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Lithium for bipolar disorder: prevent adverse effects

Lithium is the reference drug for stabilising the mood of patients suffering from bipolar disorder. But it needs to be carefully dosed since there is a very narrow margin between the therapeutic dose and the appearance of sometimes severe adverse effects. With careful adjustment of the dosage the risk of adverse effects remains low.

Lithium is a reference drug for stabilising the mood of patients suffering from bipolar disorders and preventing acute suicidal and manic episodes. But there is a fine line – a narrow therapeutic margin – between an effective dosage and a dosage causing disproportionate adverse effects. Regular monitoring of the concentration of lithium in the blood is recommended.

Overdoses of lithium can sometimes be fatal.

According to an analysis of data collected from several thousand patients taking lithium, this treatment is associated above all with an increased risk of hypothyroidism, hyperparathyroidism, weight gain and a decrease in the ability to concentrate their urine; renal failure however is rare.

Lithium is mainly eliminated via the kidneys. Kidney failure exposes the patient to an increased concentration of lithium in the blood and symptoms of overdose. Vomiting, diarrhoea or profuse sweating also raise  the level of lithium in the blood.

In practice, in patients taking lithium, it is important to monitor lithium levels and kidney, thyroid and parathyroid functions, as well as weight.

©Prescrire 1 March 2014

"Frequency of the adverse effects of lithium" Prescrire Int 2014; 23 (147): 68-69. (Pdf, subscribers only).
Download the full review.
Pdf, subscribers only

For more information:

Proper management
of lithium therapy
Prescrire Int 2011;
20 (122): 295-296.
Pdf, subscribers only