Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to lithium.

Lithium is used to treat and prevent episodes of mania (frenzied, abnormally excited mood) in people with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Lithium is in a class of medications called antimanic agents. It works by decreasing abnormal activity in the brain.

Lithium comes as a tablet, capsule, extended-release (long-acting) tablet, and solution (liquid) to take by mouth. The tablets, capsules, and solution are usually taken three to four times a day. The extended-release tablets are usually taken two to three times a day. Take lithium at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lithium exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the extended-release tablet whole; do not split, chew, or crush it.

Your doctor may increase or decrease the dose of your medication during your treatment. Follow these directions carefully.

Lithium may help to control your condition but will not cure it. It may take 1 to 3 weeks or longer for you to feel the full benefit of lithium. Continue to take lithium even if you feel well. Do not stop taking lithium without talking to your doctor.

Lithium is also sometimes used to treat depression, schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), disorders of impulse control (inability to resist the urge to perform a harmful action), and certain mental illnesses in children. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking lithium,

• Tell your doctor and pharmacist if you are allergic to lithium or any other medications.
• Tell your doctor if you are taking diuretics (‘water pills’). Your doctor may tell you not to take lithium if you are taking this medication or will monitor you carefully for side effects.
• Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: acetazolamide (Diamox); aminophylline; angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); angiotensin II receptor antagonists such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis); and valsartan (Diovan); antacids such as sodium bicarbonate; caffeine (found in certain medications to treat drowsiness and headaches); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac, others), felodipine (Plendil), isradipine (DynaCirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine (Nymalize), nisoldipine (Sular), and verapamil (Calan, Covera, Verelan); carbamazepine (Tegretol); medications for mental illness such as haloperidol (Haldol); methyldopa (Aldomet); metronidazole (Flagyl); nonsteroidal anti-inflammatory drugs (NSAIDs) such as celecoxib (Celebrex), indomethacin (Indocin), and piroxicam (Feldene); potassium iodide; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft); and theophylline (Theolair, Theochron). Your doctor may have to change the doses of your medication or monitor you more carefully for side effects.
• Tell your doctor if you have or have ever had heart or kidney disease. Also tell your doctor if you have or develop severe diarrhea, excessive sweating, or fever during your treatment. Your doctor may tell you not to take lithium or may monitor you more carefully for side effects.
• Tell your doctor if you have or have ever had organic brain syndrome (any physical condition that affects the way your brain works) or thyroid disease or if you have ever fainted without an explanation. Also tell your doctor if you or anyone in your family have or have ever had Brugada syndrome (a disorder that can cause a potentially fatal irregular heart rhythm) or if anyone in your family has died suddenly with no explanation before the age of 45 years.
• Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking lithium, call your doctor. Lithium may harm the fetus.
• If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lithium.
• You should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

It is important to follow a proper diet, including the right amounts of fluid and salt during your treatment. Your doctor will give you specific directions about the diet that is right for you. Follow these directions carefully.

Talk to your doctor about drinking drinks that contain caffeine, such as tea, coffee, cola, or chocolate milk.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Lithium may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• Restlessness
• Fine hand movements that are difficult to control
• Mild thirst
• Loss of appetite
• Stomach pain
• Gas
• Indigestion
• Weight gain or loss
• Dry mouth
• Excessive saliva in the mouth
• Change in the ability to taste food
• Swollen lips
• Acne
• Hair loss
• Unusual discomfort in cold temperatures
• Constipation
• Depression
• Joint or muscle pain
• Paleness
• Thin, brittle fingernails or hair
• Itching
• Rash

Some side effects may be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical help:

• Unusual tiredness or weakness
• Excessive thirst
• Frequent urination
• Slow, jerky movements
• Movements that are unusual or difficult to control
• Blackouts
• Seizures
• Fainting
• Dizziness or lightheadedness
• Fast, slow, irregular, or pounding heartbeat
• Shortness of breath
• Chest tightness
• Confusion
• Hallucinations (seeing things or hearing voices that do not exist)
• Crossed eyes
• Painful, cold, or discolored fingers and toes
• Headache
• Pounding noises inside the head
• Swelling of the feet, ankles, or lower legs

If you experience any of the following symptoms, stop taking lithium and call your doctor immediately:

• Drowsiness
• Shaking of a part of your body that you cannot control
• Muscle weakness, stiffness, twitching, or tightness
• Loss of coordination
• Diarrhea
• Vomiting
• Slurred speech
• Giddiness
• Ringing in the ears
• Blurred vision

Lithium may cause other side effects. Call your doctor if you experience any unusual symptoms while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• Diarrhea
• Vomiting
• Drowsiness
• Muscle weakness
• Loss of coordination
• Giddiness
• Blurred vision
• Ringing in the ears
• Frequent urination

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.