Effects of lithium carbonate

Contents

Lithium Carbonate

SIDE EFFECTS

The occurrence and severity of adverse reactions are generally directly related to serum lithium concentrations and to individual patient sensitivity to lithium. They generally occur more frequently and with greater severity at higher concentrations.

Adverse reactions may be encountered at serum lithium concentrations below 1.5 mEq/L. Mild to moderate adverse reactions may occur at concentrations from 1.5 to 2.5 mEq/L, and moderate to severe reactions may be seen at concentrations from 2.0 mEq/L and above.

Fine hand tremor, polyuria, and mild thirst may occur during initial therapy for the acute manic phase and may persist throughout treatment. Transient and mild nausea and general discomfort may also appear during the first few days of lithium administration.

These side effects usually subside with continued treatment or with a temporary reduction or cessation of dosage. If persistent, a cessation of lithium therapy may be required. Diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination may be early signs of lithium intoxication, and can occur at lithium concentrations below 2.0 mEq/L. At higher concentrations, giddiness, ataxia, blurred vision, tinnitus, and a large output of dilute urine may be seen. Serum lithium concentrations above 3.0 mEq/L may produce a complex clinical picture involving multiple organs and organ systems. Serum lithium concentrations should not be permitted to exceed 2.0 mEq/L during the acute treatment phase.

The following reactions have been reported and appear to be related to serum lithium concentrations, including concentrations within the therapeutic range:

Central Nervous System: tremor, muscle hyperirritability (fasciculations, twitching, clonic movements of whole limbs), hypertonicity, ataxia, choreoathetotic movements, hyperactive deep tendon reflex, extrapyramidal symptoms including acute dystonia, cogwheel rigidity, blackout spells, epileptiform seizures, slurred speech, dizziness, vertigo, downbeat nystagmus, incontinence of urine or feces, somnolence, psychomotor retardation, restlessness, confusion, stupor, coma, tongue movements, tics, tinnitus, hallucinations, poor memory, slowed intellectual functioning, startled response, worsening of organic brain syndromes. Cases of Pseudotumor cerebri (increased intracranial pressure and papilledema) have been reported with lithium use. If undetected, this condition may result in enlargement of the blind spot, constriction of visual fields and eventual blindness due to optic atrophy. Lithium should be discontinued, if clinically possible, if this syndrome occurs.

Cardiovascular: cardiac arrhythmia, hypotension, peripheral circulatory collapse, bradycardia, sinus node dysfunction with severe bradycardia (which may result in syncope), Unmasking of Brugada Syndrome (See WARNINGS and PATIENT INFORMATION).

Gastrointestinal: anorexia, nausea, vomiting, diarrhea, gastritis, salivary gland swelling, abdominal pain, excessive salivation, flatulence, indigestion.

Genitourinary: glycosuria, decreased creatinine clearance, albuminuria, oliguria, and symptoms of nephrogenic diabetes insipidus including polyuria, thirst and polydipsia.

Dermatologic: drying and thinning of hair, alopecia, anesthesia of skin, acne, chronic folliculitis, xerosis cutis, psoriasis or its exacerbation, generalized pruritus with or without rash, cutaneous ulcers, angioedema.

Autonomic Nervous System: blurred vision, dry mouth, impotence/sexual dysfunction.

Thyroid Abnormalities: euthyroid goiter and/or hypothyroidism (including myxedema) accompanied by lower T3 and T4. 131Iodine uptake may be elevated (see PRECAUTIONS). Paradoxically, rare cases of hyperthyroidism have been reported.

EEG Changes: diffuse slowing, widening of frequency spectrum, potentiation and disorganization of background rhythm.

EKG Changes: reversible flattening, isoelectricity or inversion of T-waves.

Miscellaneous : fatigue, lethargy, transient scotomata, exophthalmos, dehydration, weight loss, leucocytosis, headache, transient hyperglycemia, hypercalcemia, hyperparathyroidism, albuminuria, excessive weight gain, edematous swelling of ankles or wrists, metallic taste, dysgeusia/taste distortion, salty taste, thirst, swollen lips, tightness in chest, swollen and/or painful joints, fever, polyarthralgia, and dental caries.

Some reports of nephrogenic diabetes insipidus, hyperparathyroidism, and hypothyroidism which persist after lithium discontinuation have been received.

