In the U.S.—

In Canada—

• Antidepressant therapy adjunct
• Antimanic
• Granulopoietic
• Vascular headache prophylactic

Lithium (LITH-ee-um) is used to treat the manic stage of bipolar disorder (manic-depressive illness). Manic-depressive patients experience severe mood changes, ranging from an excited or manic state (for example, unusual anger or irritability or a false sense of well-being) to depression or sadness. Lithium is used to reduce the frequency and severity of manic states. Lithium may also reduce the frequency and severity of depression in bipolar disorder.

It is not known how lithium works to stabilize a person's mood. However, it does act on the central nervous system. It helps you to have more control over your emotions and helps you cope better with the problems of living.

It is important that you and your family understand all the effects of lithium. These effects depend on your individual condition and response and the amount of lithium you use. You also must know when to contact your doctor if there are problems with the medicine's use. Lithium may also be used for other conditions as determined by your doctor.

This medicine is available only with your doctor's prescription, in the following dosage forms:

Oral
• Capsules (U.S. and Canada)
• Slow-release capsules (Canada)
• Syrup (U.S.)
• Tablets (U.S. and Canada)
• Extended-release tablets (U.S. and Canada)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For lithium, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to lithium. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet—Make certain your health care professional knows if you are on a low-sodium or low-salt diet. Too little salt in your diet could lead to serious side effects.

Pregnancy—Lithium is not recommended for use during pregnancy, especially during the first 3 months. Studies have shown that lithium may rarely cause thyroid problems and heart or blood vessel defects in the baby. It has also been shown to cause muscle weakness and severe drowsiness in newborn babies of mothers taking lithium near time of delivery.

Breast-feeding—Lithium passes into the breast milk. It has been reported to cause unwanted effects such as muscle weakness, lowered body temperature, and heart problems in nursing babies. Before taking this medicine, be sure you have discussed with your doctor the risks and benefits of breast-feeding.

Children—Lithium may cause weakened bones in children during treatment.

Older adults—Unusual thirst, an increase in amount of urine, diarrhea, drowsiness, loss of appetite, muscle weakness, trembling, slurred speech, nausea or vomiting, goiter, or symptoms of underactive thyroid are especially likely to occur in elderly patients, who are often more sensitive than younger adults to the effects of lithium.

Other medicines—Although certain medicines should not be used together at all, in other cases 2 different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking lithium, it is especially important that your health care professional know if you are taking any of the following:

• Acetazolamide (e.g., Diamox)
• Antipsychotics (medicine for mental illness)—Blood levels of both medicines may change, increasing the chance of serious side effects

• Diuretics (water pills) or
• Inflammation or pain medicine, except narcotics—Higher blood levels of lithium may occur, increasing the chance of serious side effects

• Medicine for asthma, bronchitis, emphysema, sinusitis, or cystic fibrosis that contains the following:
  • Calcium iodide or
  • Iodinated glycerol or
  • Potassium iodide—Unwanted effects on the thyroid gland may occur

• Brain disease or
• Schizophrenia—You may be especially sensitive to lithium, and mental effects (such as increased confusion) may occur

• Diabetes mellitus (sugar diabetes)—Lithium may increase the blood levels of insulin; the dose of insulin you need to take may change

• Difficult urination or
• Infection (severe, occurring with fever, prolonged sweating, diarrhea, or vomiting) or
• Kidney disease—Higher blood levels of lithium may occur, increasing the chance of serious side effects

• Epilepsy or
• Goiter or other thyroid disease, or
• Heart disease or
• Parkinson's disease or
• Psoriasis—Lithium may make the condition worse

• Leukemia (history of)—Lithium may cause the leukemia to occur again

Take this medicine after a meal or snack. Doing so will reduce stomach upset, tremors, or weakness and may also prevent a laxative effect.

For patients taking the long-acting or slow-release form of lithium:

• Swallow the tablet or capsule whole.
• Do not break, crush, or chew before swallowing.

For patients taking the syrup form of lithium:

• Dilute the syrup in fruit juice or another flavored beverage before taking.

