Lithionit
Mood Stabiliser for Bipolar Disorder – Prevention of Manic and Depressive Episodes
Quick Facts About Lithionit
Key Takeaways About Lithionit
- Gold-standard mood stabiliser: Lithium remains one of the most effective treatments for preventing both manic and depressive episodes in bipolar disorder, with proven anti-suicidal properties
- Narrow therapeutic index: The difference between a therapeutic and toxic dose is small, making regular blood monitoring (every 2–3 months) essential for safe use
- Avoid NSAIDs: Common painkillers like ibuprofen and naproxen can dangerously increase lithium levels — use paracetamol (acetaminophen) instead
- Maintain consistent salt and fluid intake: Changes in salt consumption, dehydration, fever, or heavy sweating can alter lithium levels and increase the risk of toxicity
- Monitor thyroid and kidneys: Long-term lithium use can affect thyroid and kidney function, requiring regular screening blood tests
What Is Lithionit and What Is It Used For?
Lithionit is a prolonged-release lithium preparation used primarily to prevent recurrent manic and depressive episodes in patients with bipolar disorder. It can also be used in hospital settings to treat acute manic states, where full effect is typically achieved within approximately one week.
Lithionit contains the active substance lithium (as anhydrous lithium sulfate), a naturally occurring element that has been used in psychiatry since the late 1940s. It is classified as a mood stabiliser and belongs to the antimanic agents group. Lithium was the first medication demonstrated to be effective for the long-term prevention of mood episodes in bipolar disorder, and it remains one of the most widely studied and prescribed treatments for this condition worldwide.
Bipolar disorder (previously known as manic-depressive illness) is a chronic psychiatric condition characterised by episodes of mania or hypomania (abnormally elevated mood, energy, and activity) alternating with episodes of depression (profound sadness, loss of interest, and low energy). Without treatment, these episodes can be severely disabling and carry a significant risk of self-harm. Lithium works to reduce both the frequency and severity of these mood episodes, helping patients maintain a more stable emotional state.
The exact mechanism by which lithium stabilises mood is not fully understood, despite decades of research. Current evidence suggests that lithium modulates multiple intracellular signalling pathways. It is believed to inhibit the enzyme glycogen synthase kinase-3 (GSK-3), modulate the inositol phosphate pathway, and influence neurotransmitter systems including serotonin, noradrenaline, and dopamine. Additionally, lithium has demonstrated neuroprotective properties, potentially protecting brain cells from damage and promoting neuronal growth and resilience.
One of lithium's most clinically important properties is its unique anti-suicidal effect. Multiple large-scale studies and meta-analyses have consistently shown that lithium reduces the risk of suicide and suicide attempts in patients with bipolar disorder and recurrent depression. This property distinguishes lithium from most other mood-stabilising medications and is a key reason why international treatment guidelines continue to recommend it as a first-line treatment.
Lithium is included on the World Health Organization's List of Essential Medicines, reflecting its critical importance in global mental healthcare. It is one of the oldest continuously used psychiatric medications and has one of the strongest evidence bases of any treatment in psychiatry. The Lithionit formulation is a prolonged-release (slow-release) tablet, designed to provide more stable blood lithium levels and reduce gastrointestinal side effects compared to immediate-release formulations.
What Should You Know Before Taking Lithionit?
Before starting Lithionit, your doctor must assess your kidney function, thyroid function, heart health, and electrolyte balance. Lithium is contraindicated in patients with severe kidney disease, cardiovascular disease, or severely disturbed electrolyte and fluid balance. Several medications and lifestyle factors can dangerously alter lithium blood levels.
Contraindications
You should not take Lithionit if any of the following apply to you:
- Severe kidney disease – lithium is almost exclusively excreted by the kidneys, and impaired kidney function can lead to dangerous accumulation of lithium in the body
- Cardiovascular disease – lithium can cause ECG changes and affect cardiac rhythm
- Severely disturbed salt and fluid balance – dehydration and electrolyte imbalances dramatically increase the risk of lithium toxicity
- Allergy to lithium sulfate or any other ingredient in this medicine (see Contents section)
Warnings and Precautions
Talk to your doctor or pharmacist before taking Lithionit if you have or have had any of the following conditions:
- Heart rhythm disturbances (ECG abnormalities) – lithium can affect cardiac conduction
- High blood pressure – some blood pressure medications interact significantly with lithium
- Myasthenia gravis (severe muscle weakness) – lithium may worsen neuromuscular symptoms
- Epilepsy or other seizure disorders – lithium may lower the seizure threshold
- Mild to moderate kidney problems – careful dose adjustment and more frequent monitoring are needed
- Any form of brain damage – the central nervous system may be more sensitive to lithium's effects
- Low-salt diet or weight-loss diet – reduced sodium intake increases lithium retention and raises blood levels
- High caffeine consumption – large amounts of coffee or tea can affect lithium excretion by the kidneys
- Elderly patients – particularly those taking diuretics, ACE inhibitors, or NSAIDs, as the risk of elevated lithium levels is higher
- Previous or planned bariatric (weight-loss) surgery – absorption and excretion of lithium may change significantly, requiring dose adjustments
- Brugada syndrome (or family history of Brugada syndrome, cardiac arrest, or sudden death) – lithium may unmask or worsen this inherited heart condition
- Illness with fever and sweating (e.g. influenza)
- Prolonged diarrhoea or vomiting
- Significant changes in diet or fluid intake
- Signs of lithium toxicity: drowsiness, dizziness, slurred speech, muscle stiffness, tremor, nausea, or confusion
- Persistent headache and/or visual disturbances (possible intracranial hypertension)
It is critically important that your dietary habits, especially salt intake, do not change significantly after your Lithionit dose has been established through blood tests. Lithium blood levels change when sodium intake changes — increased salt intake causes more lithium to be excreted, while reduced salt intake causes lithium to accumulate. Similarly, large amounts of caffeine (coffee or tea) can increase lithium excretion, potentially reducing the drug's effectiveness.
Thyroid monitoring: Lithium treatment can lead to hypothyroidism (underactive thyroid) in a significant proportion of patients. Your doctor should regularly check your thyroid function with blood tests. If hypothyroidism develops, it can usually be managed with levothyroxine (thyroid hormone replacement) while continuing lithium treatment.
Parathyroid monitoring: Lithium can cause hyperparathyroidism (overactive parathyroid glands), leading to elevated calcium levels in the blood. Your doctor should periodically check your blood calcium levels. In some cases, long-term lithium use has been associated with parathyroid enlargement or benign parathyroid tumours (adenomas).
Kidney monitoring: Patients with kidney problems require closer monitoring of lithium levels and dose adjustments. Long-term lithium therapy (over 10 years) in patients with significantly impaired kidney function may carry a small risk of developing benign or malignant kidney tumours (microcysts, oncocytoma, and renal cell carcinoma). Your kidney function should be checked regularly throughout treatment.
Pregnancy and Breastfeeding
There is a risk of harm to the developing foetus with lithium use during pregnancy. Do not use Lithionit during pregnancy unless specifically directed by your doctor after a thorough risk-benefit assessment. Lithium exposure during the first trimester has been historically associated with an increased risk of Ebstein's anomaly, a congenital heart malformation, although more recent studies suggest the absolute risk is lower than initially thought (estimated at 1 in 1,000 to 1 in 2,000 exposed pregnancies).
Newborn babies whose mothers used Lithionit during the last three months of pregnancy may experience symptoms including tremor, muscle stiffness or weakness, drowsiness, agitation, breathing difficulties, and feeding problems. If your baby shows any of these symptoms, contact your doctor immediately.
Breastfeeding: Lithium passes into breast milk in significant amounts, and there is a risk that the infant may be affected. Breastfeeding should therefore be avoided during Lithionit treatment. If breastfeeding is considered essential, the infant's lithium levels and thyroid and kidney function must be closely monitored.
Use in Children
The safety and efficacy of lithium in children under 18 years of age have not been established. Lithionit should not be used in children and adolescents unless under specialist psychiatric supervision and after careful consideration of the benefits and risks.
Driving and Operating Machinery
Lithionit treatment may impair your concentration and reaction time. You should find out how the treatment affects you before performing activities that require alertness, such as driving or operating machinery. If you experience drowsiness, dizziness, or coordination difficulties, do not drive or use machines. Discuss with your doctor if these effects persist.
How Does Lithionit Interact with Other Drugs?
Lithium has numerous clinically significant drug interactions. NSAIDs, ACE inhibitors, ARBs, and diuretics are among the most dangerous, as they can substantially increase lithium blood levels and cause toxicity. Always inform your doctor about all medications you are taking, including over-the-counter products.
Because lithium has a narrow therapeutic index, even modest changes in blood lithium levels caused by drug interactions can have serious consequences. Drugs that affect kidney function or sodium handling are particularly likely to alter lithium levels. The following tables summarise the most clinically important interactions.
Major Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Ibuprofen, Diclofenac, Naproxen | NSAIDs (anti-inflammatory) | Reduce renal lithium excretion, increasing blood levels by 15–50% | Avoid if possible; use paracetamol instead. If essential, monitor lithium levels closely |
| Celecoxib, Etoricoxib | COX-2 inhibitors | Similar to NSAIDs – reduce lithium excretion | Avoid combination; monitor lithium levels if unavoidable |
| Enalapril, Lisinopril | ACE inhibitors (blood pressure) | Reduce renal lithium clearance, leading to accumulation | Monitor lithium levels frequently when starting, stopping, or changing dose |
| Losartan | Angiotensin II receptor antagonist | Reduces lithium excretion, increasing blood levels | Monitor lithium levels closely; dose adjustment may be needed |
| Hydrochlorothiazide, Furosemide | Diuretics (water tablets) | Thiazides significantly increase lithium levels; loop diuretics have a lesser effect | Thiazides: avoid or reduce lithium dose by 25–50%. Monitor levels closely |
| Haloperidol, Thioridazine | Antipsychotics (neuroleptics) | Increased risk of neurotoxicity, including neuroleptic malignant syndrome | Use with caution; monitor for neurological symptoms (fever, rigidity, confusion) |
Moderate Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Fluoxetine, Fluvoxamine | SSRIs (antidepressants) | Risk of serotonin syndrome when combined with lithium | Monitor for symptoms: agitation, tremor, hyperthermia, rapid heart rate |
| Venlafaxine | SNRI (antidepressant) | Risk of serotonin syndrome | Use with caution; monitor closely |
| Carbamazepine | Anticonvulsant / mood stabiliser | Increased neurotoxicity risk without changes in blood levels of either drug | Monitor for neurological symptoms; consider dose reduction |
| Sumatriptan | Triptan (migraine treatment) | Risk of serotonin syndrome | Use with caution; monitor for serotonergic symptoms |
| Theophylline, Caffeine | Xanthine derivatives | Increase lithium excretion, potentially reducing its effectiveness | Maintain consistent caffeine intake; monitor lithium levels if intake changes |
| Dapagliflozin | SGLT2 inhibitor (diabetes/heart failure) | May reduce lithium blood levels, decreasing effectiveness | Monitor lithium levels when starting or stopping dapagliflozin |
| Topiramate | Anticonvulsant | May alter lithium blood levels | Monitor lithium levels; adjust dose as needed |
| Metronidazole | Antibiotic/antiparasitic | May increase lithium levels | Monitor lithium levels during concurrent use |
| Aciclovir | Antiviral | May increase lithium levels by reducing renal clearance | Monitor lithium levels; temporary dose reduction may be needed |
This is not a complete list of all possible interactions. Always tell your doctor and pharmacist about all medications you are taking, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Even seemingly minor changes in medication can have significant effects on lithium blood levels.
What Is the Correct Dosage of Lithionit?
The dosage of Lithionit is highly individual and must be determined by your doctor based on regular blood tests measuring your lithium levels. There is no standard dose that works for everyone. Therapeutic lithium blood levels are typically 0.4–0.8 mmol/L for maintenance therapy and 0.8–1.2 mmol/L for acute mania treatment.
Always take Lithionit exactly as your doctor has told you. The dose varies considerably from patient to patient and is determined by repeated measurements of the lithium concentration in your blood. This requires regular blood tests, usually every 2–3 months throughout the entire course of treatment. Blood should be drawn 12 hours after your last dose (trough level) for accurate measurement.
Adults – Prophylactic (Preventive) Treatment
Prevention of Manic and Depressive Episodes
Starting dose: 1 tablet (42 mg lithium) morning and evening
Dose adjustment: After one week, your doctor will measure the lithium concentration in your blood and adjust the dose accordingly
Target blood level: 0.4–0.8 mmol/L (typically requires 2–6 tablets daily)
It may take several weeks of treatment before you experience the full mood-stabilising effect. Do not change your dose without consulting your doctor.
Adults – Acute Manic Episodes (Hospital Setting)
Treatment of Acute Mania
Starting dose: 2 tablets (84 mg lithium) four times daily for a few days
Dose adjustment: Rapidly adjusted based on blood lithium levels
Target blood level: 0.8–1.2 mmol/L
Full antimanic effect is typically achieved within approximately one week. After the acute episode resolves, the dose is gradually reduced to maintenance levels.
