Lithobid (Lithium) – Oral

What Is Lithobid?

Lithobid (lithium) extended-release is a prescription medication option that's typically used for manic episodes associated with bipolar disorder.

Lithobid is classified as an antimanic agent. It's also commonly called a mood stabilizer. It's thought to affect how sodium moves in and out of your nerve and muscle cells and to affect the following naturally occurring chemicals in your brain: dopamine, epinephrine (adrenaline), and norepinephrine (noradrenaline).

Lithobid is available as lithium carbonate ER tablets. Lithium carbonate is also available in immediate-release (IR) tablets and capsules.

What Is Lithobid Used For?

Lithobid is used for bipolar disorder, and it can be used to relieve a manic episode, as well as a maintenance (long-term) treatment to reduce the frequency and intensity of these episodes.

It's estimated that 7 million people live with bipolar in the United States. The condition affects people of all sexes alike. People with bipolar disorder experience shifts of periods between mania and depression. The age of onset for bipolar is usually 25 years old, with some people starting to have symptoms as teenagers or younger. Childhood onset, however, is rare.

How to Take Lithobid

Take Lithobid by mouth as prescribed, which is usually two to three times daily. Take it with or without food. In some cases, your healthcare provider may move your dosing to once per day. The immediate-release versions of lithium usually are taken anywhere from one to three times per day.

Swallow the ER tablets whole. Don't crush, chew, or split them.

Storage

When you bring home Lithobid from the pharmacy, store the medication between 59 and 86 degrees F and should be fine at room temperature. Lithobid should also be protected from moisture. Keep your medications tightly closed and out of the reach of children and pets, ideally locked in a cabinet or closet.

Avoid pouring unused and expired drugs down the drain or in the toilet. Visit the FDA's website to know where and how to discard all unused and expired drugs. You can also find disposal boxes in your area. Ask your pharmacist or healthcare provider any questions you have about the best ways to dispose of your medications.

If you plan to travel with Lithobid, get familiar with your final destination's regulations. Checking with the U.S. Embassy or Consulate might be a helpful resource. Make a copy of your Lithobid prescription and keep your medication in its original container from your pharmacy with your name on the label. If you have any questions about traveling with your medicine, ask your pharmacist or healthcare provider.

Off-Label Uses

Healthcare providers may use lithium for the following off-label uses:

• Hypomania: Hypomania is a milder form of mania that sometimes occurs in people with bipolar 2. Lithium might be beneficial in treating hypomania.
• Bipolar depression: Studies suggest that lithium might help treat bipolar depression. Experts also recommend lithium for bipolar depression as short-term or maintenance (long-term) treatment.
• Depression: Lithium may be prescribed if antidepressants are ineffective or only partially effective at treating your depression.
• Suicide risk: Studies suggest that lithium might lower the risk of suicide in people with certain mental health conditions, such as depression or bipolar. Experts support lithium in combination therapy to reduce suicide risk in people with depression. Experts also support lithium by itself or in combination therapy for suicide risk reduction in people with bipolar.
  

What Are the Side Effects of Lithobid?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of lithium may include:

• Acne-like rash
• Appetite changes
• Diarrhea
• Dizziness
• Drowsiness
• Dry mouth
• Feelings of thirst
• Frequent urination (peeing)
• Hand tremors
• Headache
• Nausea or vomiting
• Thinning hair or hair loss
  

Side effects typically lessen as treatment continues, but you should notify your healthcare provider if they persist or worsen.

Severe Side Effects

Get medical help right away if you develop the following serious side effects:

• Severe allergic reaction
• Unsteady stance or gait (how you walk)
• Vision changes
• Serotonin syndrome: Mental status changes (e.g., confusion), neuromuscular symptoms (e.g., muscle rigidity or tremor), dizziness, rapid heartbeat, gastrointestinal effects (e.g., nausea, diarrhea), and seizures

The following side effects are common with Lithobid. These side effects, however, may become excessive or severe.

• Feelings of thirst
• Frequent urination
• Hand tremors
• Nausea or vomiting

Call 911 if your symptoms feel life-threatening.

Long-Term Side Effects

Potential long-term side effects with lithium may include:

• Hypothyroidism (underactive, or low, thyroid): Symptoms of hypothyroidism may include weight gain, constipation, and excessive tiredness.
• Rare kidney problems: If you're having kidney impairment, symptoms may include puffy eyes, swollen feet or ankles, and blood in foamy urine.
  

Dosage: How Much Lithobid Should I Take?

