How to Prevent Toxicity from Lithium

Lithium is a prescription medication that is used in the treatment of bipolar disorder type I and type II. The specific FDA approved indications for lithium includes its use as a maintenance treatment of mania in people with bipolar disorder (also known as manic-depression) in order to prevent or diminish the intensity of future manic episodes.

Additionally, there are "off label" investigational uses of lithium which include using lithium for it's potential to augment the effects of antidepressants, as well as the use of lithium in the treatment of aggression, post-traumatic stress disorder and conduct disorder in children

There are numerous brand names for lithium in the United States and Canada. It is crucial that an individual who is on a brand name formulation understand that their medication poses the same inherent risks as generic lithium. There is one brand name of lithium in the United States, Lithobid®, and there are numerous Canadian brand names including: Apo-Lithium® Carbonate; Apo-Lithium® Carbonate SR; Carbolith™; Duralith®; Euro-Lithium; Lithane™; PMS-Lithium Carbonate; and PMS-Lithium Citrate.

Lithium has the potential to be very toxic at relatively low levels. A drug with this potential is said to have a low therapeutic index. With all medications, but particularly those with a low therapeutic index, patients should follow the dosage instructions precisely and take their medication exactly as directed. Individuals on lithium should never increase or decrease their dosage without first consulting their physician.

The extended release tablets or capsules of lithium should not be crushed or chewed. Damaging the lithium pills in this way will alter the delivery of the medication and can easily result in toxic levels of lithium.

In order to avoid lithium side effects, it is essential for lithium users to stay adequately hydrated, particularly in the summer when insensible losses of body water are increased from sweating. Likewise, people taking lithium should avoid sudden changes in the sodium content of their diet. The amount of sodium an individual consumes directly affects the amount of water their body retains. A low sodium diet, while useful for lowering blood pressure, can be dangerous in lithium users by increasing lithium toxicity.

It is also important for patients on lithium to limit their intake of caffeine via coffee, teas and energy drinks. Caffeine induces diuresis (fluid loss from the kidneys) which can increase the toxicity of lithium. On a similar note, individuals who are being treated for hypertension with diuretic medications should make sure that their physician is aware that they are on lithium.

People taking lithium should contact a health care provider without delay if they experience unresolved diarrhea, sudden changes in weight, muscular tremors or lack of coordination, fever, or any noticeable changes in their urinary volume. Lithium has significant potential for harmful toxic effects. However, patients on lithium can minimize their risk by following the guidelines above.

Source: LexiDrugs, LexiComp Online. 2010.