Lithium is a mood stabiliser used in bipolar disorder, mainly to prevent episodes of mania and depression. It is very effective, but has a narrow therapeutic window — it requires regular blood tests and close medical supervision.
Also known as: Priadel, Camcolit, carbonato de lítio
Amiodarone + lithium: increased risk of ventricular arrhythmias with concomitant use (QUADRO 2).
Amiodarone (iodine-rich) can alter thyroid function and lithium also affects the thyroid; both have cardiac effects (bradycardia, QT prolongation, arrhythmias). QUADRO 2 of Annex 7 records this interaction in the amiodarone section. The combination may potentiate hypo- or hyperthyroidism and increase the arrhythmia risk, especially in the elderly. Lithium has a narrow therapeutic window and its levels must be monitored, along with TSH, ECG and electrolytes. Warn the patient of thyroid dysfunction symptoms (fatigue, cold/heat intolerance, palpitations) and of lithium toxicity signs (tremor, confusion).
Amiodarone + lithium: risk of thyroid toxicity and synergy in cardiotoxicity — monitor thyroid function, lithium levels and ECG.
QUADRO 2 lists lithium among the drugs that increase the risk of ventricular arrhythmias with concomitant amiodarone use (additive QT prolongation).
Monitor ECG (QT interval) and signs of arrhythmia.
Palpitations, syncope, ventricular arrhythmias in a patient on amiodarone + lithium.
Use with caution; monitor ECG and electrolytes in the combination.
Prontuário Terapêutico do INFARMED (11th ed., 2012) — Annex 7, QUADRO 2 (Amiodarone)
Combining Lithium with Ibuprofen increases serum Lithium concentrations, with a risk of toxicity.
NSAIDs, by inhibiting the synthesis of renal prostaglandins, reduce renal blood flow and lithium excretion, potentially raising serum lithium and precipitating toxicity (nausea, coarse tremor, confusion, ataxia, seizures) within days. The effect is particularly relevant in the elderly and in patients with reduced renal function. The lithium label and the Portuguese Prontuário Terapêutico recommend monitoring serum lithium and signs of toxicity when starting, adjusting or stopping the NSAID, and preferring paracetamol as the analgesic.
Ibuprofen + lithium: the NSAID reduces renal lithium clearance, with a risk of raised serum lithium and toxicity (tremor, confusion, seizures). Monitor lithium levels.
Non-steroidal anti-inflammatory drugs such as Ibuprofen reduce the renal excretion of Lithium, raising its levels.
Lithium levels after starting or adjusting the NSAID.
Confusion, coarse tremor, ataxia, vomiting, diarrhoea or seizures suggest Lithium toxicity and require urgent evaluation.
Avoid NSAIDs in patients taking Lithium; if unavoidable, use the lowest dose and monitor Lithium levels.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 ; approved Ibuprofen label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14515409-736f-4119-b6a0-cb19ee2e948e — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining chlorpromazine with lithium can cause confusion, a lowered seizure threshold and, rarely, encephalopathy.
Lithium lowers the seizure threshold; chlorpromazine may alter neurological response and mask lithium toxicity signs.
Serum lithium, tremor, level of consciousness.
Coarse tremor, confusion, vomiting, ataxia.
Monitor serum lithium and neurological status; consider dose adjustment in combination.
DailyMed — Lithium Carbonate label, antipsychotic interactions: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b839ff4b-f62d-41ab-a823-550a756d58ec
Lithium can lower the seizure threshold when combined with promethazine; there is also additive sedation risk.
The lithium carbonate label lists antipsychotics and sedatives as drugs that lower the seizure threshold.
Serum lithium, tremor, seizure history.
Tremor, confusion, seizures.
Monitor neurological status; counsel the patient on lithium toxicity signs.
DailyMed — Lithium Carbonate label, seizure threshold: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b839ff4b-f62d-41ab-a823-550a756d58ec
Combining Lithium with Metronidazole increases serum Lithium concentrations, with a risk of toxicity.
In patients stabilised on relatively high lithium doses, short-term metronidazole therapy has been associated with elevation of serum lithium and, in a few cases, signs of lithium toxicity; the metronidazole label recommends obtaining serum lithium and creatinine levels a few days after starting metronidazole, to detect any increase that may precede clinical symptoms of lithium intoxication. The lithium label includes metronidazole among the drugs that can raise lithium levels, with a recommendation for frequent monitoring and dose adjustment.
Lithium + metronidazole: can raise lithium levels and cause toxicity. Check lithium and creatinine a few days after starting metronidazole.
Metronidazole may increase serum Lithium concentrations; the mechanism involves reduced renal excretion.
Confusion, tremor or vomiting after starting Metronidazole require level testing and reassessment.
Confusion, tremor or vomiting after starting Metronidazole require level testing and reassessment.
Monitor Lithium levels and watch for signs of toxicity during Metronidazole use.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 ; approved Metronidazole label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d5784eeb-6b99-4e8a-847b-b0d1090ed48a — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Haloperidol with Lithium increases the risk of neurotoxicity and severe extrapyramidal symptoms.
An encephalopathic syndrome (weakness, lethargy, fever, tremulousness, confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes) followed by irreversible brain damage has occurred in a few patients treated with lithium plus haloperidol, although a causal relationship has not been established; the haloperidol label recommends monitoring patients on this combination closely for early evidence of neurological toxicity and discontinuing treatment promptly if such signs appear. Use the lowest effective doses of both, monitor neurological signs and lithium levels, and reassess the combination if symptoms arise.
Haloperidol + lithium: encephalopathic syndrome/neurotoxicity described. Monitor closely for early neurological signs.
Co-administration of antipsychotics and Lithium can produce encephalopathy, confusion and extrapyramidal syndrome, especially at high doses.
Confusion, rigidity, tremor or signs of neuroleptic malignant syndrome require discontinuation and urgent evaluation.
Confusion, rigidity, tremor or fever require discontinuation and urgent evaluation.
Use cautious doses of both and monitor for the onset of neurological signs.
DailyMed/FDA (NIH/NLM) — approved Haloperidol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e2eed126-cb82-42b1-9b48-9cbeb6873b50 ; approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Lithium with Captopril increases serum Lithium concentrations, with a risk of toxicity.
Angiotensin-converting enzyme (ACE) inhibitors such as captopril can raise serum lithium levels and cause signs of lithium toxicity in patients on concomitant lithium; the captopril label recommends co-administering with caution and monitoring serum lithium levels frequently, noting that if a diuretic is also used, the risk of lithium toxicity increases. Monitoring is especially important when starting the ACE inhibitor and at any dose change, and should include signs of lithium toxicity (tremor, confusion, ataxia, dysarthria, diarrhoea).
Captopril + lithium: the ACE inhibitor can raise lithium levels and cause toxicity. Use with caution and monitor lithium levels frequently.
Captopril, an angiotensin-converting enzyme inhibitor, reduces the renal excretion of Lithium, raising its levels.
Monitor Lithium levels after starting Captopril.
Signs of Lithium toxicity require discontinuation and evaluation.
Monitor Lithium levels and renal function during co-administration.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 ; approved Captopril label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a43a5373-ded9-4912-8c98-edaec8352836 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Lithium with Diclofenac increases serum Lithium concentrations, with a risk of toxicity.
NSAIDs, including diclofenac, reduce renal lithium clearance by inhibiting renal prostaglandin synthesis: the diclofenac label documents increases in the mean minimum plasma lithium concentration of about 15% and a reduction in renal clearance of approximately 20%. The rise in lithium levels can precipitate lithium toxicity (tremor, confusion, ataxia, dysarthria), especially in the elderly, with dehydration or renal impairment. Monitor lithium levels when starting, adjusting or stopping the NSAID, use the lowest effective dose and watch for signs of toxicity.
Diclofenac + lithium: the NSAID reduces renal lithium clearance and raises lithium levels. Monitor levels and signs of toxicity.
NSAIDs such as Diclofenac decrease the renal excretion of Lithium, raising its serum levels.