Elderly Patients
Elderly patients often require lower doses of lithium because kidney function naturally declines with age, leading to slower lithium excretion and higher blood levels. Your doctor will start with a conservative dose and monitor lithium levels more frequently. Elderly patients taking diuretics, ACE inhibitors, or NSAIDs are at particularly high risk of lithium accumulation and toxicity.
Children and Adolescents
The safety and efficacy of lithium have not been established in patients under 18 years of age. Lithionit should not be used in this age group unless under specialist psychiatric supervision.
How to Take the Tablets
Take the tablets at fixed times each day as directed by your doctor. Swallow the prolonged-release tablets whole — do not crush, chew, or break them, as this will destroy the slow-release mechanism and may cause rapid absorption, leading to peak blood levels that are too high. To reduce the risk of gastrointestinal side effects, Lithionit can be taken with food.
Missed Dose
If you forget to take a dose at the scheduled time, do not take a double dose at the next dosing time. Simply continue with your regular dosing schedule. Missing occasional doses may reduce the effectiveness of the treatment, so try to take your medication at consistent times each day.
Overdose
Lithium toxicity is a medical emergency. If too high a concentration is reached in the blood, poisoning (intoxication) can occur. Always contact a doctor or emergency services immediately if you suspect lithium overdose, regardless of symptoms.
- Early signs: Drowsiness, dizziness, difficulty coordinating movements, involuntary movements, slurred speech, involuntary eye movements, tremor, muscle stiffness, and nausea. Persistent diarrhoea or vomiting may also occur.
- Worsening toxicity: Confusion, restlessness, agitation, hallucinations, tremor, rapid involuntary muscle jerks, seizures, loss of consciousness, and severely elevated body temperature.
- Severe toxicity: Altered heart rhythm, dangerously low blood pressure, and kidney failure.
What Are the Side Effects of Lithionit?
Common side effects of lithium include increased thirst and urination, weight gain, tremor (hand shaking), and elevated blood calcium. Many side effects occur at the start of treatment and often improve over time. Thyroid, parathyroid, and kidney function should be monitored regularly throughout treatment.
Like all medicines, Lithionit can cause side effects, although not everybody gets them. Many side effects appear early in treatment — such as thirst, diarrhoea, fatigue, and tremor — and often resolve on their own after a period of adjustment. If side effects become troublesome, consult your doctor. Gastrointestinal symptoms can often be reduced by taking the tablets with food.
- Signs of lithium toxicity: drowsiness, dizziness, slurred speech, muscle stiffness, coarse tremor, confusion, or seizures
- High fever, excessive sweating, reduced consciousness, and stiff muscles (possible neuroleptic malignant syndrome, especially if taking antipsychotics)
- Widespread rash, high body temperature, elevated liver enzymes, blood abnormalities, and swollen lymph nodes (DRESS syndrome)
- Persistent headache and/or visual disturbances (possible intracranial hypertension)
Very Common
May affect more than 1 in 10 people
- Nephrogenic diabetes insipidus (increased thirst and increased urine production)
- Weight gain (avoid calorie-rich drinks)
- Fine hand tremor
- Elevated blood calcium (hypercalcaemia)
Common
May affect up to 1 in 10 people
- Increased urine volume (polyuria)
- Increased thirst (polydipsia)
- Fluid retention (oedema)
- Fatigue and tiredness in arms and legs
- Diarrhoea
- Nausea and stomach pain (especially during the first weeks)
- Acne-like skin rash
- ECG changes
- Thyroid function effects (e.g. goitre, hypothyroidism)
- Reduced concentration and reaction time
- Reversible leukocytosis (temporary increase in white blood cells)
Uncommon
May affect up to 1 in 100 people
- Muscle weakness
- Transient Parkinson-like symptoms
- Psoriasis (new onset or worsening)
- More serious ECG changes
- Headache
Rare and Frequency Not Known
May affect up to 1 in 1,000 people or frequency not established
- Fatigue (especially during first weeks)
- Dry mouth or increased saliva production
- Hyperparathyroidism (overproduction of parathyroid hormone)
- Neuroleptic malignant syndrome (mainly with concurrent antipsychotics)
- Benign or malignant kidney tumours (with long-term treatment)
- Impaired kidney function or kidney failure (with long-term treatment)
- Lichenoid skin or mucous membrane reactions
- Hair loss
- Persistent nerve damage (may manifest as slurred speech and coordination difficulties)
- Intracranial hypertension (raised pressure in the skull)
- Parathyroid gland enlargement or parathyroid adenoma
- DRESS syndrome (drug reaction with eosinophilia and systemic symptoms)
- Unmasking or worsening of Brugada syndrome
Weight gain is a common concern and it is important to be aware of calorie intake, particularly from sugar-sweetened beverages. Thyroid, parathyroid, and kidney function should be monitored through regular blood tests throughout the duration of treatment.
