lithium (Rx)

Brand and Other Names:Eskalith, Lithobid
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet, extended release

  • 300mg
  • 450mg

tablet

  • 300mg

capsule

  • 150mg
  • 300mg
  • 600mg

solution

  • 8mEq/5mL

Bipolar Disorder

Immediate release: 900-1800 mg/day PO divided q6-8hr

Extended release: 900-1800 mg/day PO divided q12hr

Lower initial dosage may be used to minimize adverse drug reactions

Serum lithium should be monitored 12 hours after dose, twice weekly until serum concentration and clinical condition stabilize, and every other month thereafter

Increase dose as tolerated to target serum lithium concentrations of 0.8-1.2 mEq/L (acute goal) or 0.8-1.0 mEq/L (maintenance goal)

Huntington's Disease (Orphan)

Lithium citrate tetrahydrate (in reverse micelle formulation)

Orphan indication sponsor

  • Medesis Pharma; L'Oree des Mas, 34 670 Baillargues, France

Administration

Preferably taken with food

Dosage Forms & Strengths

tablet, extended release

  • 300mg
  • 450mg

tablet

  • 300mg

capsule

  • 150mg
  • 300mg
  • 600mg

solution

  • 8mEq/5mL

Bipolar Disorder (Off-label)

<7 years: Safety and efficacy not established

≥7 years (<30 kg): 300 mg PO BID; increase dose by 300 mg/day at weekly intervals based on response and tolerability; titrate dose to maintain serum trough concentration of 0.8-1.2 mEq/L

≥7 years (<30 kg): 300 mg PO TID; first week of therapy; may increase dose by 300 mg/day at weekly intervals; titrate to response to maintain serum trough concentration of 0.8-1.2 mEq/L

Extended release (≥12 years)

  • Fixed dosing
    • <22 kg: 600 mg/day PO divided BID
    • 22-41 kg 900 mg/day PO divided BID
    • >41 kg: 1200 mg/day PO divided BID
    • Increase dose as tolerated to target serum lithium concentrations of 0.8-1.2 mEq/L (acute goal) or 0.8-1.0 mEq/L (maintenance goal)
  • Weight based dosing
    • 15 mg/kg/dose PO PID; not to exceed 600 mg/dose initially  
    • Increase dose as tolerated to target serum lithium concentrations of 0.8-1.2 mEq/L (acute goal) or 0.8-1.0 mEq/L (maintenance goal)

Dosing in elderly patients should be cautious, usually starting at low end of range

Elderly patients often respond to reduced dosage and may exhibit signs of toxicity at serum concentrations ordinarily tolerated by younger patients

Next:

Interactions

Interaction Checker

and lithium

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              Serious - Use Alternative (38)

              • artemether

                artemether and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • artemether/lumefantrine

                artemether/lumefantrine and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • azilsartan

                azilsartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

              • bedaquiline

                bedaquiline and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • bremelanotide

                bremelanotide will decrease the level or effect of lithium by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.

              • candesartan

                candesartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

              • ceritinib

                ceritinib and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • chloroquine

                chloroquine and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • citalopram

                citalopram and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • clarithromycin

                clarithromycin and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • clozapine

                clozapine and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • crizotinib

                crizotinib and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • desflurane

                desflurane and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • desvenlafaxine

                lithium and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

              • donepezil

                donepezil and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • encorafenib

                encorafenib and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • entrectinib

                entrectinib and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • eprosartan

                eprosartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

              • fexinidazole

                fexinidazole and lithium both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              • irbesartan

                irbesartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

              • isocarboxazid

                isocarboxazid and lithium both increase serotonin levels. Avoid or Use Alternate Drug.

              • lefamulin

                lefamulin and lithium both increase QTc interval. Avoid or Use Alternate Drug.

              • linezolid

                linezolid and lithium both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

              • lorcaserin

                lithium and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

              • losartan

                losartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

              • mefloquine

                mefloquine increases toxicity of lithium by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              • metoclopramide intranasal

                lithium, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              • olmesartan

                olmesartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

              • ozanimod

                ozanimod increases toxicity of lithium by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

              • phenelzine

                phenelzine and lithium both increase serotonin levels. Avoid or Use Alternate Drug.

              • procarbazine

                procarbazine and lithium both increase serotonin levels. Avoid or Use Alternate Drug.

              • sacubitril/valsartan

                sacubitril/valsartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

                sacubitril/valsartan increases levels of lithium by unknown mechanism. Avoid or Use Alternate Drug.

