lithium (cont.)
When carbamazepine (Tegretol) and lithium are used together, some patients
may experience side effects, including dizziness, lethargy, and tremor. Central
nervous system side effects also may occur when lithium is used with
antidepressants, [for example, fluoxetine (Prozac) sertraline (Zoloft), and
paroxetine (Paxil), fluvoxamine (Luvox), amitriptyline (Elavil), imipramine
(Tofranil), desipramine (Norpramin)].
Medications which cause the urine to become alkaline (the opposite of acidic)
can increase the amount of lithium that is lost into the urine. This results in
lower blood concentrations of lithium and reduces the effects of lithium. Such
drugs include potassium acetate, potassium citrate
(Urocit-K), sodium bicarbonate, and
sodium citrate (Bicitra, Cytra-2, Liqui-Citra, Oracit, Shohl's).
Caffeine appears to reduce serum lithium concentrations, and side effects of
lithium have increased in frequency when caffeine is consumed.
Both diltiazem (Cardizem-CD, Tiazac, Dilacor-XR) and verapamil (Calan-SR,
Isoptin-SR, Verelan, Covera-HS) have been reported to have variable effects on
lithium levels in blood. In some patients there may be decreased lithium blood
levels and in others lithium toxicity.
Methyldopa (Aldomet) may increase the likelihood of lithium toxicity.
Various reactions have resulted when lithium is administered with
phenothiazines, [for example, chlorpromazine (Thorazine),
thioridazine
(Mellaril), trifluoperazine (Stelazine) or with haloperidol
(Haldol)]. Such
reactions have included delirium, seizures, encephalopathy, high fever or
certain neurologic reactions that affect movement of muscles, called
extrapyramidal symptoms.
Lithium can cause goiter or hypothyroidism. The use of lithium with potassium
iodide can increase the likelihood of this adverse reaction.
The use of the beta blocker, propranolol (Inderal), with lithium can lead to
a slow heart rate and dizziness. Other beta blockers, [for example, metoprolol
(Lopressor), atenolol (Tenormin)] also may interact with lithium and be
associated with a slow heart rate.
PREGNANCY: Lithium crosses the placenta and has been associated with
toxicity in the fetus. Children born to women taking lithium during
pregnancy
have an increased risk of goiter and cardiac anomalies. If possible, lithium
should be withheld during the first trimester. Women of childbearing age who may
require lithium should be counseled about becoming pregnant.
NURSING MOTHERS: Lithium is secreted into breast milk. Symptoms of
lithium toxicity, including changes in the electrocardiogram, have been seen in
some breast-fed infants, whose mothers were taking lithium. If possible, women
taking lithium should not breast-feed their infants.
SIDE EFFECTS: The most common side effects that can occur in persons
taking lithium are fine hand tremor, dry mouth, altered taste perception, weight
gain, increased thirst, increased frequency of urination, mild
nausea or
vomiting, impotence, decreased libido, diarrhea, and kidney abnormalities. Many
of the gastrointestinal side effects (nausea, taste alterations, diarrhea) often
disappear with continued therapy. Additionally, they may be less common if
lithium is taken in divided doses with meals. If diarrhea or excessive urination
lead to dehydration, lithium toxicity is possible. Lithium can also cause
changes in the electrocardiogram, low blood pressure, and decreased heart rate.
The following side effects suggest that lithium blood levels may be too high,
and that the dose of lithium may need to be reduced (after confirmation by
measurement of lithium levels in blood):
- loss of appetite,
- visual impairment,
- tiredness; muscle weakness,
- muscle fasciculations (twitches),
- tremor,
- unsteady gait,
- confusion, seizure,
- arrhythmias,
- slurred speech,
- coma.
About 1 in every 25 persons who receives lithium develops a goiter (an
enlarged thyroid gland). Hypothyroidism (low thyroid hormone levels) has been
reported. Signs of hypothyroidism may include:
- dry rough skin,
- hair loss,
- hoarseness,
- mania,
- mental depression,
- increased sensitivity to cold, and
- swelling of the feet, lower legs, and neck.
Reference: FDA Prescribing Information
Last Editorial Review: 11/16/2007
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