A few reports have been received of the development of painful discoloration of fingers and toes and coldness of the extremities within one day of starting lithium treatment. The mechanism through which these symptoms (resembling Raynaud’s Syndrome) developed is not known. Recovery followed discontinuance.

Read the entire FDA prescribing information for Lithium Carbonate (lithium carbonate)

What side effects can lithium cause?

The most concerning side effects of long term lithium use are hypothyroidism and kidney problems.

According to a 2015 review article, these side effects are most likely to affect women below the age of 60 years. They are also more common among people with higher-than-average concentrations of lithium in the blood.

Kidney dysfunction

According to the package insert for lithium, prolonged use of this drug can affect the ability of the kidneys to concentrate urine. This impairment can cause a condition called nephrogenic diabetes insipidus (NDI). Symptoms include extreme thirst and frequent urination.

NDI can cause dehydration and a rise in blood lithium levels. These effects can be toxic to both the kidneys and the rest of the body.

People who take lithium require regular monitoring of their sodium levels and kidney function. If these tests indicate even slight issues with the kidneys, a doctor may prescribe a lower dosage of lithium. Alternatively, they may recommend a different medication altogether.

Thyroid problems

Share on PinterestA person with hypothyroidism may experience fatigue, depression, and intolerance to cold.

Hypothyroidism is another concern for those taking lithium. In a person with hypothyroidism, the thyroid gland does not produce enough hormones.

This condition can cause symptoms that include:

  • depression
  • dry skin
  • fatigue
  • intolerance to cold
  • trouble thinking quickly
  • weight gain

A person who is taking lithium will need to undergo regular tests to monitor their thyroid function.

Hyperparathyroidism

Not only can lithium cause long term thyroid problems, but it can also affect the parathyroid glands. These glands are chiefly responsible for regulating calcium levels in the body.

Hyperparathyroidism can affect the body’s ability to detect calcium, leading to a condition called hypercalcemia in which a person’s calcium levels become too high.

Hypercalcemia can lead to further complications, such as osteoporosis and cardiovascular issues.

According to an article in the journal Case Reports in Medicine, lithium-induced hyperparathyroidism is four times more likely to occur in women than in men.

Lithium

Generic Name: lithium (LITH ee um)
Brand Names: Lithobid, Eskalith, Lithonate, Lithotabs, Eskalith-CR

Medically reviewed by P. Thornton, DipPharm Last updated on Mar 3, 2019.

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What is lithium?

Lithium affects the flow of sodium through nerve and muscle cells in the body. Sodium affects excitation or mania.

Lithium is used to treat the manic episodes of bipolar disorder (manic depression). Manic symptoms include hyperactivity, rushed speech, poor judgment, reduced need for sleep, aggression, and anger.

Lithium also helps to prevent or lessen the intensity of manic episodes.

Important Information

Do not use lithium without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.

Lithium toxicity can cause death. Lithium is a medicine with a narrow range of safety and toxicity can occur if you take only slightly more than a recommended dose.

Stop using lithium and call your doctor right away if you have symptoms of lithium toxicity: muscle weakness, twitching, drowsiness, feeling light-headed, mood changes, blurred vision, ringing in your ears, irregular heartbeats, confusion, slurred speech, clumsiness. trouble breathing, or seizures.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Drink extra fluids to keep from getting dehydrated while you are taking this medication.

Tell your doctor if you have been sweating excessively, or if you are sick with fever, vomiting, or diarrhea.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Lithium can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Before taking this medicine

You should not use lithium if you are allergic to it.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

  • breathing problems;

  • heart disease;

  • kidney disease;

  • a thyroid disorder;

  • an abnormal electrocardiograph or ECG (sometimes called an EKG);

  • fainting spells; or

  • a family member who died before age 45.

Some medicines can interact with lithium and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

It is not known whether lithium will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

You should not breast-feed while using this medicine.

Lithium is not approved for use by anyone younger than 7 years old.

How should I take lithium?

Take lithium exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Never use lithium in larger amounts, or for longer than prescribed. Overdose can occur if you take only slightly more than a recommended dose.

Swallow the tablet whole and do not crush, chew, or break it.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Call your doctor if you are sick with a fever and vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking lithium, which may affect your dose needs. Do not change your dose or medication schedule without your doctor’s advice.

Drink extra fluids each day to prevent dehydration.

