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

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Interactions

Interaction Checker

and lithium

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            Contraindicated (2)

            • dronedarone

              lithium and dronedarone both increase QTc interval. Contraindicated.

            • thioridazine

              lithium and thioridazine both increase QTc interval. Contraindicated.

            Serious - Use Alternative (106)

            • amiodarone

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

            • amisulpride

              amisulpride and lithium both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

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

            • anagrelide

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

            • arsenic trioxide

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

            • 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.

            • asenapine

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

            • azilsartan

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

            • azithromycin

              lithium and azithromycin both increase QTc interval. 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.

            • buprenorphine

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

            • 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.

            • chlorpromazine

              lithium and chlorpromazine 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.

            • disopyramide

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

            • dofetilide

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

            • donepezil

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

            • droperidol

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

            • eliglustat

              lithium and eliglustat 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.

            • eribulin

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

            • erythromycin base

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

            • erythromycin ethylsuccinate

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

            • erythromycin lactobionate

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

            • erythromycin stearate

              lithium and erythromycin stearate both increase QTc interval. 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.

            • flecainide

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

            • foscarnet

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

            • glasdegib

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

            • goserelin

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

            • hydroxychloroquine sulfate

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

            • ibutilide

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

            • iloperidone

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

            • inotuzumab

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

            • 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.

            • isoflurane

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

            • ivosidenib

              lithium and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

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

            • lenvatinib

              lithium and lenvatinib 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.

            • lopinavir

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

            • 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.

            • macimorelin

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

            • maprotiline

              lithium and maprotiline both increase QTc interval. 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.

            • methadone

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

            • 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.

            • midostaurin

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

            • mifepristone

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

            • mirtazapine

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

            • mobocertinib

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

            • moxifloxacin

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

            • nilotinib

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

            • olmesartan

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

            • ondansetron

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

            • osimertinib

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

            • oxaliplatin

              lithium and oxaliplatin both increase QTc interval. 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.

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

            • paliperidone

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

            • panobinostat

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

            • pazopanib

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

            • pentamidine

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

            • phenelzine

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

            • pimavanserin

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

            • pimozide

              lithium and pimozide both increase QTc interval. Contraindicated.

            • pitolisant

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

            • ponesimod

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

            • procainamide

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

            • procarbazine

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

            • propafenone

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

            • quetiapine

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

            • quinidine

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

            • quinine

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

            • ribociclib

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

            • ropeginterferon alfa 2b

              ropeginterferon alfa 2b and lithium both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.

            • 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.

            • saquinavir

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

            • selpercatinib

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

            • sevoflurane

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

            • siponimod

              lithium and siponimod both increase QTc interval. 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.

            • sorafenib

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

            • sotalol

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

            • telmisartan

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

            • tetrabenazine

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

            • toremifene

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

            • tranylcypromine

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

            • trazodone

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

            • valsartan

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

            • vandetanib

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

            • vemurafenib

              lithium and vemurafenib both increase QTc interval. 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.

            • ziprasidone

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

            Monitor Closely (212)

            • 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.

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

            • 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.

            • ciprofloxacin

              lithium and ciprofloxacin both increase QTc interval. 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.

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

            • 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.

            • daridorexant

              lithium and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • 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.

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

            • 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.

            • dextroamphetamine transdermal

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

            • 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.

            • difelikefalin

              difelikefalin and lithium both increase sedation. 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.

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

            • 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).

            • fingolimod

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

            • fluconazole

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

            • fluoxetine

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

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

            • 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).

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

            • 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.

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

            • 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.

            • gemifloxacin

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

            • gemtuzumab

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

            • gilteritinib

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

            • granisetron

              granisetron and lithium both increase QTc interval. 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).

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

            • histrelin

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

            • hydrochlorothiazide

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

            • hydroxyzine

              hydroxyzine and lithium both increase QTc interval. 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.

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

            • indapamide

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

              lithium and indapamide both increase QTc interval. 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.

            • isradipine

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

            • itraconazole

              itraconazole and lithium both increase QTc interval. 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.

            • lapatinib

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

            • leuprolide

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

            • levofloxacin

              lithium and levofloxacin both increase QTc interval. 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.

            • lofexidine

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

            • loperamide

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

            • 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.

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

            • octreotide

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

            • ofloxacin

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

            • 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).

              lithium and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances

            • 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.

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

            • pasireotide

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

            • 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).

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

            • 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.

            • posaconazole

              lithium and posaconazole both increase QTc interval. 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.

            • primaquine

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

            • procarbazine

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

            • prochlorperazine

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

              lithium and prochlorperazine both decrease QTc interval. Use Caution/Monitor.

            • 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.

              lithium and promethazine both decrease QTc interval. Use Caution/Monitor.

            • protriptyline

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

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

            • 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.

            • ranolazine

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

            • rilpivirine

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

            • 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).

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

            • rizatriptan

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

            • romidepsin

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

            • 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.

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

            • solifenacin

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

            • 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.

            • sunitinib

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

            • tacrolimus

              lithium and tacrolimus both increase QTc interval. 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.

            • telavancin

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

            • 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).

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

            • 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.

            • triclabendazole

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

            • 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).

              lithium and trifluoperazine both decrease QTc interval. Use Caution/Monitor.

            • trimipramine

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

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

            • triptorelin

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

            • 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.

            • vardenafil

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

            • venlafaxine

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

              lithium and venlafaxine both decrease QTc interval. Use Caution/Monitor.

            • voclosporin

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

            • voriconazole

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

            • vorinostat

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

            • 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
            -
            600 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
            -
            150 mg capsule
            lithium carbonate oral
            -
            450 mg tablet
            lithium carbonate oral
            -
            300 mg capsule
            lithium carbonate oral
            -
            300 mg tablet
            lithium carbonate oral
            -
            300 mg capsule
            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
            -
            300 mg tablet
            lithium carbonate oral
            -
            300 mg tablet
            lithium carbonate oral
            -
            600 mg capsule
            lithium carbonate oral
            -
            450 mg tablet
            lithium carbonate oral
            -
            450 mg tablet
            lithium carbonate oral
            -
            450 mg tablet
            lithium carbonate oral
            -
            300 mg tablet
            lithium carbonate oral
            -
            150 mg capsule
            lithium carbonate oral
            -
            150 mg capsule

            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 last or get worse, 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).Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using lithium. Lithium 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, talk to your doctor right away about the risks and benefits of this medication.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 February 2022. Copyright(c) 2022 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

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            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.
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            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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            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.
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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.