Lithium (Carbolith®, Lithane®, Lithmax® and generic forms) belongs to a group of medications called “mood stabilizers.”

What is this medication used for?

Lit hium is approved by Health Canada for treatment in ages 12 years and older with episodes of mania (severely elevated mood) and hypomania (mania with less severe symptoms) associated with bipolar disorder, and for prevention of future manic and depressive episodes associated with bipolar disorder.

Lithium is also used for management of impulsive and aggressive behaviour, prevention of cluster headaches, and in combination with other medications for treatment-resistant depression in children and adolescents. It may also be used to reduce risk of suicide. When potential benefits outweigh risks, lithium may be prescribed “off-label.” Learn more about off-label medication use: http://bit.ly/KMH-off-label-use

Tell your doctor or pharmacist if you:

• Have allergies or bad reactions to a medication
• Take (or plan to take) other prescription or non- prescription medications, including natural medicines. Some medications interact with lithium. Your doctor may adjust medication doses or monitor for side effects
• Have a history of heart or kidney disease, diabetes, brain injury or an eating disorder
• Anticipate excessive sweating due to work or exercise, have a fever, loose stools (diarrhea), vomiting or follow a low salt/low sodium diet
• Miss a menstrual period, are pregnant, breast-feeding or planning a pregnancy
• Use alcohol or drugs. Taking lithium together with certain substances may cause a bad reaction. Learn more at www.DrugCocktails.ca

When will the medication start to work?

Lithium needs to be taken for 1-2 weeks before you notice an improvement in your symptoms. It may take 3 weeks or longer to see the full effect of the medication. Symptom improvement may be seen earlier if lithium is combined with other medications.

It is important that you continue taking lithium regularly, even if you are feeling well as it can prevent symptoms from returning. Unless directed by your doctor, do not increase, decrease or stop taking lithium if there are no improvements in the first few weeks. A delay in response is normal.

Talk with your doctor if you feel lithium treatment has not been helpful or if side effects are too bothersome. Your doctor may recommend switching you to a different medication.

This medication is not addictive. Do not stop taking it before talking to your doctor.

How do I take this medication?

Lithium is usually taken once daily in the evening, but may be taken in divided doses two or three times a day, at the same time(s) each day. Take it with food. Usually, you will start with a low dose and slowly increase this dose over several days or weeks, based on how you tolerate it.

Your doctor may ask you to have blood tests to measure the amount of lithium in your blood. If you take lithium in divided doses, do not take your dose just before a blood test as this can affect your results. Instead, take your dose after the blood test is completed.

There are two forms of lithium: immediate-release capsules and sustained-release tablets. Sustained-release tablets (Lithmax®) may be broken in half, but they should not be crushed or chewed. A liquid form of lithium may be prepared by a compounding pharmacy if your child is unable to swallow the capsules or tablets.

Possible common or serious side effects:

Side effects may be more common when starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

• Dizziness, drowsiness, confusion or headache
• Feelings of agitation, restlessness or shaking of hands
• Increased thirst or increased frequency of urination
• Stomach ache, nausea, diarrhea or vomiting
• Increased appetite or weight gain
• Skin rash, hair loss, itchy red patches (psoriasis) or acne

Contact your doctor immediately if you experience:

• Unexplained rash, seizure, fever or excessive sweating
• Muscle weakness or cramps, twitching or tiredness
• Feeling cold, constipation, weight gain or coarse hair
• Slurred speech, blurred vision, clumsiness or confusion
• Swelling in any area of the body including your neck
• Thoughts of hurting yourself, suicide, increased hostility or worsening symptoms

What precautions should my doctor and I be aware of when taking this medication?

• Many medications may interact with lithium, including commonly used anti-inflammatory medications, blood pressure medications, fiber supplements and several other medications. If you are (or begin) taking any other prescription, over-the-counter medication, natural health product or supplement, check with your doctor or pharmacist to see if they are safe to use.
• When taking this medication, it is important to drink enough liquids to prevent dehydration. Maintain a consistent salt intake and replace fluids lost due to excessive sweating from work or exercise. Limit your intake of caffeine-containing products (such as coffee, black/green tea, soft drinks and energy drinks) to help reduce side effects.
• While taking this medication, if you feel dizzy, drowsy or slowed down, do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking lithium.

How does this medication work?

Lithium affects actions of the brain chemicals norepinephrine, dopamine and serotonin. This has a stabilizing effect on nerves, which helps reduce severe mood fluctuations (such as mania or depression) associated with bipolar disorder. The exact way that lithium improve symptoms of bipolar disorder, treatment-resistant depression, or reduces risk of suicide is not known.

What special instructions should I follow while using this medication?

• Keep all appointments with your doctor and the lab. Your doctor may order lab tests to check how you are responding and monitor for side effects.
• Try to keep a healthy, well-balanced diet and exercise regularly.
• Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you take lithium regularly and forget to take a dose, take the missed dose as soon as you remember. If you take lithium once daily in the evening and don’t

remember until the next morning, skip the missed dose and continue with your regular schedule.

If you take lithium in divided doses and it is within 4 hours of your next scheduled dose, skip the missed dose and continue with your regular schedule. DO NOT double your next dose to try to ‘catch up’.

How do I store this medication?

Keep this medication in the original container, stored at room temperature away from moisture and heat and protected from light. Keep this medication out of reach and sight of children.

How well does the medication work in children and adolescents?

Lithium helps reduce symptoms of manic or depressive episodes associated with bipolar disorder as well as prevent future manic or depressive episodes from occurring. Lithium has been shown to be better than placebo (an inactive pill) for treatment of manic episodes associated with bipolar disorder in children and adolescents. Lithium may be used alone or in combination with other mood stabilizers to manage bipolar disorder. When effective, lithium helps to stabilize mood, control emotions

and improve overall functioning. Evidence in adults has shown lithium may be helpful for treatment-resistant depression in combination with antidepressants, and for reducing the risk of suicide and self-harm.

How long should I take the medication for?

This depends on the symptoms you have, how frequently they occur, and how long you have had them. Most people with bipolar disorder will need to take lithium for at least 6 months. This allows time for symptoms to stabilize and for function to improve.

Your doctor will discuss the benefits and risks of taking lithium with you. At this time, you can also discuss how long you might need to take this medication. If you have bipolar disorder and you tolerate this medication well, you may be asked you take this medication on an ongoing basis.

Do not increase, decrease, or stop taking this medication without discussing it with your doctor. If you stop taking lithium suddenly, it is possible that your symptoms may return or you may experience a seizure.