It may take up to 3 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not begin to improve after 1 week of treatment.

You may need frequent blood tests.

If you need surgery, tell the surgeon ahead of time that you are using this medicine.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Lithium dosing information

Usual Adult Dose for Mania:

Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime
Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day
Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Adult Dose for Bipolar Disorder:

Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime
Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day
Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Pediatric Dose for Mania:

12 years and older:
Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime
Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day
Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

Usual Pediatric Dose for Bipolar Disorder:

12 years and older:
Acute Control:
-Usual dose: 1800 mg/day
-Extended release formulations: 900 mg orally in the morning and at nighttime
-Regular release formulations: 600 mg orally 3 times a day, in the morning, afternoon, and nighttime
Long-term Control:
-Maintenance dose: 900 to 1200 mg/day
-Extended release formulations: 600 mg orally in the morning and at nighttime
-Regular release formulations: 300 mg orally 3 to 4 times a day
Uses:
-Treatment of manic episodes of bipolar disorder
-Maintenance treatment for individuals with bipolar disorder

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Stop taking lithium and seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Early signs of toxicity include: vomiting, diarrhea, drowsiness, muscle weakness, or loss of coordination.

What should I avoid while taking lithium?

Avoid driving or hazardous activity until you know how lithium will affect you. Your reactions could be impaired.

Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Follow your doctor’s instructions about the type and amount of liquids you should drink.

Do not change the amount of salt you consume in your diet. Changing your salt intake could change the amount of lithium in your blood.

Lithium side effects

Get emergency medical help if you have signs of an allergic reaction to lithium: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Too much lithium in your body can cause death. Lithium toxicity can occur if you take only slightly more than a recommended dose.

Stop using this medicine and call your doctor right away if you have symptoms of lithium toxicity: muscle weakness, twitching, drowsiness, feeling light-headed, mood changes, blurred vision, ringing in your ears, irregular heartbeats, confusion, slurred speech, clumsiness, trouble breathing, or seizures.

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • shortness of breath;

  • fever, increased thirst or urination;

  • weakness, dizziness or spinning sensation;

  • memory problems, hallucinations;

  • problems with balance or muscle movement;

  • loss of bowel or bladder control;

  • a seizure (blackout or convulsions);

  • dehydration symptoms – feeling very thirsty or hot, being unable to urinate, heavy sweating, or hot and dry skin; or

  • increased pressure inside the skull -severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common lithium side effects may include:

  • dizziness, drowsiness;

  • tremors in your hands;

  • trouble walking;

  • dry mouth, increased thirst or urination;

  • nausea, vomiting, loss of appetite, stomach pain;

  • cold feeling or discoloration in your fingers or toes;

  • rash; or

  • blurred vision.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect lithium?

Tell your doctor about all your current medicines. Many drugs can affect lithium, especially:

  • buspirone;

  • fentanyl;

  • St. John’s wort;

  • tramadol;

  • a “triptan” migraine headache medicine;

  • tryptophan;

  • an antidepressant or antipsychotic medication; or

  • a MAO inhibitor – isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

This list is not complete and many other drugs may interact with lithium. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use lithium only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 5.02.

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Coping With Medication- Related Weight Gain: Advice From Doctors & Consumers

By Milly Dawson, MS, MPH

  • Post Views: 38,010 Views

    Making peace with the fact that what gives us stability of mind can also expand our waistline is difficult, but necessary. Even if the problem cannot be eliminated, it often can be contained.

    With nearly two-thirds of American adults overweight, and nearly one-third of them obese, those with bipolar who are burdened by excess pounds gained through drug side effects have plenty of company. For anyone who weighs too much, the issue runs far deeper than personal appearance, as so many adverse health effects are associated with excess weight. Yet, experts remain uncertain why many common bipolar drugs foster weight gain. Indeed, there are few tested methods to address the problem, although doctors do offer some, mostly commonsensical, advice, as detailed here.

    “In psychiatry, many medications have the potential to cause weight gain, says Christoph Correll, MD, a psychiatrist and psychopharmacologist at Zucker Hillside Hospital and Schneider Children’s Hospital in Glen Oaks, New York. “And among all psychiatric medications, the two classes used most in bipolar disorder, mood stabilizers and the new generation antipsychotics, are among the ones that cause the most weight gain.” Dr. Correll’s research focuses on the side effects of antipsychotic medications.

