LithiumReturn to Lithium overview
On a journey out of a very black hole, medication, particularly lithium, has provided some much needed foot holes, it’s just other stuff has, longer term, helped me not to slip back down
You can drink some alcohol while taking lithium, but you must not get dehydrated
- You can continue to drink some alcohol while taking lithium but drinking alcohol can make you dehydrated. If this happens, the lithium level may rise in your body and reach a toxic level.
- If you decide to drink any alcohol, you must make sure that you drink water as well to stop yourself getting dehydrated.
- Do not drink a lot of alcohol, to keep the risk down.
- If you want to drink alcohol, remember that you might also get sleepy so make sure you can get home safely.
Do not drive a car or ride a bike just after you start taking lithium
- 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, until you know how it affects you.
- Do not worry - most people do these things as normal while taking lithium.
Try not to take lithium for the first time just before your exams
- Lithium can affect your memory, your eyesight, and make your hands shake when you start taking it.
- 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 to study.
- Do not worry - most people can take exams as normal while taking lithium.
Lithium does not mix well with drugs
- A person taking lithium needs to be as steady as possible in their diet and other things they put in their body.
- Erratic use of street drugs might affect the level of lithium in the body.
- Taking ecstasy can make a person dehydrated, which can lead to lithium toxicity.
Lithium levels can be changed by high doses of caffeine
- If you drink a lot of coffee, cola drinks or caffeine drinks, it can reduce your level of lithium in the body and it might not work as well for you.
- If you suddenly stop drinking caffeine, it could make the level rise.
- Do not make any changes to your diet and drinks 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.
Lithium levels can be changed by salt (sodium) intake
- Make sure you do not make big changes to the amount of salt (sodium) in your diet without consulting your doctor first.
- Having more salt in your diet than usual can make the lithium level become too low.
- However, you must not go on a low-salt diet without close monitoring because this could make the lithium level become too high.
Lithium is not a banned substance in sport
- Lithium is not a banned substance in sport.
- It might, however, affect your reaction times or make your hands shake, so think about this if your sport needs a steady hand or quick reactions.
- Do not worry - most people do sport as normal while taking lithium.
Your weight can be affected by lithium, but you must keep to your normal diet
- A side-effect of lithium can be weight gain.
- It is hard to know how it will affect each person.
- It is very 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 take in less food and drink. This can be dangerous.
- Talk to your doctor if you would like to make changes to your diet whilst on lithium, or if you are gaining too much weight.
Let your family and friends know you are taking lithium so they can support you and help you look out for side effects
- The side-effects of lithium might put a strain on your friendships and relationships, especially in the first few days of taking it.
- You might feel confused or giddy.
- These side-effects should get better after a few days.
- You should then be getting the good effects of lithium, and that should improve your relationships in itself.
- It might actually be a great idea to choose a good friend to tell about your medicine when you start taking it. (Or - even better - to take a friend with you to the doctor before you start taking the medicine!)
- They could look at the medicine leaflet, or at this website.
- They could help you to understand whether the medicine changes your behaviour, or gives you side-effects (sometimes it is hard for us to see it ourselves).
Lithium can have side-effects that might affect your sex life
The good effects of lithium may have a good effect on your sex life as your symptoms settle and you can concentrate on your relationships.
There are some side-effects that include:
- Difficulty for men in getting an erection or finding it difficult to ejaculate
- Difficulty for men or women to have an orgasm
- If you put weight on, or get an acne or psoriasis flare-up, you may just feel less sexy
These effects should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to the doctor and see what else you could try.
We have not seen lithium affecting fertility in humans
- No effects on fertility have been reported in humans taking lithium.
- If you are trying for a baby, then talk to your doctor about your medicines because there are risks associated with taking lithium during pregnancy.
Use good contraception while you are taking lithium
- Lithium can affect the development of a baby in the womb.
- Women taking lithium should use good contraception so that they do not become pregnant.
- Hormone contraceptive pills are not affected by lithium.
- If you want to get pregnant, then talk to your doctor about your medicines because there are risks associated with taking lithium during pregnancy.
If you are considering becoming pregnant, or discover that you are pregnant, whilst taking lithium, then talk to your doctor
- Taking lithium during pregnancy may pose some risks to the baby, but these risks need to be weighed up against the risk of illness if you stop taking lithium.
- Useful information and advice about the risks of lithium in pregnancy is available from the following websites:
- Best Use of Medicine in Pregnancy (BUMPS): http://medicinesinpregnancy.org/Medicine--pregnancy/Lithium/
- The Choice and Medication website has a “handy fact sheet on lithium and pregnancy”, and is usually free to access via your mental health trust: www.choiceandmedication.org
- If you discover that you are pregnant whilst taking lithium, then you should talk to your doctor as soon as possible.
