Lithium (patient information)

# IMPORTANT WARNING
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to lithium.

# Why this medication is prescribed
Lithium is used to treat and prevent episodes of mania (frenzied, abnormally excited mood) in people with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Lithium is in a class of medications called antimanic agents. It works by decreasing abnormal activity in the brain.

# How this medication should be used
Lithium comes as a tablet, capsule, extended-release (long-acting) tablet, and solution (liquid) to take by mouth. The tablets, capsules, and solution are usually taken three to four times a day.The extended-release tablets are usually taken two to three times a day. Take lithium at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lithium exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow the extended-release tablet whole; do not split, chew, or crush it.
Your doctor may increase or decrease the dose of your medication during your treatment. Follow these directions carefully.
Lithium may help to control your condition but will not cure it. It may take 1-3 weeks or longer for you to feel the full benefit of lithium. Continue to take lithium even if you feel well. Do not stop taking lithium without talking to your doctor.

# Other uses for this medicine
Lithium is also sometimes used to treat certain blood disorders, depression, schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), disorders of impulse control (inability to resist the urge to perform a harmful action), and certain mental illnesses in children. Talk to your doctor about the risks of using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Special precautions
Before taking lithium:
- tell your doctor and pharmacist if you are allergic to lithium or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: acetazolamide (Diamox); aminophylline; angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik);angiotensin II receptor antagonists such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan); antacids such as sodium bicarbonate; caffeine (found in certain medications to treat drowsiness and headaches); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac, others), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine (Nimotop), nisoldipine (Sular), and verapamil (Calan, Covera, Isoptin, Verelan);carbamazepine (Tegretol); diuretics ('water pills'); medications for mental illness such as haloperidol (Haldol); methyldopa (Aldomet); metronidazole (Flagyl); nonsteroidal anti-inflammatory medications (NSAIDs) such as celecoxib (Celebrex), indomethacin (Indocin), and piroxicam (Feldene); potassium iodide; phenytoin (Dilantin); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); and theophylline (Theolair, Theochron). *Your doctor may have to change the doses of your medication or monitor you more carefully for side effects.
- tell your doctor if you have or have ever had organic brain syndrome (any physical condition that affects the way your brain works); or thyroid, heart, or kidney disease. Also tell your doctor if you have severe diarrhea, excessive sweating, or fever. Call your doctor if you develop these symptoms during your treatment.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking lithium, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lithium.
- you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

# Special dietary instructions
It is important to follow a proper diet, including the right amounts of fluid and salt during your treatment. Your doctor will give you specific directions about the diet that is right for you. Follow these directions carefully.
Talk to your doctor about drinking drinks that contain caffeine, such as tea, coffee, cola, or chocolate milk.

# What to do if you forget a dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

# Side effects

## Minor side effects
Lithium may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- restlessness
- fine hand movements that are difficult to control
- loss of appetite
- stomach pain or bloating
- gas
- indigestion
- weight gain or loss
- dry mouth
- excessive saliva in the mouth
- tongue pain
- change in the ability to taste food
- swollen lips
- acne
- hair loss
- unusual discomfort in cold temperatures
- constipation
- depression
- joint or muscle pain
- thin, brittle fingernails or hair

## Severe side effects
Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately:
- tiredness
- shaking of a part of your body that you cannot control
- muscle weakness, stiffness, twitching, or tightness
- loss of coordination
- diarrhea
- vomiting
- excessive thirst
- frequent urination
- giddiness
- ringing in the ears
- slow, jerky movements
- movements that are unusual or difficult to control
- blackouts
- seizures
- slurred speech
- fast, slow, irregular, or pounding heartbeat
- chest tightness
- confusion
- hallucinations (seeing things or hearing voices that do not exist)
- crossed eyes
- painful, cold, or discolored fingers and toes
- headache
- pounding noises inside the head
- changes in vision
- paleness
- itching
- rash
- swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
Lithium may cause other side effects. Call your doctor if you experience any unusual symptoms while you are taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- diarrhea
- vomiting
- upset stomach
- drowsiness
- muscle weakness
- loss of coordination

# Other information
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Eskalith CR
- Eskalith
- Lithobid