Lithium
Brand: Lithobid
Boxed warning
Lithium toxicity can occur at doses close to therapeutic levels; serum level monitoring must be available.
- Caution
- Dehydration, low sodium, NSAIDs, and thiazides push levels into the toxic range.
- Pregnancy
- Avoid in the first trimester if possible: cardiac malformation (Ebstein anomaly) risk.
Common side effects
- Tremor
- Increased thirst and urination
- Weight gain
- Thyroid and kidney effects
Key interactions
- Thiazide diuretics and NSAIDs raise lithium levels
- ACE inhibitors raise its level
- Low sodium intake raises its level
Counseling points
- Keep salt and fluid intake steady
- Call the prescriber during vomiting, diarrhea, or heavy sweating
- Blood levels, thyroid, and kidney function are checked regularly
- Report tremor, confusion, or unsteadiness
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