Lithium is contraindicated for use in individuals who have known hypersensitivity to the medication. Lithium is not habit-forming or addictive. Individuals who discontinue lithium therapy do not experience withdrawal, however, there are some individuals who may develop severe mood destabilization if the medication is discontinued. This medication should not be discontinued without first speaking with your healthcare provider. For some specific populations of people, lithium should be avoided, used with caution, or strictly monitored.
Caution should be used in individuals who:. Lithium is not FDA-approved for use in children younger than 7 years of age. The safety and effectiveness of lithium have not been established in pediatric patients younger than 7 years of age.
Clinical studies of lithium carbonate tablets did not include sufficient numbers of individuals older than 65 to determine whether they respond differently than younger subjects. Lithium is known to be substantially excreted by the kidneys.
The risk of intoxication with this medication may be greater in seniors as older patients are more likely to have decreased renal function. Care should be taken in dose and patient selection for those older than 65 years of age.
Lithium may cause harm when administered to pregnant women. The risk of adverse effects on the fetus is especially prominent within the first trimester of pregnancy. Other medications should be considered in the first trimester of pregnancy and a fetal echocardiogram is recommended between 16 to 20 weeks of gestation. If lithium use is continued or initiated during pregnancy, serum lithium concentrations should be monitored closely and lithium dosage lowered or discontinued two to three days prior to delivery.
Breastfeeding is not recommended with maternal lithium use. Lithium carbonate is known to be present in human breast milk. Infants exposed to lithium in breast milk may have signs and symptoms of lithium toxicity including hypertonia, hypothermia, cyanosis, and ECG changes. If a woman chooses to breastfeed while taking lithium, the infant should have thyroid function tests performed and blood levels of lithium monitored closely for signs of lithium toxicity.
Breastfeeding should be immediately discontinued if a breastfed infant develops any signs or symptoms of lithium toxicity. As lithium is primarily eliminated through the kidney, lithium clearance from the body is decreased in individuals with abnormal renal function and kidney disease, and the risk of lithium intoxication is increased. Lithium is known to result in drug interactions with many other medications.
It is important to discuss all medications you are taking or have taken prior to taking lithium and for the duration of lithium treatment. Lithium is contraindicated for use with the following medications:. The use of ACE inhibitors such as enalapril in combination with lithium has been warned against due to a potential increased risk of lithium toxicity.
While there is historical precedent against this combination, more recent case reports suggest potential negative effects could be offset with adequate hydration and avoidance of hydrochlorothiazide HCTZ. While this is promising data, it is important to discuss any potential side effects associated with taking these medications together with your healthcare provider before taking ACE inhibitors with lithium.
Skip to main content Search for a topic or drug. Lithium side effects and how to avoid them Weight gain is a common side effect of lithium, but it can also cause serious reactions like serotonin syndrome or toxicity. Because of this side effect, many patients stop taking the medication, which can lead to manic behavior and depression. Additionally, excessive weight gain can lead to type 2 diabetes and heart disease.
In addition to weight gain, other side effects of lithium may include hand tremors, acne, memory problems and water retention. According to the National Association on Mental Illness, about 30 percent of patients who use lithium to control mental disorders cannot tolerate the medication because side effects cannot be controlled. However, while the drug's side effects may be difficult to tolerate, lithium is one of the most effective drugs used to treat bipolar disorder.
By experimenting with the dosage, the weight gain, water retention and gastrointestinal difficulties that sometimes occur can be reduced. According to the National Association on Mental Illness, doctors often try various dosage amounts and monitor the results through blood tests.
Hypothyroidism is a result of incorrect dosages, which also causes weight gain and can be controlled by changing the prescription. He was suggested diet control and physical exercise no formal program , and was maintaining well for next two years, after which he reported further weight gain of 13 kg i.
Investigations including blood sugar, lipid profile and thyroid functions were within normal range. Considering previous good response, lithium treatment was continued at the same dosage. He was started on metformin mg daily which was increased to mg twice daily for weight gain related to lithium. After six months, there was reduction of 8 kg i. The changes in body weight and BMI are summarized in Figure 1. Fasting blood sugar was monitored during follow ups, which was within normal range.
Our patient gained 25 kg over three years while on lithium maintenance therapy for bipolar disorder. Although he was receiving quetiapine along with lithium in the initial two months, it was tapered off and the weight gain occurred while on lithium monotherapy.
In absence of any other cause, it appears that weight gain is related to lithium. On Naranjo adverse drug reaction probability scale, score was 7, which is suggestive of probable association. Lithium is considered as one of the medication that is least likely to cause weight gain, in comparison with other mood stabilizers. Treatment of lithium-induced weight gain includes non-pharmacological measures such as exercise, avoidance of liquid calories and restricted calorie intake, 14 as well as several medications that have been useful for psychotropic-induced weight gain.
Metformin has been found to be effective for weight gain associated with antipsychotics in non-diabetic patients. Our patient responded to metformin therapy with significant weight reduction 8 kg over six months, and was tolerated well. The weight-reducing mechanism of metformin is possibly multifactorial, involving changes in hypothalamic physiology, including leptin and insulin sensitivity, as well as circadian rhythm changes affecting food intake, regulation of fat oxidation and storage in liver, skeletal muscle, and adipose tissue.
Studies need to examine the role of metformin for the treatment of lithium-induced weight gain in randomized controlled trials. National Center for Biotechnology Information , U. Journal List Clin Psychopharmacol Neurosci v. Clin Psychopharmacol Neurosci.
Published online Feb Samir Kumar Praharaj. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Lithium is the first line treatment for maintenance treatment of bipolar disorder.
Keywords: Lithium, Metformin, Weight gain, Antimanic. CASE A year-old male, height cm, presented with history suggestive of mania of 2 weeks duration. Open in a separate window. Coryell W. Maintenance treatment in bipolar disorder: a reassessment of lithium as the first choice.
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