About lithium

Lithium is used to prevent and treat a number of mood disorders. It can be given to control mania. This is where a person's mood is very high, causing overactive and excitable behaviour. It is also used to manage very low moods, such as in people with repeated periods of depression. It is also useful in a condition known as bipolar disorder, where there are extreme high and low moods. Lithium is also used to treat behavioural disorders, such as aggressive or self-harming behaviours.

Lithium reduces the intensity and frequency of mood swings. It alters the way that nerve cells respond to chemicals that are present in the brain. It is known that it is a very effective medicine and has been used for more than 50 years.

Lithium is available as tablets and liquid medicine, and there are several brands of both available. The amount of lithium released from the different brands varies, so it is important that you keep to the same brand of lithium.

Before taking lithium

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking lithium it is important that your doctor knows:

• If you are pregnant, trying for a baby or breast-feeding.
• If you have an underactive thyroid.
• If you have a heart condition, or a heart rhythm disorder.
• If you have problems with the way your kidneys work.
• If you have psoriasis (a skin disorder).
• If you have an adrenal gland disorder called Addison's disease.
• If you have myasthenia gravis (this is a condition causing muscle weakness).
• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
• If you have ever had an allergic reaction to a medicine.

How to take lithium

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack, and any additional information you have been given. The leaflet will give you more information about the specific brand of lithium you have been given, and a full list of side-effects which you may experience from taking it.
• You will be started on lithium by a specialist doctor, usually in a hospital. You will need to have regular blood tests to make sure that the dose is adjusted to suit you. This is because the amount of lithium in your bloodstream has to be just right - too little and it will not work sufficiently; too much and it could be harmful. These blood tests are referred to as 'a lithium level', a 'serum lithium level' or a 'plasma lithium level'. They are needed frequently in the early stages of your treatment and if your dose is changed, but less often once your lithium level is stable.
• Take lithium exactly as your doctor tells you to. Your doctor or pharmacist will tell you how much to take and when to take it. As your dose is being adjusted, it is likely that you will be asked to take more than one dose a day. Once it is stable, it is usual to take just one dose daily. You can take lithium before or after your meals.
• Many lithium tablets are specially made to release the medicine slowly into your bloodstream. For this reason, you should swallow the tablets whole - do not crush or chew them. Also, do not break the tablets in half unless you have been told by your doctor that you may do so. If you have any difficulties swallowing tablets, you should discuss this with your doctor, as an alternative preparation may be more suitable for you.
• Try to get into the habit of taking lithium at the same times each day, as this will help you to remember to take it regularly.
• If you do forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.

Getting the most from your treatment

• When you first begin treatment with lithium you may be given a Lithium Treatment Pack. This contains an information booklet, a lithium alert card, and a record book. You should carry the lithium alert card with you at all times and show it to any healthcare professional who is treating you. The record book is so you can keep a record of your blood test results.
• Keep your regular appointments with your doctor. This is so your doctor can continue to check on your lithium levels and progress.
• Although it may take several weeks before you feel the benefits of this treatment, many people notice a difference earlier. You should continue to take lithium regularly.
• Each time you collect a prescription, check to make sure you have been supplied with the same brand of lithium as before. If it looks different to usual, ask your pharmacist to check for you. This is because the amount of lithium released from the different brands varies, so it is important that you keep to the same brand as you have had before.
• Many medicines can interfere with lithium and cause the level of lithium in your bloodstream to become too high. Always check with your pharmacist or doctor before you take any other medicines. This is particularly important if you are buying painkillers which could contain a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. Some cold and flu remedies also contain NSAIDs
• It is important that you don't become dehydrated. You should drink plenty of water each day, but try to drink about the same amount every day, as any large changes in how much you drink may affect your lithium levels. Likewise, any changes in the amount of salt in your diet may affect your levels. Also, if you plan to make any major changes to what you eat (such as going on a diet), discuss this with your doctor first.
• If you get an infection or an illness that causes you to sweat a lot, or be sick or have diarrhoea, it could affect your lithium levels. If this happens, speak with your doctor for advice about what you should do.
• If you are due to have an operation or some other medical treatment, tell the person carrying out the treatment that you are taking lithium. It may be necessary for you to miss or delay taking a dose.
• Do not stop taking lithium, or deliberately miss any doses. Stopping suddenly can cause problems and your doctor will want you to reduce your dose gradually if this becomes necessary.

Can lithium cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

Important: signs that you may have too much lithium in your blood are: blurred eyesight, being sick, diarrhoea, muscle weakness or jerkiness, feeling drowsy, and a lack of co-ordination. If these happen, contact your doctor straightaway.

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store lithium

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines