Lithium

You may start to notice some positive effects within the first week, but it usually takes several weeks to start to work. If you respond to treatment the beneficial effects will then continue to increase over the next few months and can continue to increase over the next six to 12 months.

Your doctor will start your lithium with a low dose and then increase it gradually to a dose that is right for you.

A side effect of lithium can be weight gain. This can affect people differently and it is not possible to predict the effects until you start taking it. Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking lithium.

Making sure you do enough exercise and eat a healthy diet (with vegetables and fibre) can help you to avoid putting on too much weight. Exercise is also good at helping with your mood.

Mental health conditions like bipolar disorder can make being active and eating healthily more of a challenge. Talk to your doctor, pharmacist and specialist healthcare team for lifestyle advice and where to get support if this would be helpful.

It is important to keep to your normal diet of food and drink while you take lithium. This is because the level of lithium in your body can rise if you reduce your salt intake and have less to drink. This can be dangerous.

Make sure you do not make big changes to the amount of salt in your diet without consulting your doctor first. You must not go on a low-salt diet without close monitoring because this could make the lithium level become too high. Having more salt in your diet than usual can make the lithium level become too low.

A side effect of lithium is a dry mouth and a metallic taste. Over a long time, a dry mouth can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well, have regular dental check-ups, and try to drink water or low-calorie drinks. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking lithium so they can support you and help you look out for side effects.

You can feel drowsy in the first few days of taking lithium, or if the dose is increased. This should get better after a week or two. If it makes you feel drowsy, try taking it just before you go to bed.

If you have been taking lithium for more than a month and you continue to feel very tired, sleepy or struggle to function during the day, you should go back to your doctor and discuss what changes could be made to help.

Alcohol

It may be possible to drink some alcohol in moderation while taking lithium but having the two together might make you very sleepy and unsteady on your feet.

During the first few weeks of treatment, it might be best to stop drinking alcohol until you see how the medicine affects you.

Drinking alcohol can dehydrate your body. This can be dangerous if you are taking lithium because it can result in the lithium levels in your body increasing and they could reach a toxic level.

If you drink alcohol, always make sure you drink water or another soft drink as well to prevent yourself becoming dehydrated.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

The use of street drugs may change your behaviour which could include the amount of food you eat and drink and affect the level of lithium in your body. If it increases, this could be dangerous.

Taking ecstasy can make you dehydrated, which can lead to lithium toxicity.

Lithium may reduce the effects of amfetamines, and taking amfetamines with lithium may increase the risk of serotonin syndrome. Watch out for symptoms such as fever, tremors, diarrhoea and agitation.

There are many different street drugs, but we don’t know what effect taking them with lithium will have, so it’s best to be cautious. Taking these together could result in the risk of toxicity as well as other dangers like blacking out and not remembering what you have done.

There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on drugs and alcohol.

Lithium does not mix well with some other medicines, including herbal remedies. It may affect how they work, could cause more side effects or may change the lithium level in your body. If the level of lithium becomes too high this could be dangerous.

Before you start taking lithium, tell your doctor if you are taking any other medications including things you have bought from a pharmacy (or other shop) for common illnesses like colds and flu. This includes medications that you put on your skin. You can also show them the lithium treatment card you were given when you started lithium.
Do not take anti-inflammatory painkillers such as ibuprofen while you are taking lithium. This is because ibuprofen and related medicines (e.g. naproxen, diclofenac) can make the lithium level become too high.

Diuretics (‘water tablets’) and certain types of blood-pressure medicine can also make the lithium level become too high.

A few people who take lithium will, on their doctor’s advice, need to take one of these interacting medicines at the same time. If this is the case, then the lithium dose will be adjusted to take the interacting medicine into account, and you may need more frequent blood tests to check your lithium level.

Sometimes lithium is combined with antidepressant medicine if the antidepressant hasn’t worked as well as expected on its own. When these medicines are combined there have been some reports of serotonin syndrome occurring. This is rare, but you need to be aware of the symptoms so you know what to do if you get them. Symptoms include high temperature (fever), shivering, excessive sweating, agitation, confusion, trembling, and weird muscle movements. If you get these symptoms, you must seek medical attention straight away.

There is also a risk of serotonin syndrome if you take a type of anti-migraine medicine called a ‘triptan’ while taking lithium.

Some people will need to take an antipsychotic medicine while they are taking lithium.

When these medicines are combined, there have been some reports of neuroleptic malignant syndrome (NMS) occurring. This is rare, but you need to be aware of the symptoms so you know what to do if you get them. Symptoms include confusion, disorientation, agitation, tiredness, shaking, excessive sweating, rigid muscles, muscle cramps, weird muscle movements, and high temperature (fever). If you get these symptoms, then you must seek medical attention straight away.

Antipsychotic medicines and some other medicines may affect your heart rhythm if taken with lithium, and you may need to have a test called an electrocardiogram (ECG) to check on your heart.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with lithium. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

If you drink a lot of coffee, cola drinks or caffeine drinks while taking lithium, it can reduce the level of lithium in your body, which means it might not work as well for you.

If you suddenly stop drinking caffeine, it could make the level rise.

Do not make any big changes to your diet before talking to your doctor, so they can watch your lithium levels more closely. This might mean having an extra blood test after a change has been made to check the lithium in your blood is still at the right level.

There are multiple companies that manufacture this medicine and the non-active ingredients may vary between products and also between the different strengths of tablets that are available.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

The Priadel liquid contains a small amount of alcohol, but not enough to affect your blood alcohol level.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Taking lithium may affect your reaction time, give you blurred vision, make you feel dizzy, and make your hands shake when you start taking it.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days or weeks until your dose is stable and you know how it affects you.

Most people drive as normal while taking lithium. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

You must tell The DVLA (Driver and Vehicle Licensing Agency) if you have bipolar disorder, schizophrenia, schizoaffective disorder or other mental health conditions that could affect your driving. You can be fined if you do not tell The DVLA about a medical condition that affects your driving and may be prosecuted if you are involved in an accident as a result.

Pregnancy

There is evidence that suggests taking lithium while pregnant can make health problems more likely whilst your baby is developing. Early screenings can help detect if there are any health problems with your baby.

If you become pregnant while you are on lithium, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing lithium and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking lithium during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Untreated depression or bipolar illness can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking lithium while pregnant, you should tell your midwife. If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with lithium.

If you and your doctor agree that you will continue to take lithium during your pregnancy, you will need regular blood tests to monitor your lithium levels. Your body processes lithium differently during pregnancy so your dose might change.

Post-natal

If you have continued to take lithium during pregnancy it is advised that you plan to give birth in hospital. This means you and your baby can be monitored by doctors and your midwife, and you can quickly get any extra support if you need it.

Some new born babies whose mothers take lithium during pregnancy can get withdrawal symptoms at birth and soon after, like restlessness, floppy muscles or being very sleepy.

Tell your midwife if you are taking lithium, so that they can help if the baby has any symptoms after birth.

Breastfeeding

Lithium is passed to the baby in breastmilk in varying amounts.
If your baby was born early, then breastfeeding while you take lithium may not be recommended. Talk to your midwife and doctor about feeding options.

If you breastfeed while taking lithium, seek urgent medical advice if your baby becomes restless, very sleepy or develops feeding problems.

Sex

Lithium can have side effects that may affect your sex life. These include:

• problems getting an erection
• difficulty reaching orgasm

Untreated depression can have a negative effect on your sex life, so if lithium helps you to recover, positive effects can include improving your desire, experience and enjoyment of intimate relationships again.

Fertility

There is no evidence to suggest that lithium will affect your fertility. Talk to your doctor about your lithium if you are trying to get pregnant or planning a family.

Lithium is not a banned substance in sport.

Most people play sports as normal while taking lithium. However, it may affect your ability to play sports that require quick reactions or a steady hand. It might also affect your ability to focus.

If you have any concerns, discuss this with your doctor.

Ideally it is best not to take lithium for the first time just before your exams as it may affect your concentration.

It’s not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking lithium.

You should talk to your doctor about any future exams if you are starting lithium. You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start lithium to improve your motivation and ability to study. Bear in mind that depression itself can affect concentration.

Most people take exams as normal while taking lithium, but if you have concerns, discuss this with your doctor.