              • sodium phosphate rectal

                sodium phosphate rectal decreases levels of lithium by Other (see comment). Avoid or Use Alternate Drug. Comment: Sodium phosphates may cause hypernatremia which increases lithium renal clearance; more common with large doses of oral sodium phosphate.

              • telmisartan

                telmisartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

              • tranylcypromine

                tranylcypromine and lithium both increase serotonin levels. Avoid or Use Alternate Drug.

              • valsartan

                valsartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

              • vilazodone

                lithium, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

              • vortioxetine

                lithium, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

              Monitor Closely (176)

              • 5-HTP

                5-HTP and lithium both increase serotonin levels. Use Caution/Monitor.

              • aceclofenac

                aceclofenac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • acemetacin

                acemetacin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • albuterol

                albuterol and lithium both increase QTc interval. Use Caution/Monitor.

              • alfuzosin

                alfuzosin and lithium both increase QTc interval. Use Caution/Monitor.

              • almotriptan

                almotriptan and lithium both increase serotonin levels. Use Caution/Monitor.

              • amitriptyline

                amitriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • amoxapine

                amoxapine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • apomorphine

                apomorphine and lithium both increase QTc interval. Use Caution/Monitor.

              • arformoterol

                arformoterol and lithium both increase QTc interval. Use Caution/Monitor.

              • aripiprazole

                lithium, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

                aripiprazole and lithium both increase QTc interval. Use Caution/Monitor.

              • asenapine

                lithium, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • aspirin

                aspirin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • aspirin rectal

                aspirin rectal increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • atomoxetine

                atomoxetine and lithium both increase QTc interval. Use Caution/Monitor.

              • benazepril

                benazepril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule. Monitor lithium levels.

              • bendroflumethiazide

                bendroflumethiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.

              • buspirone

                buspirone and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • captopril

                captopril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule. Monitor lithium levels.

              • carbamazepine

                carbamazepine, lithium. Mechanism: unknown. Use Caution/Monitor. Risk of neurotoxicity.

              • cariprazine

                lithium, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • celecoxib

                celecoxib increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • chlorothiazide

                chlorothiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.

              • chlorpromazine

                lithium, chlorpromazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

              • chlorthalidone

                chlorthalidone increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • citalopram

                citalopram, lithium. Mechanism: unknown. Use Caution/Monitor. Lithium may enhance the serotonergic effects of citalopram, caution should be exercised when citalopram and lithium are coadministered.

              • clomipramine

                clomipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • clozapine

                lithium, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • cocaine

                cocaine and lithium both increase serotonin levels. Use Caution/Monitor.

              • cyclopenthiazide

                cyclopenthiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.

              • dasatinib

                dasatinib and lithium both increase QTc interval. Use Caution/Monitor.

              • degarelix

                degarelix and lithium both increase QTc interval. Use Caution/Monitor.

              • desipramine

                desipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • deutetrabenazine

                deutetrabenazine and lithium both increase QTc interval. Use Caution/Monitor.

              • dexfenfluramine

                dexfenfluramine and lithium both increase serotonin levels. Use Caution/Monitor.

              • dextroamphetamine

                dextroamphetamine and lithium both increase serotonin levels. Use Caution/Monitor.

              • dextromethorphan

                dextromethorphan and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • diclofenac

                diclofenac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • diflunisal

                diflunisal increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • dihydroergotamine

                dihydroergotamine and lithium both increase serotonin levels. Use Caution/Monitor.

              • dihydroergotamine intranasal

                dihydroergotamine intranasal and lithium both increase serotonin levels. Use Caution/Monitor.

              • diltiazem

                diltiazem increases toxicity of lithium by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of neurotoxicity.

              • dolasetron

                dolasetron and lithium both increase QTc interval. Use Caution/Monitor.

              • doxepin

                doxepin and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

                doxepin and lithium both increase QTc interval. Use Caution/Monitor.

              • dulaglutide

                dulaglutide, lithium. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.

              • duloxetine

                duloxetine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • efavirenz

                efavirenz and lithium both increase QTc interval. Use Caution/Monitor.

              • eletriptan

                eletriptan and lithium both increase serotonin levels. Use Caution/Monitor.

              • enalapril

                enalapril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • ergotamine

                ergotamine and lithium both increase serotonin levels. Use Caution/Monitor.