Watch for signs of Lithium toxicity after starting Diclofenac.
Signs of Lithium toxicity (confusion, tremor, vomiting, seizures) require urgent evaluation.
Avoid the combination; if needed, use the lowest Diclofenac dose and monitor Lithium levels.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 ; approved Diclofenac label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b0931350-28a9-4f00-9254-1d72e31f04c3 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Lithium with Enalapril increases serum Lithium concentrations, with a risk of toxicity.
Lithium toxicity has been reported in patients receiving lithium concomitantly with drugs that cause sodium elimination, including ACE inhibitors; the enalapril label describes cases of lithium toxicity in patients on enalapril and lithium, reversible after discontinuation of both, and recommends monitoring serum lithium levels frequently if enalapril is given with lithium. The mechanism involves reduced renal lithium elimination associated with sodium depletion. Monitor lithium levels at the start and during the combination and watch for signs of toxicity (tremor, confusion, ataxia, diarrhoea).
Enalapril + lithium: lithium toxicity reported with ACE inhibitors. Monitor lithium levels frequently during the combination.
Angiotensin-converting enzyme inhibitors such as Enalapril reduce the renal clearance of Lithium, raising its levels.
Watch for signs of Lithium toxicity after starting Enalapril.
Signs of Lithium toxicity after starting Enalapril require level testing and evaluation.
Monitor Lithium levels and renal function if the combination is needed.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 ; approved Enalapril label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b31372f7-cda3-4ead-a481-4cde62e843fd — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Lithium with Fluoxetine increases the risk of serotonin syndrome and may raise Lithium levels.
Lithium can precipitate serotonin syndrome, potentially life-threatening, and the risk increases with concomitant use of other serotonergic drugs, including SSRIs such as fluoxetine; the lithium and fluoxetine labels recommend informing the patient of the increased risk and monitoring symptoms (agitation, hallucinations, delirium, tachycardia, hyperthermia, tremor, rigidity, myoclonus, hyperreflexia, seizures, gastrointestinal symptoms), especially at initiation and dose increases. If symptoms arise, stop lithium and the serotonergic agents and start supportive treatment.
Fluoxetine + lithium: risk of serotonin syndrome. Inform the patient and monitor symptoms, especially at initiation and dose increases.
Lithium and Fluoxetine increase serotonergic activity; SSRIs may also reduce Lithium excretion, raising its levels.
Watch for agitation, tremor, hyperthermia, hyperreflexia, myoclonus or diarrhoea (serotonin syndrome).
Fever, agitation, hyperreflexia or myoclonus (serotonin syndrome) require discontinuation and urgent evaluation.
Use the combination cautiously, at low doses, and monitor Lithium levels.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 ; approved Fluoxetine label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=09fb3100-1e06-4cdc-8016-7e4f5d097490 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Lithium with Hydrochlorothiazide increases serum Lithium concentrations, with a risk of toxicity.
Thiazides such as hydrochlorothiazide reduce renal lithium clearance: diuretic-induced sodium loss decreases lithium elimination and markedly increases the risk of toxicity. The hydrochlorothiazide label states that lithium generally should not be given with diuretics and refers to the lithium package insert; the lithium label confirms that diuretic-induced sodium loss can reduce lithium clearance and raise lithium levels. If the combination is unavoidable, reduce the lithium dose, monitor lithium levels frequently and watch for signs of toxicity (tremor, confusion, ataxia, dysarthria); ensure adequate sodium intake.
Hydrochlorothiazide + lithium: thiazides reduce renal lithium clearance and greatly increase the risk of toxicity. Avoid; if unavoidable, monitor lithium levels.
Thiazide diuretics reduce the renal excretion of Lithium (increased tubular reabsorption), raising its serum levels.
Frequent Lithium levels and electrolyte/creatinine checks.
Signs of Lithium toxicity (confusion, tremor, vomiting, seizures) require discontinuation and urgent evaluation.
Avoid the combination whenever possible; if needed, closely monitor Lithium levels and renal function.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 ; approved Hydrochlorothiazide label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0789baef-3424-43ab-a3fb-4908172da565 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
NSAID + lithium: risk of raised serum lithium and lithium toxicity.
