Lithium, Oral

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KEY POINTS

• This medicine is taken by mouth to treat bipolar disorder. Take it exactly as directed.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may cause unwanted side effects that may be severe. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• This medicine may interact with many other medicines. Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

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What are other names for this medicine?

Type of medicine: antimanic

Generic and brand names: lithium carbonate, oral; lithium citrate, oral; Lithobid

What is this medicine used for?

This medicine is taken by mouth to treat bipolar (manic-depressive) disorder.

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• Kidney disease
• Heart disease, including Brugada Syndrome
• Problems with dehydration
• Problems with levels of sodium in your blood
• Hypothyroidism (your thyroid gland does not produce enough thyroid hormone)
• Unexplained fainting

Also, tell your healthcare provider if anyone in your family has Brugada Syndrome or has had a sudden unexplained death (especially before the age of 45 years).

Females of childbearing age: Do not take this medicine if you are pregnant because it may harm the baby. If you become pregnant, contact your healthcare provider right away. Do not breast-feed while taking this medicine.

How do I take it?

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more or less or take it longer than prescribed. Take this medicine regularly every day. Do not stop taking this medicine without your healthcare provider's approval.

Check with your healthcare provider before using this medicine in children under age 12.

This medicine may come in different forms. If you have controlled-release tablets, do not break, crush, or chew them. Ask your pharmacist if you have the controlled-release tablets.

If you have the liquid form of this medicine, use the dose measuring device provided in the medicine package. Do not use a common household teaspoon. If you do not have a measuring device, ask your pharmacist.

Ask your healthcare provider about drinking more liquid every day and how much salt you should have in your diet. Do not change the amount of liquid or salt in your diet without your healthcare provider's approval.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: confusion, nausea, vomiting, diarrhea, trouble walking, drowsiness, muscle weakness, tremors, seizures, coma, blurred vision, ringing in the ears.

What should I watch out for?

You will need to have lab tests regularly to see how this medicine affects you. Keep all appointments for these tests.

Tell your healthcare provider right away if you have unusual sleepiness, severe diarrhea, severe nausea or vomiting, loss of balance, tremors, problems with vision, ringing in the ears, weakness, or if you urinate more than normal. These could be signs of too high of lithium levels in your blood.

This medicine may cause a life-threatening heart condition. If you develop severe dizziness, fainting, irregular heartbeat, or shortness of breath while taking this medicine, contact your healthcare provider right away.

This medicine may make you drowsy or dizzy. Do not drive or operate machinery unless you are fully alert.

Avoid activities that cause you to sweat heavily. Do not make a major change in your eating habits or go on a diet without your healthcare provider's approval. Contact your provider if you have diarrhea, vomiting, or an infection with a fever. The loss of water and salt from your body could lead to serious side effects while you are taking this medicine.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

If you have diabetes: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Diarrhea; loss of balance; severe dizziness or fainting; shortness of breath; seizures; fast, slow, or irregular heartbeat; loss of appetite; unusual tiredness or weakness; drowsiness; trembling; ongoing or severe nausea; vomiting; slurred speech; blurred vision; severe confusion; ringing in your ears; fever; unusual changes in urination; unusual sweating; uncontrolled movements.

