salt) diet as this can increase the levels of lithium in your blood and increase the chance of getting side effects.
The amount of fluids you drink is very important as it can affect the levels of lithium in your blood. Getting dehydrated will affect the levels so it's good to drink plenty of fluids.
Some people may put on weight when taking lithium. Try to eat well without increasing your portion sizes. Regular exercise can also help to keep your weight stable.
Can I drive or ride a bike?
When you first start taking lithium – or if the dose has recently been changed – it may make you feel tired, dizzy, sleepy and make your hands shake.
This could affect you if you drive a car, ride a bike, or do anything else that needs focus.
You're recommended to stop doing these things for the first few days, until you know how lithium affects you and until you feel more alert.
If you have been diagnosed with bipolar disorder you must tell the Driver and Vehicle Licensing Agency (DVLA).
Can I take lithium with recreational drugs?
Using recreational drugs can affect the level of lithium in the body.
Taking ecstasy while you're on lithium can make you dehydrated, which can lead to lithium toxicity.
Tell your doctor if you think you may take recreational drugs while you're on lithium.