What is this medication?

LITHIUM (LITH ee um) treats bipolar disorder. It works by balancing substances in your brain that help regulate mood, behaviors, and thoughts.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Active infection
• Breathing problems
• Brugada Syndrome
• Dehydration (diarrhea or sweating)
• Diet low in salt
• Heart disease
• High levels of calcium in the blood
• History of irregular heartbeat
• Kidney disease
• Low level of potassium or sodium in the blood
• Parathyroid disease
• Problems urinating
• Thyroid disease
• An unusual or allergic reaction to lithium, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

Take this medication by mouth. Take it as directed on the prescription label at the same time every day. Use a specially marked oral syringe, spoon, or dropper to measure each dose. Ask your pharmacist if you do not have one. Household spoons are not accurate. You can take it with or without food. If it upsets your stomach, take it with food. Keep taking it unless your care team tells you to stop.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team about the use of this medication in children. While it may be prescribed for children as young as 7 years for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medication?

Do not take this medication with any of the following:

• Cisapride
• Dronedarone
• Pimozide
• Thioridazine

This medication may also interact with the following:

• Caffeine
• Carbamazepine
• Certain medications for depression, anxiety, or other mental health conditions
• Certain medications for high blood pressure
• Certain medications for migraine headache, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
• Diuretics
• Fentanyl
• Linezolid
• MAOIs, such as Carbex, Eldepryl, Marplan, Nardil, and Parnate
• Medications that relax muscles for surgery
• Methyldopa
• Metronidazole
• NSAIDs, medications for pain and inflammation, such as ibuprofen or naproxen
• Other medications that cause heart rhythm changes, such as dofetilide
• Phenytoin
• Potassium iodide
• SGLT2 inhibitors, such as canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin
• Sodium bicarbonate
• Sodium chloride
• St. John's Wort
• Theophylline
• Tramadol
• Tryptophan
• Urea

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. It can take several weeks of treatment before you start to get better.

The amount of salt (sodium) in your body influences the effects of this medication, and this medication can increase salt loss from the body. Eat a normal diet that includes salt. Do not change to salt substitutes. Avoid changes involving diet, or medications that include large amounts of sodium like sodium bicarbonate. Ask your care team for advice if you are not sure.

Drink plenty of fluids while you are taking this medication. Avoid drinks that contain caffeine, such as coffee, tea and colas. You will need extra fluids if you have diarrhea or sweat a lot. This will help prevent toxic effects from this medication. Be careful not to get overheated during exercise, saunas, hot baths, and hot weather. Consult your care team if you have a high fever or persistent diarrhea.

This medication may affect your coordination, reaction time, or judgment. Do not drive or operate machinery until you know how this medication affects you. Sit up or stand slowly to reduce the risk of dizzy or fainting spells. Drinking alcohol with this medication can increase the risk of these side effects.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
• Increased pressure around the brain—severe headache, blurry vision, change in vision, nausea, vomiting
• Increased thirst and amount of urine
• Irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea, which may be signs of serotonin syndrome
• Lithium toxicity—diarrhea, vomiting, tremors, loss of balance or coordination, uncontrollable eye movement, ringing of the ears, muscle weakness, twitching muscles, slurred speech, confusion

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Dizziness
• Fatigue
• Nausea
• Tremors or shaking

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from moisture. Keep container tightly closed. Throw away any unused medication after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.