NSAIDs, including naproxen, reduce renal lithium clearance by inhibiting renal prostaglandin synthesis: the naproxen label documents increases in the mean minimum plasma lithium concentration of about 15% and a reduction in renal clearance of approximately 20%. The rise in lithium levels can precipitate lithium toxicity (tremor, confusion, ataxia, dysarthria), especially in the elderly, with dehydration or renal impairment. Monitor lithium levels when starting, adjusting or stopping the NSAID, use the lowest effective dose and watch for signs of toxicity.
Lithium + naproxen: the NSAID reduces renal lithium clearance and raises lithium levels. Monitor levels and signs of toxicity.
NSAIDs reduce renal lithium clearance (decreased excretion), raising lithium levels.
Serum lithium and renal function during combined therapy.
Nausea, confusion, tremor, signs of neurotoxicity; arrhythmias.
Stop or reduce the NSAID with serum lithium monitoring; watch for signs of lithium toxicity.
DailyMed (FDA) — approved Naproxen label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=24d44eb6-921e-4150-a6b2-81f42ced32ab ; approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=582697c1-063f-366f-e063-6294a90a8d1b — additional reference: Prontuário Terapêutico do INFARMED (11th ed., 2012)
Filgrastim + lithium: lithium may potentiate filgrastim-induced neutrophil release — use with caution and monitor neutrophil counts.
DailyMed (Neupogen) records: "Drugs which may potentiate the release of neutrophils, such as lithium, should be used with caution" (Drug Interactions section). Both drugs promote neutrophil release from the bone marrow, so the combination may potentiate neutrophilia and related complications.
Monitor neutrophil count (risk of excessive neutrophilia) during the combination.
Marked neutrophilia (count far above target) during the combination.
Use the combination with caution, monitoring the absolute neutrophil count; adjust filgrastim dose if neutrophilia is excessive.
DailyMed/FDA (NIH/NLM) — approved Neupogen label (Amgen), Drug Interactions section: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=97cc73cc-b5b7-458a-a933-77b00523e193
Methyldopa increases lithium levels (reduced renal clearance), with a high risk of lithium toxicity.
Methyldopa reduces renal lithium excretion; toxicity can occur even at usual doses.
Serum lithium (1–2 weeks after starting), tremor, confusion, ataxia.
Coarse tremor, confusion, vomiting, ataxia, drowsiness.
Avoid the combination; if unavoidable, reduce the lithium dose and monitor serum lithium closely.
DailyMed — Methyldopa Tablet and Lithium Carbonate labels (documented combination toxicity): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9e22e1d8-04ec-4b67-92ea-b09c706f2703
Aminophylline (theophylline) increases renal lithium excretion, potentially reducing its therapeutic effect and precipitating manic relapse.
Theophylline increases renal lithium clearance (Annex 7: "Theophylline: increased renal lithium excretion with reduced lithium effect").
Serum lithium, relapse symptoms (mood, sleep, agitation).
Manic symptom relapse, serum lithium below therapeutic range.
Monitor serum lithium after starting/stopping aminophylline; adjust the lithium dose if needed.
INFARMED Prontuário Terapêutico (11th ed., 2012), Annex 7 — Lithium: "Theophylline: increased renal lithium excretion with reduced lithium effect"; DailyMed — Lithium Carbonate label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b839ff4b-f62d-41ab-a823-550a756d58ec
NSAID + lithium: lithium levels increased 15-30%. Risk of lithium toxicity (tremor, confusion, seizures).
Indomethacin has the greatest effect on lithium levels among NSAIDs. The main mechanism is reduced renal lithium clearance via inhibition of prostaglandin E2 in the kidney. Prostaglandins regulate renal blood flow and tubular reabsorption — their inhibition reduces lithium excretion by 15-30%. The effect is dose-dependent and most pronounced during the first 5-7 days of concomitant treatment. Other NSAIDs (ibuprofen, naproxen) also increase lithium levels, but to a lesser degree (5-15%). Lithium toxicity initially manifests with fine tremor, nausea, and diarrhoea, progressing to confusion, ataxia, and seizures. The therapeutic window of lithium is narrow (0.6-1.2 mEq/L), so small changes can have significant clinical consequences.
