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High risk medicines: lithium

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Lithium is used as a mood stabiliser.

Lithium is sometimes prescribed in the management and treatment of mania, hypomania, recurrent depression, and bipolar disorder. It is sometimes prescribed for aggressive behaviour.

Lithium is usually prescribed by brand name so that the person receives the same medicine each time. This is because different brands may be absorbed differently. Currently in the UK, lithium salts are available as the following brands: Camcolit®, Liskonum®, Priadel®, Li-Liquid®.

Prescribing

A specialist in secondary care will usually start a prescription for lithium. This is because doses need to be changed based on serum lithium levels and clinical response.

It is normally prescribed under a shared care agreement between the secondary care consultant and the GP. This agreement clearly defines the responsibility of each healthcare professional and the patient. For example, the secondary care consultant is often responsible for initiating and reviewing the dose. The GP is then responsible for prescribing and ongoing blood monitoring.

Monitoring

Lithium levels are usually monitored at least every three months. This is sometimes more frequent in older people. Thyroid hormone levels and kidney function are also monitored every six months.

Regular blood tests are required so that the correct dose is prescribed. If the prescribed dose is too low, the medicine will not be effective. If the dose is too high, it could be harmful due to lithium toxicity. Very rarely, a high dose can be fatal.

Administering

Lithium is usually taken at night. This is because the person's blood needs to be tested at least 12 hours after they take their last dose.

Most lithium tablets are 'modified release' and should not be crushed or chewed.

Safety alert

The National Reporting and Learning Service issued an alert to highlight the importance of lithium compliance and monitoring. The service produced a booklet and supporting information. These should be given to all people taking lithium.

The booklet explains important information about:

  • the medicine
  • how to take it
  • how to recognise side effects
  • how to keep track of ongoing blood monitoring

Be aware of the signs of lithium toxicity. Contact the GP if any symptoms present. Symptoms include:

  • blurred vision
  • vomiting
  • diarrhoea
  • muscle weakness
  • drowsiness
  • feeling shaky
  • lack of coordination

Always maintain adequate fluid intake. Dehydration can cause lithium toxicity.

People taking lithium should not take over the counter non‑steroidal anti‑inflammatory drugs. These include ibuprofen and naproxen. If prescribed, this should be on a regular (not 'when required') basis. You should monitor the person monthly until a stable lithium level is reached. Then continue monitoring every three months.

Last updated:
21 August 2018

 


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