              • escitalopram

                escitalopram and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • etodolac

                etodolac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • fenfluramine

                fenfluramine and lithium both increase serotonin levels. Use Caution/Monitor.

              • fenoprofen

                fenoprofen increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • ferric maltol

                ferric maltol, lithium. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).

              • fluoxetine

                fluoxetine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • fluphenazine

                lithium, fluphenazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

                lithium, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • flurbiprofen

                flurbiprofen increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • fluvoxamine

                fluvoxamine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • fosinopril

                fosinopril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • fostemsavir

                lithium and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

              • frovatriptan

                frovatriptan and lithium both increase serotonin levels. Use Caution/Monitor.

              • haloperidol

                lithium, haloperidol. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

                lithium, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • hydrochlorothiazide

                hydrochlorothiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.

              • ibuprofen

                ibuprofen increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • ibuprofen IV

                ibuprofen IV increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • iloperidone

                lithium, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • imidapril

                imidapril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • imipramine

                imipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • indapamide

                indapamide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.

              • indomethacin

                indomethacin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • insulin aspart

                lithium, insulin aspart. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin aspart protamine/insulin aspart

                lithium, insulin aspart protamine/insulin aspart. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin degludec

                lithium, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Lithium may either increase or decrease the blood glucose lowering effect of antidiabetic agents.

                lithium, insulin degludec. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin degludec/insulin aspart

                lithium, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Lithium may either increase or decrease the blood glucose lowering effect of antidiabetic agents.

              • insulin detemir

                lithium, insulin detemir. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin glargine

                lithium, insulin glargine. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin glulisine

                lithium, insulin glulisine. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin inhaled

                lithium, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Lithium may either increase or decrease the blood glucose lowering effect of antidiabetic agents.

                lithium, insulin inhaled. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin isophane human/insulin regular human

                lithium, insulin isophane human/insulin regular human. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin lispro

                lithium, insulin lispro. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin lispro protamine/insulin lispro

                lithium, insulin lispro protamine/insulin lispro. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin NPH

                lithium, insulin NPH. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • insulin regular human

                lithium, insulin regular human. unspecified interaction mechanism. Use Caution/Monitor. Lithium salts may cause either hypoglycemia or hyperglycemia. Insulin dosage adjustment and increased glucose monitoring may be required.

              • isocarboxazid

                lithium, isocarboxazid. Mechanism: unknown. Use Caution/Monitor. Risk of malignant hyperpyrexia. Interactions esp. expected w/non selective MAOIs.

              • isoniazid

                isoniazid and lithium both increase serotonin levels. Use Caution/Monitor.

              • ketoprofen

                ketoprofen increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • ketorolac

                ketorolac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • ketorolac intranasal

                ketorolac intranasal increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • L-tryptophan

                L-tryptophan and lithium both increase serotonin levels. Use Caution/Monitor.

              • levomilnacipran

                levomilnacipran and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • linezolid

                lithium, linezolid. Mechanism: unknown. Use Caution/Monitor. Risk of malignant hyperpyrexia. Interactions esp. expected w/non selective MAOIs.

              • lisdexamfetamine

                lithium, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

              • lisinopril

                lisinopril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • lofepramine

                lofepramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • lornoxicam

                lornoxicam increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • loxapine

                lithium, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • loxapine inhaled

                lithium, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • lsd

                lithium and lsd both increase serotonin levels. Use Caution/Monitor.

              • lurasidone

                lithium, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • maprotiline

                maprotiline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • meclofenamate

                meclofenamate increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • mefenamic acid

                mefenamic acid increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • meloxicam

                meloxicam increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • meperidine

                lithium and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.

              • methyclothiazide

                methyclothiazide increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.

              • metolazone

                metolazone increases toxicity of lithium by decreasing elimination. Use Caution/Monitor.

              • midazolam intranasal

                midazolam intranasal, lithium. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • milnacipran

                milnacipran and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • mirtazapine

                lithium and mirtazapine both increase serotonin levels. Use Caution/Monitor.

              • moexipril

                moexipril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • molindone

                lithium, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • morphine

                lithium and morphine both increase serotonin levels. Use Caution/Monitor.

              • nabumetone

                nabumetone increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • naproxen

                naproxen increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • naratriptan

                naratriptan and lithium both increase serotonin levels. Use Caution/Monitor.

              • nefazodone

                nefazodone and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • nortriptyline

                nortriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • olanzapine

                lithium, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • oliceridine

                lithium, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.

              • osilodrostat

                osilodrostat and lithium both increase QTc interval. Use Caution/Monitor.

              • oxaprozin

                oxaprozin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • paliperidone

                lithium, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • parecoxib

                parecoxib increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • paroxetine

                paroxetine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • pentazocine

                lithium and pentazocine both increase serotonin levels. Use Caution/Monitor.

              • perindopril

                perindopril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • perphenazine

                lithium, perphenazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

                lithium, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • phenelzine

                lithium, phenelzine. Mechanism: unknown. Use Caution/Monitor. Risk of malignant hyperpyrexia. Interactions esp. expected w/non selective MAOIs.

              • pimavanserin

                lithium, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • pimozide

                lithium, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • piroxicam

                piroxicam increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • potassium iodide

                potassium iodide, lithium. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Concomitant use with antithyroid drugs may potentiate the hypothyroid and goitrogenic effects of potassium iodide.

              • procarbazine

                lithium, procarbazine. Mechanism: unknown. Use Caution/Monitor.

              • prochlorperazine

                lithium, prochlorperazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

              • promazine

                lithium, promazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

              • promethazine

                lithium, promethazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

              • protriptyline

                protriptyline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • quetiapine

                lithium, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • quinapril

                quinapril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • ramipril

                ramipril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • risperidone

                lithium, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • rizatriptan

                rizatriptan and lithium both increase serotonin levels. Use Caution/Monitor.

              • ropeginterferon alfa 2b

                ropeginterferon alfa 2b will increase the level or effect of lithium by Other (see comment). Use Caution/Monitor. Certain proinflammatory cytokines, including interferons, can suppress CYP450 enzymes resulting in increased exposures of some CYP substrates. Therefore, monitor patients who are receiving concomitant drugs that are CYP450 substrates with a narrow therapeutic index from toxicities to such drugs.

              • salicylates (non-asa)

                salicylates (non-asa) increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • salsalate

                salsalate increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • SAMe

                lithium and SAMe both increase serotonin levels. Use Caution/Monitor.

              • selegiline

                selegiline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • selegiline transdermal

                selegiline transdermal and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • sertraline

                sertraline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • St John's Wort

                lithium and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.

              • sulfasalazine

                sulfasalazine increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • sulindac

                sulindac increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • sumatriptan

                sumatriptan and lithium both increase serotonin levels. Use Caution/Monitor.

              • sumatriptan intranasal

                sumatriptan intranasal and lithium both increase serotonin levels. Use Caution/Monitor.

              • teduglutide

                teduglutide increases levels of lithium by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.

              • thioridazine

                lithium, thioridazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

              • thiothixene

                lithium, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • tinidazole

                tinidazole increases effects of lithium by unknown mechanism. Use Caution/Monitor. Metronidazole has been reported to elevate serum lithium levels. Tinidazole effects on lithium are unknown. Consider monitoring serum lithium and creatinine levels after several days of concomitant use with lithium and tinidazole to detect potential lithium intoxication.

              • tolfenamic acid

                tolfenamic acid increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • tolmetin

                tolmetin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • topiramate

                topiramate increases levels of lithium by unspecified interaction mechanism. Use Caution/Monitor. Increase in lithium exposure may occur with doses of up to 600 mg/day; monitor lithium levels when coadministered with high-dose topiramate .

              • tramadol

                lithium and tramadol both increase serotonin levels. Use Caution/Monitor.

              • trandolapril

                trandolapril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

              • tranylcypromine

                lithium, tranylcypromine. Mechanism: unknown. Use Caution/Monitor. Risk of malignant hyperpyrexia. Interactions esp. expected w/non selective MAOIs.

              • trazodone

                trazodone and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • trifluoperazine

                lithium, trifluoperazine. Other (see comment). Use Caution/Monitor. Comment: Risk of neurotoxicity. Multiple mechanisms involved.

                lithium, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • trimipramine

                trimipramine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • ustekinumab

                ustekinumab, lithium. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.

              • valerian

                valerian and lithium both increase sedation. Use Caution/Monitor.

              • venlafaxine

                venlafaxine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

              • xipamide

                xipamide increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.

              • ziprasidone

                lithium, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • zolmitriptan

                zolmitriptan and lithium both increase serotonin levels. Use Caution/Monitor.

              Minor (53)

              • alprazolam

                alprazolam increases levels of lithium by decreasing renal clearance. Minor/Significance Unknown.

              • amitriptyline

                lithium, amitriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • amlodipine

                amlodipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

              • amoxapine

                lithium, amoxapine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • atracurium

                lithium increases effects of atracurium by unknown mechanism. Minor/Significance Unknown.

              • cadexomer iodine

                cadexomer iodine, lithium. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypothyroid effects.

              • cisatracurium

                lithium increases effects of cisatracurium by unknown mechanism. Minor/Significance Unknown.

              • clevidipine

                clevidipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

              • clomipramine

                lithium, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • desipramine

                lithium, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • dosulepin

                lithium, dosulepin. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • doxepin

                lithium, doxepin. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • duloxetine

                duloxetine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • escitalopram

                escitalopram, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • ethotoin

                ethotoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.

              • felodipine

                felodipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

              • fluoxetine

                fluoxetine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • fosphenytoin

                fosphenytoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.

              • green tea

                green tea increases levels of lithium by unspecified interaction mechanism. Minor/Significance Unknown. Lithium levels may increase following abrupt caffeine withdrawal.

              • imipramine

                lithium, imipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • iodinated glycerol

                iodinated glycerol, lithium. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypothyroid effects.

              • iodine

                iodine, lithium. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypothyroid effects.

              • isradipine

                isradipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

              • levomilnacipran

                levomilnacipran, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • lofepramine

                lithium, lofepramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • maprotiline

                lithium, maprotiline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • methyldopa

                methyldopa increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.

              • metronidazole

                metronidazole increases levels of lithium by decreasing metabolism. Minor/Significance Unknown.

              • milnacipran

                milnacipran, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • nefazodone

                nefazodone, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • nicardipine

                nicardipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

              • nifedipine

                nifedipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

              • nisoldipine

                nisoldipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

              • nortriptyline

                lithium, nortriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • onabotulinumtoxinA

                lithium increases effects of onabotulinumtoxinA by unknown mechanism. Minor/Significance Unknown.

              • pancuronium

                lithium increases effects of pancuronium by unknown mechanism. Minor/Significance Unknown.

              • paroxetine

                paroxetine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • phenytoin

                phenytoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.

              • protriptyline

                lithium, protriptyline. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • rapacuronium

                lithium increases effects of rapacuronium by unknown mechanism. Minor/Significance Unknown.

              • rocuronium

                lithium increases effects of rocuronium by unknown mechanism. Minor/Significance Unknown.

              • sargramostim

                lithium increases effects of sargramostim by pharmacodynamic synergism. Minor/Significance Unknown.

              • sertraline

                sertraline, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • sodium chloride

                sodium chloride, lithium. Other (see comment). Minor/Significance Unknown. Comment: High sodium intake decreases lithium concentration; low sodium may increase lithium levels. Mechanism: Lithium excretion is proportional to salt intake.

              • sodium polystyrene sulfonate

                sodium polystyrene sulfonate decreases levels of lithium by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • succinylcholine

                lithium increases effects of succinylcholine by unknown mechanism. Minor/Significance Unknown.

              • theophylline

                theophylline decreases levels of lithium by increasing renal clearance. Minor/Significance Unknown.

              • trazodone

                lithium, trazodone. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

                trazodone, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • trimipramine

                lithium, trimipramine. Other (see comment). Minor/Significance Unknown. Comment: Risk of neurotoxicity in geriatric pts. Multiple mechanisms involved.

              • vasopressin

                lithium decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • vecuronium

                lithium increases effects of vecuronium by unknown mechanism. Minor/Significance Unknown.

              • venlafaxine

                venlafaxine, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

              • verapamil

                verapamil increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

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              Adverse Effects

              >10%

              Leukocytosis (most patients)

              Polyuria/polydypsia (30-50%)

              Dry mouth (20-50%)

              Hand tremor (45% initially, 10% after 1 year of treatment)

              Confusion (40%)

              Decreased memory (40%)

              Headache (40%)

              Muscle weakness (30% initially, 1% after 1 year of treatment)

              Electrocardiographic (ECG) changes (20-30%)

              Nausea, vomiting, diarrhea (10-30% initially, 1-10% after 1-2 years of treatment)

              Hyperreflexia (15%)

              Muscle twitch (15%)

              Vertigo (15%)

              1-10%

              Extrapyramidal symptoms, goiter (5%)

              Hypothyroidism (1-4%)

              Acne (1%)

