Lithium tablets and liquid medicine

About lithium

Lithium is used to treat a number of mood disorders such as mania, hypomania and depression. It is also taken by many people long-term as a mood stabiliser to prevent such episodes. In a person with mania, their mood is very high, causing overactive and excitable behaviour; whereas people with depression have very low moods. Lithium is useful in a condition known as bipolar disorder, where there are extreme high and low moods. It is also used to treat some behavioural disorders, such as aggressive or self-harming behaviours.

Lithium reduces the intensity and frequency of mood swings. It affects the amount of some chemical substances present in the brain, and it may also affect the way that nerve cells respond to some of the chemical substances. It has been used for more than 50 years, and it is known to be a very effective medicine.

Lithium is available as tablets and liquid medicine. There are several different brand names for lithium, such as Camcolit®, Liskonum®, Priadel® and Li-Liquid®. The amount of lithium released from products made by different manufacturers varies, so it is important that you always take the same brand of lithium.

Before taking lithium

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can 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 breastfeeding.

• If you know you have an underactive thyroid gland.

• If you have a heart condition, or a heart rhythm disorder.

• If you have any problems with the way your kidneys work.

• If you have either of these conditions: epilepsy, psoriasis.

• If you have an adrenal gland disorder called Addison's disease.

• If you have a condition causing severe muscle weakness, called myasthenia gravis.

• If you are taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal and complementary medicines.

• If you have ever had an allergic reaction to a medicine.
  

How to take lithium

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack, and any additional information you have been given. They will give you more information about the specific brand of lithium you have been prescribed, and will also provide you with a full list of the side-effects which you could 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 you are prescribed 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 will tell you how much to take and how often 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 either with or without food.

• Many lithium tablets are specially made to release the medicine slowly into your bloodstream. They are called modified-release tablets. You should swallow this type of tablet 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 time(s) 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 will 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 scheduled appointments with your doctor as you will need to have regular blood tests. This is so your doctor can check on your lithium levels and continue to monitor your progress.

• Although it may take several weeks before you feel the benefits of the treatment, many people notice a difference earlier. You should continue to take lithium regularly every day.

• Each time you collect a prescription, check to make sure you have been supplied with the same brand of lithium as usual. If your tablets/medicine look different to before, ask your pharmacist to check it out for you. This is because the amount of lithium released from the different brands of lithium varies, so it is important that you keep to the same brand as you have had previously.

• Many medicines can interfere with lithium and cause the level of lithium in your blood 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 medicine (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 can affect your levels, so should be avoided. Also, if you plan to make any major changes to what you eat (such as going on a diet), please 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. This is because it may be necessary for you to change the timing of your dose.

• Do not stop taking lithium abruptly, or deliberately miss any doses. Stopping suddenly can cause problems and your doctor will want you to reduce your dose gradually over several weeks 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. The table below contains some of the ones associated with lithium. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: there are some symptoms, which if you experience them, you should let your doctor know about straightaway. These are:

• Blurred eyesight, being sick (vomiting), diarrhoea, muscle weakness or jerkiness, feeling drowsy, and a lack of co-ordination. These are signs that you may have too much lithium in your blood.

• Persistent headache and problems with your eyesight.

• Being very thirsty, or needing to pass urine more often than normal.

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

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