NSAID + lithium: lithium levels increased 15-30%. Risk of lithium toxicity (tremor, confusion, seizures). Monitor lithium levels weekly.
Indomethacin reduces renal clearance of lithium, increasing serum levels. The effect is more pronounced with indomethacin than other NSAIDs. Toxicity can be severe.
Lithium levels, signs of toxicity (tremor, nausea, confusion, diarrhoea).
Lithium level >1.5 mEq/L, severe neurological signs.
Avoid combination if possible. If necessary, reduce lithium dose by 20-30% and monitor lithium levels weekly during the first 2 weeks.
DailyMed/FDA — approved Indomethacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d2997707-1541-4f5d-8c8d-70b0a13be8b2
Lithium can cause insulin resistance and hyperglycaemia, making regular insulin doses unstable; intensified glucose monitoring on the combination.
Lithium alters glucose metabolism and insulin sensitivity (hyperglycaemia described in lithium entries and Prontuário); short-acting regular insulin exposes fluctuations.
Capillary glucose, serum lithium, weight, polyuria/polydipsia.
New polyuria and polydipsia (hyper) or sweating/confusion (hypo).
Monitor capillary glucose and HbA1c; adjust insulin doses if fasting glucose rises; assess serum lithium in decompensation.
INFARMED Prontuário Terapêutico (11th ed., 2012), Lithium Carbonate entry; DailyMed — Lithium Carbonate and Humulin R labels: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b839ff4b-f62d-41ab-a823-550a756d58ec
Lithium can alter insulin sensitivity and destabilise the basal glycaemic control provided by NPH insulin.
Lithium-induced insulin resistance increases basal insulin requirements (hyperglycaemia); in combination, NPH peaks become unpredictable.
Fasting glucose, serum lithium, HbA1c.
Polydipsia/polyuria, weight loss (hyperglycaemia).
Reassess fasting glucose 1–2 weeks after lithium dose changes; adjust basal insulin; educate on hypoglycaemia.
INFARMED Prontuário Terapêutico (11th ed., 2012), Lithium Carbonate entry; DailyMed — Humulin N (NPH) label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f6edd793-440b-40c2-96b5-c16133b7a921
NSAID + lithium: lithium levels may increase. Risk of lithium toxicity.
Nimesulide reduces renal blood flow via prostaglandin inhibition, decreasing lithium clearance. COX-2 selectivity and short half-life (2-3 h) make the effect smaller compared to indomethacin or naproxen. However, the effect is clinically relevant with prolonged treatment. Monitor lithium levels if co-administration >7 days.
COX-2 selective NSAID + lithium: lithium levels may increase. Less effect than non-selective NSAIDs due to short half-life.
Nimesulide may reduce renal lithium clearance via prostaglandin inhibition. The effect is less than with indomethacin or naproxen, due to short half-life and COX-2 selectivity.
Lithium levels, signs of toxicity (tremor, nausea).
Lithium level >1.5 mEq/L.
Monitor lithium levels if prolonged concomitant treatment. Consider reducing lithium dose by 10-20%.
Prontuário Terapêutico; EMC-EMC Portugal — Nimesulide
Analgesic + lithium: minimal effect on lithium levels.
Metamizole has no clinically significant effect on renal lithium clearance. The interaction is theoretically possible but rarely relevant.
No specific monitoring required.
No dose adjustment required.
Prontuário Terapêutico; EMC-EMC Portugal — Metamizol
COX-2 selective NSAID + lithium: lithium levels may increase.
Celecoxib has COX-2 preference but may reduce renal lithium clearance. The effect is less than with non-selective NSAIDs but clinically relevant.
Lithium levels, signs of toxicity.
Lithium level >1.5 mEq/L.
Monitor lithium levels if concomitant treatment >7 days.
