Lithium: The First Mood Stabilizer

Part 3: Major Precautions and Warnings

by Marcia Purse

Dietary
Because lithium is related to sodium, it is important to drink plenty of fluids (avoid caffeinated beverages) and have an adequate supply of dietary salt. Too little salt can cause the body to hoard lithium instead, and too little water will decrease urination, which again can lead to lithium buildup.

Pregnancy/Breast-Feeding
Experts recommend that lithium use be discontinued during at least the first trimester of pregnancy, and throughout pregnancy if possible. Breast-feeding mothers should not take lithium.

Drug Interactions
Medications that can interact badly with lithium include:

• ibuprofen (Advil, Motrin)
• naproxen (Aleve)
• diuretics
• SSRI antidepressants (Prozac, Luvox, etc.)

and several others. Make sure your doctor has a complete list of both prescription and over-the-counter medications you take regularly or occasionally. Also be sure to tell other doctors who may prescribe for you that you are taking lithium.

The combination of haloperidol (Haldol) and lithium has caused extremely serious complications in a small number of patients. When these two medicines are prescribed together, the patient should be monitored very closely for rigidity and/or very high fever.

Geriatric Use
Elderly patients may develop lithium toxicity at much lower serum levels and so should be monitored appropriately.

Miscellaneous Cautions
Patients with psoriasis should use lithium with caution, as this medication is known to make psoriasis worse.

Care should be used if the patient has:

• cardiovascular disease
• any thyroid disease, or
• leukemia.

This is not an all-inclusive list. Read patient information that accompanies prescription and discuss this medication with your doctor.

Part 1: History, and a Mystery Solved
Part 2: Tests and Toxicity
Part 4: Whoa, Fat!