              Hair thinning (1%)

              Frequency Not Defined

              Coma

              Lethargy

              Seizures

              Renal toxicity

              Acute lithium toxicity

              Lithium-induced polyuria

              Ataxia/gait disturbance

              Postmarketing Reports

              Dermatologic: Drying and thinning of hair, alopecia, anesthesia of skin, chronic folliculitis, xerosis cutis, psoriasis onset or exacerbation, generalized pruritus with or without rash, cutaneous ulcers, angioedema, drug reaction with eosinophilia and systemic symptoms (DRESS)

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              Warnings

              Black Box Warnings

              Toxicity is closely related to serum lithium concentrations and may occur at dosages close to therapeutic levels; monitor therapy by measuring serum lithium

              Equipped facilities should be identified before initiation of therapy to provide prompt and accurate serum lithium concentration data

              Contraindications

              Documented hypersensitivity

              Severe cardiovascular disease

              Pregnancy in 1st trimester

              Unstable renal function, sodium depletion, severe dehydration

              Severe debilitation

              Cautions

              Cardiovascular disease; reports of possible association between lithium treatment and unmasking of Brugada syndrome (abnormal ECG and risk of sudden death)

              Use with caution in patients with thyroid disease

              Narrow therapeutic index

              Risk of nephrogenic diabetes insipidus; such patients should be carefully managed to avoid dehydration with resulting lithium retention and toxicity; condition is usually reversible when lithium is discontinued

              Lithium-sensitive patients may experience toxicity symptoms with serum lithium concentrations of 1-1.5 mEq/L

              Lithium toxicity is closely related to serum levels and can occur at therapeutic dosages; if manifestations of toxicity occur, discontinue for 24-48 hours, then resume at lower dosage

              Mainitain geriatric patients on dosages that produce serum lithium concentrations at lower end of desired range

              May cause central nervous system (CNS) depression and impair ability to operate heavy machinery

              Hypercalcemia reported with or without hyperparathyroidism; women and older patients are possibly at greater risk; onset does not appear to be associated with duration of therapy

              Monitor changes in renal function; chronic therapy may diminish renal concentrating ability; usually reversible when lithium therapy discontinued

              Use caution in debilitated patients; may increase risk of lithium toxicity

              Use with caution in patients at risk for suicide

              Cases consistent with nephrotic syndrome reported with use of lithium; discontinuation of lithium in patients with nephrotic syndrome has resulted in remission of nephrotic syndrome

              Routine urinalysis and other tests may be used to evaluate tubular function (e.g., urine specific gravity or osmolality following a period of water deprivation, or 24-hour urine volume) and glomerular function (e.g., serum creatinine ,creatinine clearance, or proteinuria); during lithium therapy, progressive or sudden changes in renal function, even within normal range, indicate the need for re-evaluation of treatment

              An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN, and FBS) has reported in a few patients treated with lithium plus a neuroleptic, most notably haloperidol; in some instances, the syndrome was followed by irreversible brain damage; because of possible causal relationship patients receiving such combined therapy or patients with organic brain syndrome or other CNS impairment should be monitored closely for early evidence of neurologic toxicity and treatment discontinued promptly if such signs appear; encephalopathic syndrome may be similar to or the same as Neuroleptic Malignant Syndrome (NMS)

              Lithium may prolong effects of neuromuscular blocking agents; neuromuscular blocking agents should be given with caution to patients receiving lithium

              Lithium toxicity

              • The risk of lithium toxicity is increased in patients with significant renal or cardiovascular disease, severe debilitation or dehydration, or sodium depletion, and for patients receiving prescribed medications that may affect kidney function, such as angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), diuretics (loops and thiazides) and NSAIDs; for these patients, consider starting with lower doses and titrating slowly while frequently monitoring serum lithium concentrations and signs of lithium toxicity
              • Neurological signs of lithium toxicity range from mild neurological adverse reactions such as fine tremor, lightheadedness, lack of coordination, and weakness; to moderate manifestations like giddiness, apathy, drowsiness, hyperreflexia, muscle twitching, ataxia, blurred vision, tinnitus, and slurred speech; severe manifestations such as clonus, confusion, seizure, coma, and death may occur; in rare cases, neurological sequelae may persist despite discontinuing lithium treatment and may be associated with cerebellar atrophy
              • Cardiac manifestations involve electrocardiographic changes, such as prolonged QT interval, ST and T-wave changes and myocarditis; renal manifestations include urine concentrating defect, nephrogenic diabetes insipidus, and renal failure; respiratory manifestations include dyspnea, aspiration pneumonia, and respiratory failure; gastrointestinal manifestations include nausea, vomiting, diarrhea, and bloating; no specific antidote for lithium poisoning known
              • Monitor for signs and symptoms of toxicity; if symptoms occur, decrease dosage or discontinue lithium treatment