    Recently, four major medical associations issued a consensus statement concerning the need for doctors to screen patients who are on the atypical antipsychotics for signs of rapid weight gain, or other problems leading to obesity, diabetes, and harmful blood lipid profiles. The joint statement—whose issuing groups included the American Diabetes Association and the American Psychiatric Association—cited strong evidence that the second-generation antipsychotics (SGAs) can cause a quick rise in body weight during the first few months of treatment. What’s more, the weight gain may not plateau even after a full year of using the drug.

    David Allison, PhD, serves as professor of biostatistics at the University of Alabama, where he is also the director of the university’s Clinical Nutrition Research Center. According to Dr. Allison, scientists don’t know for sure why antipsychotic drugs induce weight gain, but “in some cases we have a good idea.” Researchers suspect that these drugs foster weight gain, in part, through their effects on substances called catecholamines; these catecholamines include adrenaline and noradrenaline. Acting as hormones, these substances affect blood sugar levels and metabolism.

    To put matters simply, says Dr. Allison, these hormones have “effects on both food intake and energy expenditure. Many people think, and I agree, that the effects are mainly to food intake.” Individuals with bipolar who are on these drugs eat far more than they need, as many consumers have observed. “I did notice an increased appetite,” reports Steven Bloem of one of his medications. (His experiences with weight gain are portrayed later in this article.) “Instead of my normal two bowls of cereal, I would keep going. I’d eat four.” (Tom Roberts, whose experiences are also described in this article, recommends that physicians discuss possible weight gain earlier and more extensively in their consultations.)

    What advice do experts offer? Dr. Allison says, “It’s difficult to say with certainty what consumers can do, because we don’t have large, well-conducted clinical trials of weight loss procedures among people taking these drugs. It’s prudent and wise to try to diet and exercise, with the support of cognitive behavioral modification. Getting regular moderate exercise may help to minimize weight gain and can have positive effects on both mood and health, independent of body weight.”

    As for certain weight loss drugs that are much used among the general population, Dr. Allison says, “Some drugs are popular and fairly effective for weight loss in general. But they have not been shown to be effective among the bipolar population.”

    Dr. Correll emphasizes that nearly every person with bipolar who takes antipsychotic medications to control his or her illness runs the risk of gaining weight; there are simply no easy answers in his view. Dr. Correll explains that once a person with bipolar has made peace with the fact that he or she needs these drugs for stability of mind, then it is up to that person to take whatever steps they can to minimize the weight-inducing side effects. Even if the problem cannot be eliminated, it often can be contained.

    Dr. Correll’s three specific recommendations to help you control your weight:

    #1 Stop drinking soda, juices, and sugared drinks

    This is important, he says, “because the appetite centers in the brain do not count liquid calories as food. Even the use of diet soda may be undesirable because sugar replacements may actually induce a craving for carbohydrates.” So what should you drink? “Non-sugared tea or water,” he says. “Not coffee because it increases the release of insulin which makes you hungrier.”

    #2 Eat slowly

    Eat slowly and chew your foods as often as you can before you swallow them.” Dr. Correll explains that the appetite center in the brain actually counts food by the number of times it has been chewed. “And wait before taking seconds,” he adds. Reason: The increased appetite a person with bipolar feels may cause him or her to eat too fast and to overeat before the brain has had time to register a sensation of fullness.

    #3 Try walking for at least 30 minutes each day.

    Dr. Correll cites research done with people at risk for diabetes that showed that walking 30 minutes daily (even in three ten-minute chunks of time), may reduce their risk for diabetes by 50 percent. Dr. Correll suggests another useful approach to increasing one’s own activity level: “Make a rule for yourself that you can only watch a certain television show if you use a stair-stepper or stationary bicycle for at least 30 minutes before that show begins.” You might place the exercise machine in front of the TV and use it during the show as well, he suggests.

    What consumers are experiencing:

    Carolyn

    A high-energy person, confident and outgoing, Carolyn, 34, lives in Pittsburgh, Pennsylvania, and is pursuing a master’s degree in business administration. Previously, she held management positions with Ticket Master and AT&T Wireless. Recently laid off and facing a tough job market, Carolyn stays busy with school work, home improvements, and enjoying time with her fiancé, whose presence in her life makes her feel secure.