Modifications

The following modifications (changes) for certain groups of people should be kept in mind when using Lithobid:

Severe allergic reaction: Avoid using Lithobid if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In rat and mice studies, lithium was found to affect the fetus in a negative way. In humans, there are reports of some negative effects (e.g., heart problems) with lithium.

Speak to your healthcare provider if you plan to become pregnant or are pregnant. They will help you weigh the benefits and risks of taking lithium during your pregnancy.

Breastfeeding: Lithium is present in breast milk—but how much may vary per person. Lithium doesn't appear to cause any problems with growth and development of the infant, especially if lithium is taken by itself and the healthy nursing infant is older than 2 months.

Problems are more likely to develop in newborns or premature babies, especially if they're dehydrated. While breastfeeding, monitor your baby for abnormal behavior, restlessness, excessive drowsiness or sleepiness, and feeding problems.

Talk with your healthcare provider if you plan to breastfeed. Your healthcare provider will weigh the benefits and risks of lithium while nursing. They can also discuss the different ways available to feed your baby.

Adults over age 65: There haven't been any reported response differences to lithium between older and younger adults. Clinical studies, however, haven't included a large enough number of people in this age group to see whether they respond differently from younger adults. Generally, older adults with more than one medical condition or who take several medications should use caution. Older adults tend to be more sensitive to side effects from medications.

Children: Lithobid can be used in people 12 years and older. In general, children might be more sensitive to the effects of medications. There's a report that 300 milligrams (mg) of lithium in a 33-pound (lb.) child resulted in temporary side effects of uncontrolled muscle contractions and overactive muscle reflexes.

Kidney problems: Individuals with kidney problems may not be able to clear the medication from their bodies as easily as people with healthy organs. This means the medicine stays in the body longer and can have increased side effects. Lithium, in particular, is very sensitive to changes in kidney function. For this reason, your healthcare provider will closely monitor your kidney function and make any necessary changes to your lithium dose.

Hypothyroidism: If you have hypothyroidism, your healthcare provider will closely monitor your thyroid-related labs to make any necessary lithium dosage adjustments. If you develop hypothyroidism while taking lithium, your thyroid has trouble making enough thyroid hormones. For this reason, your healthcare provider will likely start you on levothyroxine for hypothyroidism treatment.

Severe heart condition: If you have a severe heart condition, you're more likely than average to have side effects with lithium. This is why your healthcare provider will need to closely monitor your lithium levels and make any necessary dosing changes.

Infection: Your healthcare provider might need to lower your lithium dose temporarily if you have an infection with symptoms of diarrhea or excessive sweating. This is to prevent side effects from a buildup of lithium.

Medications that affect lithium levels: In general, inform your healthcare provider about medication changes. Some medications can affect your lithium levels, raising the likelihood of side effects or making Lithobid less effective. For this reason, your healthcare provider may want to monitor your lithium levels and make any necessary dosage adjustments.

Salt changes in the body: Salt (sodium) level changes can happen from several things, such as medical conditions, medications, and diet. These changes might lead to side effects or affect lithium's effectiveness. As a result, your healthcare provider will closely monitor your lithium levels and make necessary lithium dosing changes.

Dietary changes in salt and fluid intake: Changing how much salt you eat or how much fluids you drink can result in side effects or change lithium's effectiveness. So, if you made these dietary changes, your healthcare provider may need also to modify your lithium dose.

Missed Dose

If you accidentally forgot your Lithobid dose, take it as soon as you remember. If it's already close to your next scheduled dose, then skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose. If you have any concerns about this, talk with your healthcare provider.

Try to find ways to help yourself remember to routinely keep your appointments and take your medication. If you miss too many doses, Lithobid might be less effective.

Overdose: What Happens If I Take Too Much Lithobid?

The symptoms of a suspected overdose of lithium may include:

• Blurred vision
• Diarrhea
• Dizziness or light-headedness
• Drowsiness
• Frequent urination
• Muscle movement impairment
• Muscle weakness
• Ringing ears
• Vomiting

If you think that you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

Precautions

What Are Reasons I Shouldn’t Take Lithobid?