DailyMed/FDA — approved Celecoxib label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c6dbe686
Mood stabiliser + antipsychotic: increased risk of EPS and neurotoxicity.
The combination is used therapeutically in acute mania and maintenance. However, the risk of extrapyramidal effects and neurotoxicity is additive. Lithium may potentiate EPS from antipsychotics. Monitor for neuroleptic malignant syndrome (hyperthermia, rigidity, unconsciousness). Maintain lithium levels within therapeutic range (0.6-1.0 mEq/L). Adjust doses as needed.
Mood stabiliser + antipsychotic: increased risk of EPS and neurotoxicity. Monitor for neuroleptic malignant syndrome.
The combination may increase the risk of extrapyramidal effects and neurotoxicity. Monitor for signs of neuroleptic malignant syndrome.
EPS, neurotoxicity signs.
Neuroleptic malignant syndrome.
Monitor for EPS and neurotoxicity signs (confusion, tremor, fever).
DailyMed/FDA
Mood stabiliser + antipsychotic: additive effect on manic symptoms.
The combination is used therapeutically in acute mania. Olanzapine may cause metabolic syndrome (weight gain, dyslipidaemia, hyperglycaemia), and lithium may add weight gain. Monitor weight, blood glucose, lipid profile, and EPS. Maintain lithium levels within therapeutic range. Consider metformin if metabolic syndrome develops.
Mood stabiliser + antipsychotic: additive effect on manic symptoms. Increased risk of metabolic syndrome.
The combination is used therapeutically in acute mania. Increased risk of metabolic syndrome and EPS.
Metabolic syndrome, EPS.
Severe metabolic syndrome.
Monitor weight, blood glucose, lipid profile and EPS.
DailyMed/FDA
Caffeine has a diuretic effect and can alter serum lithium; abrupt changes in caffeine intake can precipitate toxicity or loss of efficacy.
Keep caffeine intake consistent; changes should be gradual and monitored.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72
Lithium excretion depends on sodium: low-salt diets or dehydration raise serum lithium; high-salt diets lower it.
Keep salt and fluid intake consistent; avoid radical diets and dehydration.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72
Lithium is eliminated almost exclusively renally; renal impairment reduces clearance and increases the risk of toxicity.
Monitor serum lithium frequently and adjust the dose; avoid NSAIDs and thiazide diuretics.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72
Sodium depletion (low-salt diet, diuretics, dehydration) increases tubular lithium reabsorption and serum lithium.
Correct and avoid sodium-depleting factors; monitor serum lithium and electrolytes.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72
Lithium is associated with cardiac malformations (Ebstein anomaly) and neonatal toxicity; maternal levels fluctuate in pregnancy.
Avoid in the first trimester; if unavoidable, monitor serum lithium closely and watch the newborn.
Present in breast milk at relevant concentrations; generally avoided in breastfeeding.
Use effective contraception during treatment.
DailyMed/FDA (NIH/NLM) — approved Lithium label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e6b0a2d-b79c-44d8-b785-5267df9e8f72 ; Prontuário Terapêutico do INFARMED (11th ed., 2012) — Annex 2, Drugs and Breastfeeding: Continued breastfeeding may raise it, with toxicity to the infant; good maternal lithium control reduces the risks.
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Mood stabiliser; the mechanism of action as a mood stabiliser is unknown. The distribution space approximates total body water and plasma protein binding is negligible; apparent volume of distribution of 0.7 to 1 L/kg at equilibrium.
The exact mechanism is not clarified. Lithium is not metabolised in the body — the pharmacokinetics reflect only absorption, distribution in body water and renal excretion.
Complete absorption in the upper gastrointestinal tract after oral administration; peak serum concentrations 0.25 to 3 hours (immediate release) and 2 to 6 hours (sustained release).
It is not metabolised. It is excreted mainly in the urine, proportionally to the serum concentration: filtered at the glomerulus, 80% is reabsorbed by passive diffusion in the proximal tubule. Faecal excretion is insignificant.
Elimination half-life of approximately 18 to 36 hours. Apparent clearance and volume of distribution increase with body weight in children.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