    In addition to having bipolar, Carolyn has lived—and to a remarkable degree, thrived—with other mental illnesses. She also has obsessive-compulsive disorder (OCD) and has had anorexia. “I was anorexic pretty much my whole life,” she recalls. Her bipolar diagnosis came at age 27. Standing 5’4″ tall, she then weighed a mere 90 pounds, but saw herself as weighing about 200. Beginning on lithium for the bipolar disorder, Carolyn says she “quickly gained about 100 pounds. When I asked my doctor to switch the lithium for something else, he said to me, ‘You’re fat because you’re lazy. Lithium does not cause weight gain.’

    “That is so wrong—it’s ridiculous,” Carolyn says today. “Still I felt devastated. That was the last time I saw him,” she says. Carolyn has since concluded that “you learn more from consumers than from doctors. I have a really good doctor right now, but I learned the most from online groups by talking to other people about what makes you gain weight, what doesn’t, and what you can do about it.”

    Last January, Carolyn began taking a mood stabilizer and with it, she says, “The anorexia came back. I wasn’t really hungry, but I thought, ‘This is great.’ I started getting a lot of attention from other people for losing weight. I lost enough weight, about 50 or 60 pounds, to be okay and all of a sudden I realized, ‘This is me; I’m happy with me.’ Then I finally got over that whole anorexia thing and got happy with my body.”

    Carolyn now approaches her looks by focusing on her best points, as well as the many cues she receives from others that she is still appealing at 177 pounds. “I’ve sort of reinvented myself and I know I’m still plenty attractive,” Carolyn says. “Guys are still looking at me from top to bottom. I cut my hair and dyed it blonde. I get more attention as a blonde. And my legs still look really nice, so I wear this pair of knee-high boots, with a miniskirt, and a loose top over it. I do look different and I honestly try not to think about it all the time. I am a heavier person. But I like that person.”

    Tom

    Having grown up in rural Arkansas, Tom, 54, now lives in San Francisco, California, where he works as speech coach, writer, and marketing consultant. Over the years, he has also been a college instructor, radio announcer, and TV anchor.

    Tom suffered periods of “depression and hyperactivity” beginning in his early 20s, but only received a bipolar diagnosis at 42. Although his doctors immediately initiated effective drug therapies for Tom and briefly mentioned the possibility of weight gain as a side effect, in his view they did not devote enough time to talking about his illness, nor his tendency to eat for emotional reasons. “It’s frustrating with the medical profession,” Tom says. “You come in and get your meds, but I had a psychiatrist who never made eye contact with me. I wasn’t eating right and I needed education, but I didn’t get that education from my doctor. Our time together was so very limited.”

    Eventually, Tom found a psychologist with whom he discussed such issues as his emotional dependence on food and an addiction he had developed to nonalcoholic beer. The psychologist helped him on both counts.

    At 5′ 10″, a healthy weight for Tom is 170 pounds. Drugs he initially took for bipolar caused him to put on an extra 60 pounds. Then he gained even more weight following a switch in his drug regimen. “I’d never been heavy before and my self-esteem was really low,” he says. “I felt disgusted with myself.”

    Realizing that the very high, nightly dose of the anticonvulsant drug he was taking might be aggravating the weight situation, Tom asked his doctor to drop that dose, which she did on the condition that they carefully monitor his moods. About the time the dose was lowered eight months ago, Tom suffered “a major crisis,” the loss of an eight-year romantic relationship. Those two changes both suppressed his appetite. “I lost 60 pounds in four months,” he says.

    Tom now focuses on healthful habits. “I exercise, I walk a lot,” he says, “and I have a food coach who reminds me what I need to be eating on a daily basis.” Right now, his food coach has him on potatoes, bananas, and apples to address what is his underweight status at this writing.

    Tom also volunteers for the Depression and Bipolar Support Alliance (DBSA). He has met many other individuals who, like him, began taking medications without understanding all the side effects they might face. “Invariably, I meet people who have been on medications and they’re wondering why they blew up ,” he says. “Education is critical.”

    Steven

    Steven, age 49, was born and raised in Grand Rapids, Michigan, where he continues to live today. For him, misdiagnosed mental illness beginning at age 29 derailed his life’s dream of becoming a Baptist minister. “When I got depressed, the churches weren’t too hot about working with somebody with ‘nerves,’” he says. No one figured out that he had bipolar until he was 47, although he underwent years of treatment for depression and spent spells in psychiatric hospitals.