Before taking Lithobid, talk with your healthcare provider if any of the following applies to you:

• Severe allergic reaction: If you have a severe allergic reaction to Lithobid or its components (ingredients), this medication isn't the right option for you.
• Pregnancy: In humans, there are some reports that lithium might be linked to negative effects on the unborn fetus. Reach out to your healthcare provider to discuss the benefits and risks of lithium while pregnant.
• Breastfeeding: In general, lithium doesn't seem to cause any problems if the drug is taken by itself and the healthy nursing infant is over 2 months old. If there are any problems, they're more likely with dehydrated newborns and preterm babies. While breastfeeding, monitor for lithium-related side effects, such as abnormal behavior, restlessness, excessive drowsiness or sleepiness, and feeding problems. Contact your healthcare provider to talk about the benefits and risks of lithium while nursing.
• Children: Lithium can only be used in people 12 years and older. Caution should be used with children in general since this age group is more sensitive to medication side effects than adults.
• Brugada syndrome: If you unknowingly have Brugada syndrome, lithium might unmask it. So, lithium isn't typically recommended. Brugada syndrome is a heart condition that can cause a life-threatening abnormal heart rhythm. While taking lithium, look out for the following Brugada symptoms of abnormal heartbeat, light-headedness, fainting, and breathing difficulties. Notify your healthcare provider if these symptoms happen to you.

What Other Medications Interact With Lithobid?

Use caution when taking Lithobid with the following medications:

• Neuromuscular blocking agents, such as succinylcholine
• Serotonergic medications, including selective serotonin reuptake inhibitor (SSRI) antidepressants like Prozac (fluoxetine)
• Medications that increase lithium levels, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
• Medications that lower lithium levels, such as theophylline or caffeine

Neuromuscular Blocking Agents

Neuromuscular blocking agents are also sometimes called paralytics. They're usually used to prevent muscle movement during procedures. Succinylcholine is an example of a paralytic. Lithium can cause a neuromuscular blocking agent to last longer. Use with caution.

Serotonergic Medications

Serotonergics are medications that raise serotonin levels. Serotonin is a naturally-occurring chemical in the brain. Taking lithium with a serotonergic raises your chances of a rare but life-threatening condition called serotonin syndrome. Symptoms of serotonin syndrome may include sweating, tremors, and seizures. A common serotonergic example is the SSRI antidepressant, such as Prozac (fluoxetine).

Medications That Increase Lithium Levels

Medications that raise your lithium levels might increase your likelihood of side effects. If you're taking these medications, your healthcare provider will likely lower your lithium dose. Examples of these medications include:

• Water pills—like Microzide (hydrochlorothiazide) for high blood pressure
• NSAIDs—like Advil (ibuprofen) to relieve fever, pain, or inflammation (swelling)
• Angiotensin receptor blockers (ARBs)—like Diovan (valsartan) for high blood pressure
• Angiotensin-converting enzyme (ACE) inhibitors (ACE-I)—like Lotensin (benazepril) for high blood pressure
• Monoamine oxidase inhibitor (MAOI) antidepressants—like Zelapar (selegiline) for depression or Parkinson's disease (PD)

Medications That Lower Lithium Levels

Medications that lower lithium levels might make lithium less effective. An example of a medication that lowers lithium levels is theophylline, which was commonly used for lung conditions in the past. Another example is caffeine, which is often found in combination products (e.g., Excedrin) to relieve migraines. If you take these types of medications, your healthcare provider might need to increase your lithium dose.

For more detailed information about medication interactions with Lithobid, talk with your pharmacist or healthcare provider.

And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter (OTC), nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

Lithium is an antimanic. It's also commonly called a mood stabilizer. Lithium is unique in that it's the only antimanic or mood stabilizer of its kind. Other mood stabilizers are anti-seizure medications, including:

• Depakene (valproate)
• Tegretol (carbamazepine)
• Trileptal (oxcarbazepine)
• Lamictal (lamotrigine), though not recommended for the acute treatment of mania

Lithium or valproate are the typical go-to choices for manic episodes, although valproate is used more for mixed episodes (mania and depression at the same time). The alternative options for manic episodes include carbamazepine and oxcarbazepine.

As for maintenance (long-term) treatment, lithium or valproate are first-line options again. Carbamazepine and oxcarbazepine are also second-line again—with lamotrigine as an additional alternative.

While all these medications are mood stabilizers, a couple of them may be used together for severe manic episodes.

How Can I Stay Healthy While Taking Lithobid?

If you're taking Lithobid, chances are bipolar disorder has been negatively affecting your quality of life. You may have already tried different approaches or treatments.

While living with a mental health condition does have its challenges, there are ways to help improve your quality of life. Refer below for some general suggestions to help you manage bipolar:

• Take mood-related medications as recommended by your healthcare provider.
• Share your condition with loved ones when you're ready. Having strong social support is important.
• Consider keeping a diary to record your moods and become more aware of your triggers.
• Eat a healthy diet.
• Exercise regularly.
• Find ways to manage stress.
• Make sure that you get enough sleep.