- It is important not to suddenly stop taking the lithium, even if you discover that you are pregnant, because if you do, you can become unwell quite quickly. Talk to your doctor if you would like to stop taking lithium.
- If possible, it is best to plan in advance if you are taking lithium and considering becoming pregnant. Talk to your doctor about your options, which may include:
- Switching from lithium to another medicine thought to carry less risk in pregnancy, or using psychological therapies instead of medicines during the pregnancy.
- Slowly stop lithium before the first trimester of pregnancy, and then restart lithium during the second trimester of pregnancy. The first trimester is the first three months of pregnancy, in which there is the greatest risk to the baby from lithium.
- Continuing to take lithium throughout the pregnancy. This option would be considered when there is a high risk of relapse in the mental illness, which would be thought to outweigh the risks to the baby.
- Taking folic acid, which is a vitamin thought to protect against some of the risks to the baby
- The main worry here is a rare heart condition called Ebstein’s anomaly where a heart valve becomes faulty. On lithium the risk is increased from 1 in 20,000 babies to 3 in 20,000 babies so it is still very rare at 0.015%.
- Early screening at around 18-20 weeks can detect if your baby has any heart problems
- You will need more frequent blood tests to check the lithium level during pregnancy because it can change as the pregnancy progresses. Expect your lithium dose to go up from month 4 onwards to keep your body levels in the right range.
- Lithium is usually stopped around 12 hours before delivery to avoid levels going high during the delivery period.
- Talk to your doctor or midwife about the risks and benefits of breastfeeding, including what to do about your medicines if considering breastfeeding.
Is it safe to breastfeed whilst taking lithium?
- Lithium gets into the breast milk in quite variable amounts, but in most cases this does not mean you can’t breastfeed if you have a healthy full term baby.
- If your baby was premature then breastfeeding is not recommended as your baby may not be able to safely get rid of the lithium.
- If you would like to breastfeed your baby rather than bottle-feed, then do discuss this with the doctor.
- It is important for you to remain well whilst you are bonding with and looking after your baby.
- Stopping your medicine could lead to you becoming ill, which could be harmful to you and your baby.
- You should discuss this with your doctor, preferably in advance of giving birth.
- The doctor may advise switching to another medicine, or support continuing with lithium if you were taking it during pregnancy, especially if there is a high risk of relapse with the mental illness.
- Lithium blood levels are sometimes done on the baby but this isn’t routine. A thyroid blood test may often be done but keeping a general eye on baby’s development is usually fine.
- If your baby becomes restless, very sleepy or has feeding problems then stop breastfeeding and seek medical advice straight away.
If you are working or exercising in a hot place, or going on holiday to a hot place, make sure you drink plenty of water
- If you are working or exercising in a hot place, you can become dehydrated
- If you are going to visit a hot place on holiday, this can also be a risk for you
- Getting dehydrated may make the level of lithium in your body rise, leading to lithium toxicity
- Make sure you drink plenty of water to stop this happening to you
- If you are going to visit or work in a hot place for a long time, talk to your doctor before you go – you may need to change your dose or medicine
If you get a common infection like cold or flu, your lithium level could change
- Infections like cold or flu can also make you dehydrated
- Drink plenty of water to stop this risk
- Sickness and diarrhoea can make you dehydrated; drink plenty of water and if it lasts more than a day or two see your doctor
Contact your doctor to see what you should do with your lithium dose.
Search www.medicines.org.uk to find patient information leaflets and prescribing information on lithium. Tablets are lithium carbonate and liquid is lithium citrate. The SmPC lists all the inactive ingredients in the product so you can check against any allergies. If you are still unsure about this then speak to your pharmacist.
- British National Formulary (BNF) and British National Formulary for children. Download the BNF/BNFC app (blue background) on to your mobile device. No longer available for public access via the web
- Taylor D, Barnes T, Young A. Maudsley Prescribing Guidelines in Psychiatry, 13th edition. Oxford: John Wiley & Sons, May 2018. ISBN: 978-1-119-44260-8
- Royal Pharmaceutical Society. Medicines Ethics and Practice (42nd edition). London: RPS, 2018. Standards for pharmacists to work to. It is not a free publication
- World Anti Doping Agency WADA Prohibited List https://www.wada-ama.org/en/resources/science-medicine/prohibited-list-documents
- Choiceandmedication; an independent source of information on many mental health conditions and their medicines with easy to read fact sheets www.choiceandmedication.org Personal subscriptions to download the app available for £1 per month (with proportionate discounts for longer periods) but your local mental health Trust may subscribe and provide information sheets for free.
- Best Use of Medicines in Pregnancy (BUMPS). Information sheets on drugs in pregnancy http://www.medicinesinpregnancy.org/
- Drugs and Lactation Database (LactMed). Information on drugs in breastfeeding https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm