Side Effects of Lithium Carbonate ER

Lithium carbonate treats and controls bipolar disease, but you must use it carefully and work with your health care provider to determine the most beneficial dose. Serious and common side effects include dizziness, nausea and weight gain. Poisoning and death can occur when you take too much lithium, and the medication will not have any positive effects if you take too little.

Use

• Lithium carbonate reduces mania in individuals with bipolar disorder, a condition often referred to as manic depression. The medication also works to prevent manic episodes, which are marked by rapid speech, hyperactivity, sleeplessness, grandiose thinking, aggressiveness and, sometimes, hostility.

Dose

• To treat a manic episode, the usual dose of extended-release lithium carbonate is 1,800 mg per day, divided into a morning dose of 900 mg and a nighttime dose of 900 mg. Mania may persist for weeks after the beginning of treatment.
  To maintain a stable mood, the usual dose is 1,200 mg per day, again divided into equal morning and nighttime doses.
  If you are older or taking any of the medications listed in the Interactions section, you will likely take lower doses of lithium.
  Your health care provider will need to perform regular blood tests to ensure you are receiving a therapeutic dose of lithium carbonate. Expect blood work twice a week when you first begin taking lithium, and then at least every two months after a maintenance dose has been determined.

Side Effects

• Expect one or more of the following side effects:
  • Stomach pain or discomfort
  • Diarrhea
  • Tremors, tics, twitching or muscle spasms
  • Frequent urination and nighttime urination
  • Thirst
  • Weight gain
  • Edema (the collection of fluid in the body, especially at the wrist or ankle)
  • Reduced emotional response
  • Worsening of psoriasis
  You may also experience dizziness, drowsiness, lack of coordination and weakness when starting lithium therapy or moving to a higher dose.
  Other reported side effects listed in lithium carbonate's prescribing information include acne, altered taste, blackouts, excessive salivation, fatigue, hair loss, impotence/sexual dysfunction, incontinence, loss of speech and swollen joints. You may also develop diabetes or goiter if you use lithium for years because the medication affects kidney and thyroid function.
  Last, Etienne Marc Grandjean and Jean-Michel Aubrey noted in a review of problems experienced by patients taking lithium that appears in the May 2009 issue of the journal CNS Drugs that clinical researchers have documented "a slight, negative effect on vigilance, alertness, learning and short-term memory after long-term administration" of the medication.
  Generally, the occurrence of side effects is associated with dosage. That is, if you are taking a higher lithium dose, you are at greater risk for problems.
  You can minimize your risk for lithium side effects by drinking a lot of water (10 to 12 glasses each day), eating a balanced diet that includes salt, keeping your caffeine intake to a minimum, not allowing yourself to get dehydrated, and taking doses right after a meal or with food or milk.
  Never double up on doses if you miss a morning or nighttime dose. Call your health care provider for advice on what to do if you miss a dose. Also, do not go on a crash diet while taking lithium. If your food and liquid intakes drop, or if your body weight decreases, your usual doses of lithium could become too high.

Lithium Poisoning

• The prescribing information for lithium carbonate states, "The toxic concentrations for lithium (1.5 mEq/L) are close to the therapeutic concentrations (0.6 to 1.2 mEq/L)." An overdose of lithium can lead to organ failure and even death, so watch closely for signs of toxicity. Stop using the medication and contact your health care provider immediately if you suspect you have taken too much lithium.
  Early signs of lithium poisoning include diarrhea, dizziness, drowsiness, lack of coordination and vomiting. Surer signs of an overdose are inability to control one or more body part (ataxia), blurred vision, giddiness, ringing in the ears (tinnitus) and large urinary output.
  You will need dialysis if you develop lithium poisoning.

Warnings

• You may need to stop taking lithium or have your dosage adjusted downward if you are pregnant or breastfeeding; if you develop brain, heart, kidney or liver disease; or if you have diabetes, difficulty urinating, epilepsy, Parkison's disease or thyroid problems. Also, when first beginning to take lithium, do not drive or engage in hazardous activities until you know how the medication will affect your balance, coordination, eyesight and strength.

Interactions

• Several prescription and over-the-counter medications can affect how lithium carbonate works in your body. Make sure to discuss all your medications, vitamins and herbal supplements with your health care provider, but be especially sure to let your provider know if you are taking any of the following:
  • Angiotensin converting enzyme, or ACE, inhibitor (e.g., enalapril, sold by Biovail as Vasotec)
  • Acetazolamide
  • Calcium channel blockers (e.g., amlodipine, sold by Pfizer as Norvasc)
  • Carbamazepine
  • Diuretics
  • Fluoxetine
  • Iodide preparations, especially potassium iodide
  • Metronidazole
  • Nonsteroidal anti-inflammatory drugs (e.g., celecoxib, sold by Pfizer as Celebrex)
  • Sodium bicarbonate
  • Urea
  • Xanthine preparations

Availability

• Noven pharmaceuticals markets 300 mg tablets of lithium carbonate under the brand name Lithobid. Roxane produces generic lithium carbonate tablets in 300 mg and 450 mg strengths, and West-Ward Pharmaceutical Corp. produces 400 mg and 600 mg generic tablets.
  GlaxoSmithKline no longer makes its branded version of lithium carbonate, Eskalith, but drug references such as the PDR still list Eskalith.