              Serotonin syndrome

              • Lithium can precipitate serotonin syndrome, a potentially life-threatening condition; risk is increased with concomitant use of other serotonergic drugs (including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, triptans, tricyclic antidepressants, fentanyl, tramadol, tryptophan, buspirone, and St. John’s Wort) and with drugs that impair metabolism of serotonin, eg, MAOIs
              • Monitor all patients taking lithium for emergence of serotonin syndrome; discontinue treatment with lithium and any concomitant serotonergic agents immediately if above symptoms occur and initiate supportive symptomatic treatment; if concomitant use of lithium with other serotonergic drugs is clinically warranted, inform patients of increased risk for serotonin syndrome and monitor for symptoms
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              Pregnancy & Lactation

              Pregnancy category: D

              Lactation: Drug is excreted in breast milk; use not recommended

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Inhibits postsynaptic D2 receptor supersensitivity

              Alters cation transport in nerve and muscle cells and influences reuptake of serotonin or norepinephrine

              Inhibits phosphatidylinositol cycle second messenger systems

              Absorption

              Bioavailability: Immediate release, 95-100%; extended release, 60-90%

              Onset: Initial antimanic effect, 5-7 days; full effect, 10-21 days

              Peak serum time: Immediate release, 0.5-2 hr; extended release, 4-12 hr

              Peak plasma concentration: 0.4-0.9 mEq/L

              Steady-state therapeutic plasma concentration: 0.5-1.3 mEq/L

              Distribution

              Vd: Approximates total body water (0.7-1 L/kg)

              Metabolism

              Not metabolized

              Elimination

              Half-life: 18-24 hr; up to 36 hr with advanced age or renal impairment

              Dialyzable: Yes (hemodialysis, 50-90 mL/min; peritoneal dialysis, 13-15 mL/min)

              Renal clearance: 20-40 mL/min

              Excretion: Urine (95-99%)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Lithobid oral
              -
              300 mg tablet
              lithium carbonate oral
              -
              300 mg tablet
              lithium carbonate oral
              -
              450 mg tablet
              lithium carbonate oral
              -
              150 mg capsule
              lithium carbonate oral
              -
              300 mg tablet
              lithium carbonate oral
              -
              300 mg capsule
              lithium carbonate oral
              -
              600 mg capsule
              lithium carbonate oral
              -
              300 mg tablet
              lithium carbonate oral
              -
              450 mg tablet
              lithium carbonate oral
              -
              300 mg capsule
              lithium carbonate oral
              -
              150 mg capsule
              lithium carbonate oral
              -
              150 mg capsule
              lithium carbonate oral
              -
              450 mg tablet
              lithium carbonate oral
              -
              300 mg tablet
              lithium carbonate oral
              -
              150 mg capsule
              lithium carbonate oral
              -
              600 mg capsule
              lithium carbonate oral
              -
              300 mg capsule
              lithium carbonate oral
              -
              300 mg tablet
              lithium carbonate oral
              -
              600 mg capsule
              lithium carbonate oral
              -
              300 mg capsule
              lithium carbonate oral
              -
              150 mg capsule
              lithium carbonate oral
              -
              300 mg tablet
              lithium carbonate oral
              -
              450 mg tablet
              lithium carbonate oral
              -
              600 mg capsule
              lithium carbonate oral
              -
              300 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              lithium carbonate oral

              LITHIUM CONTROLLED-RELEASE - ORAL

              (LITH-ee-um)

              COMMON BRAND NAME(S): Eskalith CR, Lithobid

              WARNING: It is very important to have the right amount of lithium in your body. Too much lithium may lead to unwanted effects such as nausea, diarrhea, shaking of the hands, dizziness, twitching, seizures, trouble speaking, confusion, or increase in the amount of urine. Tell your doctor right away if these effects occur.There is only a small difference between the correct amount of lithium and too much lithium. It is important that your doctor monitor you closely during treatment. Keep all medical and laboratory appointments while you are taking lithium.

