Jeffrey Panko NP Psychiatry · Patient education
Lithium
Lithium carbonate / Lithium citrate / Immediate- and extended-release formulations
A guide for adults taking lithium.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Carbonate capsules or tablets, extended-release tablets, and citrate liquid have different strengths and schedules. Do not switch brands or formulations without instructions.
What it is used for
Lithium treats mania and helps prevent future episodes of bipolar disorder. It is also used off-label to strengthen antidepressant treatment in some people with depression.
How it works
It affects several signaling pathways inside nerve cells involved in mood regulation. The amount in the bloodstream is important: the range between a useful dose and a toxic dose is relatively narrow.
What to expect over time
Mania can improve over days to weeks, while maintenance benefit is assessed over a longer period. Dose changes are guided by symptoms, side effects, and properly timed blood levels.
Taking your medication
- Take consistently, with food or milk if needed for nausea. Swallow ER tablets whole.
- Keep fluid and salt intake reasonably steady. Avoid dehydration and sudden low-salt diets.
- Do not double a missed dose; follow the missed-dose instructions for your schedule.
- Tell your provider promptly about vomiting, diarrhea, fever, heavy sweating, or inability to drink normally.
When to get help
Emergency symptoms. Hold lithium and obtain urgent medical assessment for vomiting or diarrhea with worsening tremor, unsteady walking, slurred speech, confusion, or marked drowsiness. Call 911 for a seizure, collapse, or inability to wake.
Prompt medical advice. Contact your provider promptly during dehydrating illness or for very little urine, persistent excessive thirst, a new coarse tremor, or significant weakness. Do not wait for the next routine blood test.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Fine hand tremor
- Thirst or increased urination
- Mild nausea or loose stools
- Weight change, acne, or thyroid changes
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Lithium levels, kidney function, thyroid function, and calcium are monitored. Levels are commonly drawn about 12 hours after the last dose; follow your provider’s exact timing instructions.
Additional levels may be needed after dose changes, illness, dehydration, or interacting medicines. A new coarse tremor or unsteady walking should not be dismissed as an ordinary side effect.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss kidney or heart disease, thyroid problems, abnormal calcium, dehydration risk, and all medicines. Pregnancy requires individualized planning because lithium can affect the developing baby and dosing changes during pregnancy and after delivery. Discuss breastfeeding with your provider.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
NSAIDs such as ibuprofen or naproxen, ACE inhibitors, ARBs, and some diuretics can raise lithium levels. Check before starting or stopping them.
Changes in salt, fluids, or caffeine can alter levels. Other serotonergic or antipsychotic medicines may add toxicity risks and require review.
Everyday tips
Keep your laboratory schedule and an updated medication list.
Plan for hot weather, exercise, and illness without making large changes in salt or fluid intake on your own.
Your questions answered
Why does a blood-draw time matter?
Lithium levels change after a dose. A consistently timed sample helps your provider compare results and avoid an inappropriate dose change.
Can I stop when I feel stable?
Consult with your provider. Gradual changes help reduce relapse risk; suspected toxicity is different and needs urgent assessment.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.