    Today, Steve and his wife, who lost a daughter to a drunk driver, have started their own agency, Heartfelt Counseling Ministries, to help people with mental illness and bereavement issues. As a registered social worker, Steve explains, “I try to stay in the people business and help people who are hurting.”

    Steve is 5′ 10″ tall. When he got married at age 23, he weighed 150 pounds. Today, he is about 60 pounds heavier. “I personally didn’t care that much when I started gaining weight. I find that women care a lot more than men do—unless it gets to a certain point. But now I do care, because it’s affecting my health. I was diagnosed as a type-2 diabetic. My doctor said, ‘I don’t think it’s tied to the meds,’ but a lot of times, even though it’s in the literature, the practical doctor doesn’t know.”

    Steve does know that being overweight coupled with having diabetes significantly raises his risk of heart attack. The situation worries him and his family, and he is taking steps to address his weight problem. His current weight of 211 reflects a recent loss of 13 pounds brought about by conscious efforts to exercise more diligently and eat more carefully. Steve is grateful to be on the right mix of drugs, ones that work well for his mind. At the same time, he adds, “It’s still well within my power to better my body.”

    Printed as “The push-pull of weight gain”, Summer 2005

    • pms-Lithium Carbonate

      How does this medication work? What will it do for me?

      Lithium is used to treat manic episodes of bipolar disorder. It helps to control the symptoms of mania, which may include reduced need for sleep, poor judgment, hyperactivity, feelings of grandiosity, aggressiveness, and sometimes hostility. Lithium takes about 1 to 3 weeks before it has an effect on these symptoms. Lithium may also reduce the frequency of manic episodes if it is taken regularly.

      This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

      Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

      Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

      What form(s) does this medication come in?

      150 mg
      Each hard gelatin capsule with a yellow opaque body and an orange cap, with “pms” and “150” printed on the cap in blue ink, and “LITH” imprinted on the body in blue ink, containing a fine white to off-white powder, contains 150 mg of lithium carbonate. Nonmedicinal ingredients: talc; capsule shell: D&C Red No. 28, D&C Yellow No. 10, FD&C Blue No. 1, FD&C Red No. 40, gelatin, titanium dioxide, and yellow iron oxide.

      300 mg
      Each hard gelatin capsule with a white body and flesh-coloured cap, with “pms” and “300” printed on the cap in black ink, and “LITH” imprinted on the body in black ink, containing a fine white to off-white powder, contains 300 mg of lithium carbonate. Nonmedicinal ingredients: talc; capsule shell: gelatin, red iron oxide, and titanium dioxide.

      600 mg
      Each hard gelatin capsule with a white body and aqua blue cap, with “pms” and “600” printed on the cap, and “LITH” imprinted on the body in black ink, containing a fine white to off-white powder, contains 600 mg of lithium carbonate. Nonmedicinal ingredients: talc; capsule shell: FD&C Blue No. 1, gelatin, and titanium dioxide.

      How should I use this medication?

      The usual starting dose for treatment of mania is 900 mg to 1,800 mg daily divided into 3 equal doses. The dose may be started at a lower level depending on the circumstances of the person taking the medication. The dose of lithium is usually aimed at keeping a certain level of lithium in the bloodstream. This is why lab tests are needed to monitor the levels. Once the best dose is reached, the medication may usually be taken in a single daily dose. This dose may be lower than the total of the initial 3 daily divided doses.

      After the manic episode is controlled, it may be necessary to decrease the dose of lithium to avoid unwanted effects. At this point, the daily dose of lithium is between 500 mg and 1200 mg, divided into three doses.

      Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

      Lithium should be taken with food. Swallow the capsules whole with some water, do not crush or chew the capsules.

      It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

      Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

      Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

      Who should NOT take this medication?

      Do not take lithium carbonate if you:

      • are allergic to lithium carbonate or any ingredients of the medication
      • are severely debilitated
      • are severely dehydrated
      • are taking diuretics (water pills)
      • have low blood levels of sodium
      • have significant kidney disease
      • have significant heart disease

      What side effects are possible with this medication?

      Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

      The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

      Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

      • abdominal pain
      • diarrhea
      • increased frequency of urination or loss of bladder control (more common for women than for men, usually begins 2 to 7 years after start of treatment)
      • increased thirst
      • nausea (mild)
      • sensation of spinning (vertigo)
      • tiredness
      • trembling of hands (slight)

      Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

      Check with your doctor as soon as possible if any of the following side effects occur:

      • confusion, poor memory, or lack of awareness
      • difficulty breathing (especially during hard work or exercise)
      • fainting
      • fast or slow heartbeat
      • frequent urination
      • increased thirst
      • irregular pulse
      • stiffness of arms or legs
      • slurred speech
      • symptoms of too much calcium in the blood (e.g., fatigue, confusion, excessive thirst, increased urination, muscle weakness)
      • unusual tiredness or weakness
      • weight gain

      Stop taking the medication and seek immediate medical attention if any of the following occur:

        Early symptoms of overdose or toxicity:

      • diarrhea
      • drowsiness
      • lack of coordination
      • loss of appetite
      • muscle weakness
      • nausea or vomiting
      • slurred speech
      • trembling
      • Late symptoms of overdose or toxicity:

      • blurred vision
      • clumsiness or unsteadiness
      • confusion
      • convulsions (seizures)
      • dizziness
      • increase in amount of urine
      • ringing in the ears
      • trembling (severe)

      Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

      Are there any other precautions or warnings for this medication?

      Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

      HEALTH CANADA ADVISORY

      February 5, 2014

      Health Canada has issued new restrictions concerning the use of lithium. To read the full Health Canada Advisory, visit Health Canada’s web site at www.hc-sc.gc.ca.

      Drowsiness/reduced alertness: Lithium may affect the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.

      Fluid intake and diet: It is important to maintain a normal diet, including salt, as well as an adequate fluid intake (2,500 mL to 3,000 mL) at least during the initial period of taking this medication. Side effects have been reported to follow after large amounts of sweating or diarrhea. If this occurs, extra fluids and salt should be taken. Talk to your doctor about the appropriate amounts of fluid and salt to take. If you develop a fever, check with your doctor to see if you should reduce your dose or temporarily stop taking the medication.

      Heart disease: If you have heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with severe heart disease should not take lithium (see “Who should NOT take this medication?”).

      Hypercalcemia: Lithium can cause increases in the level of calcium in the blood (hypercalcemia). This may be linked to changes in the function of the parathyroid gland, but sometimes it is not. Tell your doctor if you experience symptoms of hypercalcemia, which include: fatigue, depression, mental confusion, nausea, vomiting, excessive thirst, appetite loss, abdominal pain, frequent urination, muscle and joint aches, and muscle weakness.

      Your doctor will order blood tests as part of your treatment with lithium. Calcium may be included in these tests to monitor for changes in the amount of calcium in your blood.

      Kidney function: Decreased kidney function may cause this medication to build up in the body, causing unwanted effects. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Long term lithium treatment often leads to a decrease in kidney function as well as symptoms of thirst, excess urination, and weight gain. Contact your doctor if you experience these symptoms.

      Lab tests: Lithium toxicity is closely related to the level of lithium in the blood, and can occur at doses that are close to normal. Your doctor will order regular blood tests so that the blood levels of lithium can be monitored.

      Stopping the medication: Do not stop taking this medication suddenly without checking with your doctor first. Stopping the medication suddenly may cause withdrawal symptoms.

      Thyroid disease: If you have thyroid disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Long-term lithium treatment is sometimes associated with the development of growths in the thyroid gland. Contact your doctor if you develop a swelling in the neck.

      Pregnancy: Lithium appears to cause an increase in heart, kidney and thyroid problems in the infants born to mothers who took lithium during pregnancy. Lithium should not be used during pregnancy or by women of childbearing potential unless no other appropriate therapy exists, and, in the opinion of the doctor, the expected benefits outweigh the possible risks.

      Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking lithium, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

      Children: The safety and effectiveness of this medication have not been established for children less than 12 years of age. The use of lithium is not recommended for this age group.

      What other drugs could interact with this medication?