              USES: This medication is used to treat manic-depressive disorder (bipolar disorder). It works to stabilize the mood and reduce extremes in behavior by restoring the balance of certain natural substances (neurotransmitters) in the brain.Some of the benefits of continued use of this medication include decreasing how often manic episodes occur and decreasing the symptoms of manic episodes such as exaggerated feelings of well-being, feelings that others wish to harm you, irritability, anxiousness, rapid/loud speech, and aggressive/hostile behaviors.

              HOW TO USE: There are different brands of this medication available. They may not have the same effects. Do not change brands without asking your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually 2-3 times daily. Take lithium with or immediately after meals to lessen stomach upset. Do not crush or chew this medication. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.Drink 8 to 12 glasses (8 ounces or 240 milliliters each) of water or other fluid each day, and eat a healthy diet with normal amounts of salt (sodium) as directed by your doctor or dietician while taking this medication. Large changes in the amount of salt in your diet may change your lithium blood levels. Do not change the amount of salt in your diet unless your doctor tells you to do so.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. The dosage is based on your medical condition, lithium blood levels, and response to treatment. This medication works best if the amount of the drug in your body is kept at a constant level. Take this drug at evenly spaced intervals.This medication must be taken exactly as prescribed. Keep taking lithium even if you feel well. Do not stop taking this drug without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Consult your doctor or pharmacist for more details.Tell your doctor if your condition does not improve or if it worsens. It may take 1 to 3 weeks to notice improvement in your condition.

              SIDE EFFECTS: See also Warning section.Drowsiness, dizziness, tiredness, increased thirst, increased frequency of urination, weight gain, and mildly shaking hands (fine tremor) may occur. These should go away as your body adjusts to the medication. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: diarrhea, vomiting, unsteady walk, confusion, trouble speaking, blurred vision, severe hand trembling (coarse tremor), vision changes (such as growing blind spot, vision loss), joint swelling/pain, pain/discoloration of finger/toes, cold hands/feet.Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, slow/fast/irregular heartbeat, shortness of breath, seizures.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking lithium, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart disease, kidney disease, urinary problems (such as difficulty urinating), underactive thyroid (hypothyroidism), seizures, Parkinson's disease, leukemia, severe dehydration, any infection with high fever, a certain skin disorder (psoriasis).Lithium treatment may rarely reveal an existing condition that affects the heart rhythm (Brugada syndrome). Brugada syndrome is an inherited, life-threatening heart problem that some people may have without knowing it. It can cause a serious (possibly fatal) abnormal heartbeat and other symptoms (such as severe dizziness, fainting, shortness of breath) that need medical attention right away. Brugada syndrome may cause death suddenly. Before starting lithium treatment, tell your doctor if you have any of the following risk factors: Brugada syndrome, unexplained fainting, family history of certain heart problems (Brugada syndrome, sudden unexplained death before 45 years old).This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).If heavy sweating or severe diarrhea occurs, check with your doctor right away how to best continue taking lithium. Take care in hot weather or during activities that cause you to sweat heavily such as during hot baths, saunas, or exercise.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication is not recommended for use during pregnancy. It may harm an unborn baby. However, since untreated mental/mood problems (such as bipolar disorder) can harm a pregnant woman and her unborn baby, do not stop taking this medication unless directed by your doctor. Instead, ask your doctor if a different medication would be right for you. If you are planning pregnancy, become pregnant, or think you may be pregnant, tell your doctor right away.Lithium passes into breast milk and may have undesirable effects on a nursing infant. Breast-feeding is not recommended while using this drug. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Other medications can affect the removal of lithium from your body, which may affect how lithium works. Examples include ACE inhibitors (such as captopril, enalapril), ARBs (such as losartan, valsartan), NSAIDs (such as celecoxib, ibuprofen), "water pills" (diuretics such as hydrochlorothiazide, furosemide), other drugs for mental/mood conditions (such as chlorpromazine, haloperidol, thiothixene), among others. Your doctor may need to adjust your dose of lithium if you are on these medications.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Some examples are street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (such as SSRIs like fluoxetine/paroxetine, SNRIs like duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.Eat a normal diet with an average amount of sodium. Consult your doctor or dietician for more details.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: diarrhea, vomiting, ringing in the ears, blurred vision, trouble walking, unusual drowsiness, seizures, shaking, loss of consciousness.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as kidney function, thyroid function, lithium and calcium blood levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, take it as soon as you remember unless your next scheduled dose is within 6 hours. In that case, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

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              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.