Additionally, increasing dietary sodium intake may also reduce lithium levels by prompting the kidneys to excrete more lithium.Lithium is known to be a potential precipitant of serotonin syndrome in people concurrently on serotonergic medications such as antidepressants, buspirone and certain opioids such as pethidine (meperidine), tramadol, oxycodone, fentanyl and others. Lithium co-treatment is also a risk factor for neuroleptic malignant syndrome in people on antipsychotics and other antidopaminergic medications.High doses of haloperidol, fluphenazine, or flupenthixol may be hazardous when used with lithium; irreversible toxic encephalopathy has been reported. Indeed, these and other antipsychotics have been associated with increased risk of lithium neurotoxicity, even with low therapeutic lithium doses. Overdose
Lithium toxicity, which is also called lithium overdose and lithium poisoning, is the condition of having too much lithium in the blood. This condition also happens in persons that are taking lithium in which the lithium levels are affected by drug interactions in the body. In acute toxicity, people have primarily gastrointestinal symptoms such as vomiting and diarrhea, which may result in volume depletion. During acute toxicity, lithium distributes later into the central nervous system resulting in mild neurological symptoms, such as dizziness.In chronic toxicity, people have primarily neurological symptoms which include nystagmus, tremor, hyperreflexia, ataxia, and change in mental status. During chronic toxicity, the gastrointestinal symptoms seen in acute toxicity are less prominent. The symptoms are often vague and nonspecific.If the lithium toxicity is mild or moderate, lithium dosage is reduced or stopped entirely.
Patients who have a rise in creatinine on three or more occasions, even if their eGFR is > 60 ml/min/
1.73m2 require further evaluation, including a urinalysis for haematuria, proteinuria, a review of their medical history with attention paid to cardiovascular, urological and medication history, and blood pressure control and management. Overt proteinuria should be further quantified with a urine protein to creatinine ratio. Discontinuation
For patients who have achieved long term remission, it is recommended to discontinue lithium gradually and in a controlled fashion. Cluster headaches, migraine and hypnic headache
Studies testing prophylactic use of lithium in cluster headaches (when compared to verapamil), migraine attacks and hypnic headache indicate good efficacy. Adverse effects
Sources for the following lists. Very Common (> 10% incidence) adverse effects of lithium include
Confusion
Constipation (usually transient, but can persist in some)
Decreased memory
Diarrhea (usually transient, but can persist in some)
Dry mouth
EKG changes — usually benign changes in T waves
Hand tremor (usually transient, but can persist in some) with an incidence of 27%. If severe, psychiatrist may lower lithium dosage, change lithium salt type or modify lithium preparation from long to short acting (despite lacking evidence for these procedures) or use pharmacological help
Headache
Hyperreflexia — overresponsive reflexes
Leukocytosis — elevated white blood cell count
Muscle weakness (usually transient, but can persist in some)
Myoclonus — muscle twitching
Nausea (usually transient)
Polydipsia — increased thirst
Polyuria — increased urination
Renal (kidney) toxicity which may lead to chronic kidney failure
Vomiting (usually transient, but can persist in some)
Vertigo
Weight gainCommon (1–10%) adverse effects include
Acne
Extrapyramidal side effects — movement-related problems such as muscle rigidity, parkinsonism, dystonia, etc.