      There may be an interaction between lithium carbonate and any of the following:

      • ACE inhibitors (e.g., enalapril, ramipril)
      • acetazolamide
      • alfuzosin
      • amiodarone
      • angiotensin II receptor blockers (e.g., irbesartan, losartan)
      • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
      • bromocriptine
      • buspirone
      • cabergoline
      • calcitonin
      • calcium polystyrene sulfonate
      • carbamazepine
      • chloroquine
      • cisapride
      • crizotinib
      • cyclobenzaprine
      • degarelix
      • desmopressin
      • desvenlafaxine
      • dextromethorphan
      • diltiazem
      • disopyramide
      • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
      • dofetilide
      • eplerenone
      • ergot alkaloids (e.g., ergotamine, dihydroergotamine)
      • flecainide
      • fluconazole
      • iodide salts (e.g., iodine, potassium iodide)
      • macrolide antibiotics (e.g., clarithromycin, erythromycin)
      • methyldopa
      • metoclopramide
      • mifepristone
      • NSAIDs (e.g., celecoxib, naproxen, ibuprofen)
      • mirtazapine
      • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
      • phenytoin
      • procainamide
      • quinidine
      • quinine
      • quinolone antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
      • rilpivirine
      • romidepsin
      • St. John’s wort
      • saquinivir
      • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
      • serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
      • sodium bicarbonate
      • sodium chloride
      • sodium polystyrene sulfonate
      • sotalol
      • tapentadol
      • tetrabenazine
      • theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
      • topiramate
      • tramadol
      • trazodone
      • tricyclic antidepressants (e.g., amitriptyline, clomipramine, nortriptyline)
      • “triptan” migraine medications (e.g., eletriptan, sumatriptan)
      • tryptophan
      • venlafaxine
      • verapamil

      If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

      • stop taking one of the medications,
      • change one of the medications to another,
      • change how you are taking one or both of the medications, or
      • leave everything as is.

      An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

      Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

      This medication is typically used 3 times a day. However, your doctor or pharmacist may have suggested a different schedule that is more appropriate for you. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed.

      It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your doctor or pharmacist first. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand.

      If you forget a dose, take it as soon as you remember — unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may irritate the stomach, and should be taken with food. It is best to avoid coffee, spicy food or alcohol.

      It is recommended to drink plenty of water while using this medication. If you drink alcohol, a moderate consumption is recommended. Talk to your pharmacist or doctor to find out exactly how much alcohol you can drink.

      What is a proper diet to go on with lithium?

      There are no specific dietary requirements while taking Lithium. Generally you can eat what you like. However Lithium requires consistent monitoring to ensure you maintain the right balance of lithium in the blood to avoid the dangerous condition of lithium toxicity. Dietary changes, particularly those containing caffeine and salt, may affect lithium levels and increase your risk of developing lithium toxicity.

      Salt consumption can cause fluctuations in serum lithium levels. While taking lithium, do not make sudden changes to your salt intake. A sudden decrease in sodium intake (a component of salt) may result in higher serum lithium levels, while a sudden increase in sodium might prompt your lithium levels to fall.

      Caffeine might interact with serum lithium levels. You should maintain your caffeine levels at approximately the same level, as sudden changes in caffeine intake might cause a fluctuation in lithium levels. A drop in caffeine levels might lead to a corresponding increase in lithium levels. Conversely, a sudden increase in caffeine consumption may decrease your lithium levels.

      Drink plenty of fluids, particularly during periods of prolonged or intense exercise. Dehydration may lead to high lithium levels, leaving you at risk for lithium toxicity.

      To minimize your chances of gastrointestinal side effects, take lithium with food or milk. https://www.drugs.com/cg/lithium-toxicity.html

      Simultaneous Determination of Lithium, Sodium, and Calcium in Lithium Carbonate

      Application Note 1090: IC Assay for Lithium, Sodium, and Calcium in Lithium Carbonatedemonstrates accurate determinations of these three analytes by separation on a cation-exchange column and detection by suppressed conductivity. This approach offers a fast (25 minutes), simple, accurate, and robust alternative to the time-consuming assays for these three analytes in the current United States Pharmacopeia (USP) monograph.

      Lithium carbonate is used to treat a number of mental health problems associated with chemical imbalance in the brain, particularly bipolar disorder. Because lithium is the key ingredient and sodium and calcium are possible cationic impurities in lithium carbonate preparations, the USP requires determination of these compounds. The assays for lithium, sodium, and calcium described in the current USP monograph are cumbersome procedures that use hazardous reagents. This single procedure to determine these three analytes was developed in response to the USP’s global initiative to modernize many of its existing monographs.

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