Lithium: The First Mood Stabilizer Part 3

Part 3: Major Precautions and Warnings

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In this section we will review some major precautions and warnings about taking lithium.

Dietary precautions

It is important to drink plenty of fluids while taking Lithium. Caffeinated beverages are not hydrating so try to avoid them. Water is always a good choice. Because Lithium is related to sodium, it is also important to have an adequate supply of dietary salt. Too little salt can cause the body to hoard lithium, and too little water will decrease urination which also leads to lithium buildup, neither of which are desired scenarios.

Pregnancy/Breast-Feeding

Experts recommend that lithium use be discontinued during at least the first trimester of pregnancy, and throughout pregnancy if possible, as it can cause birth defects. Breast-feeding mothers should not take lithium as it can enter the milk and negatively impact the infant.

Drug Interactions

Medications that can interact badly with lithium include:

  • ibuprofen (Advil, Motrin)
  • naproxen (Aleve)
  • diuretics
  • SSRI antidepressants (Prozac, Luvox, etc.) and several others.

Make sure your doctor has a complete list of both prescription and over-the-counter medications you take regularly or occasionally. Also be sure to tell other doctors who may prescribe for you that you are taking lithium.

The combination of haloperidol (Haldol) and lithium has caused extremely serious complications in a small number of patients. When these two medicines are prescribed together, the patient should be monitored very closely for rigidity and/or very high fever.

Geriatric Use

Elderly patients may develop lithium toxicity at much lower serum levels and so should be monitored appropriately.

Miscellaneous Cautions

Patients with psoriasis should use lithium with caution, as this medication is known to make psoriasis worse.

Extra care should be used if the patient has:

  • cardiovascular disease
  • any thyroid disease; or
  • leukemia

This is not an all-inclusive list. Read patient information that accompanies prescription and discuss this medication with your doctor.

Sources

Pinelli JM, Symington AJ, Cunningham KA, Paes BA. (2002) Case report and review of the perinatal implications of maternal lithium use. American Journal of Obstetrics & Gynecology, 187:245-9.

Schrauzer GN. (2002) Lithium: occurrence, dietary intakes, nutritional essentiality. Journal of the American College of Nutrition, 21:14-21.

Edited by Jenev Caddell, PsyD

Part 1: History, and a Mystery Solved
Part 2: Tests and Toxicity
Part 4: Why Does Lithium Cause Weight Gain?

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