Other: Mild thirst, mild trembling of hands, more frequent urination, mild nausea, rash, hair loss, change in sense of taste.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril, enalapril (Vasotec), fosinopril, lisinopril (Prinivil, Zestril), quinapril (Accupril), and trandolapril (Mavik)
• Acetazolamide (Diamox)
• Alfuzosin (Uroxatral)
• Anagrelide (Agrylin)
• Angiotensin receptor blockers (ARBs) such as azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan)
• Antibiotics such as azithromycin (Zithromax, Zmax), bedaquiline (Sirturo), ciprofloxacin (Cipro), clarithromycin (Biaxin), doxycycline (Doryx, Monodox, Vibramycin), erythromycin (E.E.S., Ery-Tab, Erythrocin), levofloxacin (Levaquin), linezolid (Zyvox), metronidazole, minocycline (Dynacin, Minocin, Solodyn), moxifloxacin (Avelox), ofloxacin, pentamidine (NebuPent, Pentam), telithromycin (Ketek), and tetracycline
• Antidepressants such as amitriptyline, citalopram (Celexa), desipramine (Norpramin), desvenlafaxine (Pristiq), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), nefazodone, nortriptyline (Pamelor), sertraline (Zoloft), and venlafaxine (Effexor)
• Antifungal medicines such as fluconazole (Diflucan) and voriconazole (Vfend)
• Antipsychotic medicines such as asenapine (Saphris), chlorpromazine, clozapine (Clozaril, FazaClo), fluphenazine, haloperidol (Haldol), iloperidone (Fanapt), paliperidone (Invega), perphenazine, pimozide (Orap), quetiapine (Seroquel), thioridazine, thiothixene (Navane), trifluoperazine, and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), phenytoin (Dilantin, Phenytek), and topiramate (Qudexy, Topamax, Trokendi)
• Apomorphine (Apokyn)
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Buspirone
• Calcitonin (Fortical, Miacalcin)
• Calcium channel blockers such as diltiazem (Cardizem, Cartia, Tiazac) and verapamil (Calan, Covera, Verelan)
• Cancer medicines such as arsenic trioxide (Trisenox), crizotinib (Xalkori), lapatinib (Tykerb), nilotinib (Tasigna), procarbazine (Matulane), sorafenib (Nexavar), sunitinib (Sutent), toremifene (Fareston), vandetanib (Caprelsa), and vemurafenib (Zelboraf)
• Cyclobenzaprine (Amrix)
• Dextromethorphan, an ingredient in many cough, cold, or allergy medicines such as Robitussin-DM
• Dextromethorphan/quinidine (Nuedexta)
• Diuretics (water pills) such as amiloride, bumetanide, chlorothiazide (Diuril), chlorthalidone, furosemide (Lasix), hydrochlorothiazide (Microzide), spironolactone (Aldactone), torsemide (Demadex), and triamterene (Dyrenium)
• Doxepin (Silenor)
• Eliglustat (Cerdelga)
• Fingolimod (Gilenya)
• Heart medicines such as amiodarone (Cordarone, Pacerone), disopyramide (Norpace), dronedarone (Multaq), flecainide, procainamide, propafenone (Rythmol), quinidine, ranolazine (Ranexa), and sotalol (Betapace, Sorine)
• HIV medicines such as lopinavir/ritonavir (Kaletra) and saquinavir (Invirase)
• Lorcaserin (Belviq)
• Malaria medicines such as artemether/lumefantrine (Coartem), chloroquine, mefloquine, primaquine, and quinine
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines to treat breathing or lung problems such as aminophylline, arformoterol (Brovana), formoterol (Perforomist), and theophylline
• Medicines to treat urinary and kidney problems such as ammonium chloride, methenamine (Hiprex, Urex), potassium citrate (Urocit-K), sodium bicarbonate, and sodium citrate (Bicitra)
• Methyldopa
• Mifepristone (Korlym, Mifeprex)
• Migraine medicines such as almotriptan (Axert), dihydroergotamine (D.H.E. 45, Migranal), eletriptan (Relpax), ergotamine (Ergomar), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, Sumavel), and zolmitriptan (Zomig)
• Milnacipran (Savella)
• Natural remedies such as guarana, kava, SAMe, St. John’s wort, and valerian
• Nausea medicines such as dolasetron (Anzemet), droperidol (Inapsine), ondansetron (Zofran), and promethazine
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as celecoxib (Celebrex), diclofenac (Cambia, Voltaren, Zipsor), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Pain medicines such as buprenorphine (Buprenex, Butrans), codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone/acetaminophen (Norco, Vicodin), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), oxycodone/acetaminophen (Percocet, Roxicet), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Paroxetine (Brisdelle, Paxil, Pexeva)
• Pasireotide (Signifor)
• Products that contain methylene blue (Hyophen, Prosed DS, Urophen, Uta)
• Tetrabenazine (Xenazine)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.