During treatment with lithium, drink 2 or 3 quarts of water or other fluids each day, and use a normal amount of salt in your food, unless otherwise directed by your doctor.

Take this medicine exactly as directed. Do not take more or less of it, do not take it more or less often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of unwanted effects.

Sometimes lithium must be taken for 1 to several weeks before you begin to feel better.

In order for lithium to work properly, it must be taken every day in regularly spaced doses as ordered by your doctor. This is necessary to keep a constant amount of lithium in your blood. To help keep the amount constant, do not miss any doses and do not stop taking the medicine even if you feel better.

Dosing—

The dose of lithium will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of lithium. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls of syrup that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using lithium.

• For short-acting oral dosage forms (capsules, tablets, syrup):
  • Adults and adolescents: To start, 300 to 600 milligrams three times a day.
  • Children up to 12 years of age: The dose is based on body weight. To start, the usual dose is 15 to 20 milligrams per kilogram of body weight (6.8 to 9 milligrams per pound) a day, given in smaller doses two or three times during the day.
• For long-acting oral dosage forms (slow-release capsules, extended-release tablets):
  • Adults and adolescents: 300 to 600 milligrams three times a day, or 450 to 900 milligrams two times a day.
  • Children up to 12 years of age: Dose must be determined by the doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is within 4 hours (about 6 hours for extended-release tablets or slow-release capsules) of your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the syrup form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Your doctor should check your progress at regular visits to make sure that the medicine is working properly and that possible side effects are avoided. Laboratory tests may be necessary.

Lithium may not work properly if you drink large amounts of caffeine-containing coffee, tea, or colas.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert.

Use extra care in hot weather and during activities that cause you to sweat heavily, such as hot baths, saunas, or exercising . The loss of too much water and salt from your body could lead to serious side effects from this medicine.

If you have an infection or illness that causes heavy sweating, vomiting, or diarrhea, check with your doctor. The loss of too much water and salt from your body could lead to serious side effects from lithium.

Do not go on a diet to lose weight and do not make a major change in your diet without first checking with your doctor. Improper dieting could cause the loss of too much water and salt from your body and could lead to serious side effects from this medicine.

For patients taking the slow-release capsules or the extended-release tablets:

• Do not use this medicine interchangeably with other lithium products.

It is important that you and your family know the early symptoms of lithium overdose or toxicity and when to call the doctor.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

• Early symptoms of overdose or toxicity
  • Diarrhea;  drowsiness;  lack of coordination;  loss of appetite;  muscle weakness;  nausea or vomiting ;  slurred speech;  trembling  
  
  

• Late symptoms of overdose or toxicity
  • Blurred vision;  clumsiness or unsteadiness ;  confusion;  convulsions (seizures);  dizziness;  increase in amount of urine;  ringing in the ears ;  trembling (severe) 
  
  

Check with your doctor as soon as possible if any of the following side effects occur:

• Less common
  • Confusion, poor memory or lack of awareness;  fainting;  fast or slow heartbeat;  frequent urination;  irregular pulse;  increased thirst;  stiffness of arms or legs;  troubled breathing (especially during hard work or exercise);  slurred speech;  unusual tiredness or weakness;  weight gain 
  
  

• Rare
  • Blue color and pain in fingers and toes;  coldness of arms and legs;  dizziness;  eye pain;  headache;  noises in the ears;  vision problems 
  
  

• Signs of low thyroid function
  • Dry, rough skin;  hair loss;  hoarseness;  mental depression;  sensitivity to cold;  swelling of feet or lower legs;  swelling of neck;  unusual excitement 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Increased frequency of urination or loss of bladder control—more common in women than in men, usually beginning 2 to 7 years after start of treatment;  increased thirst;  nausea (mild);  trembling of hands (slight) 
  
  

• Less common
  • Acne or skin rash;  bloated feeling or pressure in the stomach;  muscle twitching (slight)  
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, lithium is used in certain patients with the following medical conditions:

• Cluster headaches
• Mental depression
• Neutropenia (a blood condition in which there is a decreased number of a certain type of white blood cells)

Other than the above information, there is no additional information relating to proper use, precautions, or side effects for these uses.