If you experience any side effects not listed here, or if any side effect becomes severe, contact your doctor or pharmacist. Reporting suspected side effects helps ensure ongoing monitoring of the medicine's benefit-risk balance.
How Should You Store Lithionit?
Store Lithionit at room temperature (below 25°C), away from heat and moisture, out of the reach and sight of children. Do not use after the expiry date printed on the packaging.
Keep the medicine in its original blister packaging or glass bottle to protect it from moisture. Store at temperatures not exceeding 25°C. Check the expiry date (marked "EXP" on the blister, label, or carton) before taking any tablets. The expiry date refers to the last day of the stated month.
Do not flush unused tablets down the toilet or throw them in household waste. Return any unused or expired medication to your pharmacy for safe disposal, which protects the environment from pharmaceutical contamination.
What Does Lithionit Contain?
Each Lithionit prolonged-release tablet contains anhydrous lithium sulfate equivalent to 42 mg (6 mmol) of elemental lithium. The tablets are white, round, and designed for slow release to provide stable blood levels.
Active Ingredient
The active substance is anhydrous lithium sulfate, equivalent to 42 mg (6 mmol) of elemental lithium per tablet. Lithium is the lightest metal and a naturally occurring element. In pharmaceutical form, it is combined with sulfate to create a stable salt that can be formulated into a prolonged-release tablet.
Inactive Ingredients (Excipients)
The other ingredients are: polyacrylate, hypromellose, and magnesium stearate. These excipients are standard pharmaceutical ingredients used to create the prolonged-release matrix that controls the rate of lithium absorption from the gastrointestinal tract.
Tablet Appearance and Packaging
42 mg tablets: White, round, prolonged-release tablets.
Available in:
- Blister packs: 100 and 250 prolonged-release tablets
- Glass bottle: 500 prolonged-release tablets
Not all pack sizes may be available in your country.
Frequently Asked Questions About Lithionit
Lithionit contains lithium and is used as a mood stabiliser to prevent both manic episodes (abnormal elation) and depressive episodes (severe low mood) in patients with bipolar disorder. In hospital settings, it can also be used to treat acute manic states, where full effect is typically achieved within approximately one week. Lithium has been one of the most effective treatments for bipolar disorder for over 70 years and is the only mood stabiliser with proven anti-suicidal properties.
Lithium has a narrow therapeutic index, meaning the difference between an effective dose and a toxic dose is small. Regular blood tests (usually every 2–3 months) are essential to ensure your lithium levels remain within the safe and effective range (typically 0.4–0.8 mmol/L for maintenance therapy). Blood samples should be taken 12 hours after your last dose. Your doctor will also periodically check your kidney function, thyroid function, and calcium levels.
Early signs of lithium toxicity include drowsiness, dizziness, difficulty coordinating movements, slurred speech, involuntary eye movements, coarse tremor, muscle stiffness, and nausea. Persistent diarrhoea or vomiting may also occur. As toxicity worsens, symptoms may progress to confusion, restlessness, hallucinations, rapid muscle jerks, seizures, loss of consciousness, and dangerously elevated body temperature. Contact your doctor or emergency services immediately if you experience any of these symptoms.
You should avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, and naproxen, as these can significantly increase lithium blood levels and lead to toxicity. Paracetamol (acetaminophen) is generally considered a safe alternative for pain relief while taking lithium. Low-dose aspirin (75–100 mg) for cardiovascular prevention appears to be safe. Always consult your doctor or pharmacist before taking any new medication, including over-the-counter products.
Yes, lithium treatment can cause hypothyroidism (underactive thyroid) in a significant proportion of patients, estimated at 10–20% over the course of treatment. It can also cause goitre (thyroid enlargement). This is why your doctor will regularly monitor your thyroid function with blood tests. If hypothyroidism develops, it can usually be effectively managed with levothyroxine (thyroid hormone replacement) while continuing lithium treatment. In most cases, the benefits of lithium for mood stabilisation outweigh the risk of thyroid effects.
Lithium carries a risk of foetal harm, particularly during the first trimester when it has been associated with cardiac malformations (including Ebstein's anomaly, though the absolute risk is low — approximately 1 in 1,000 to 1 in 2,000 exposed pregnancies). Do not use Lithionit during pregnancy unless specifically directed by your doctor after careful risk-benefit assessment. If you discover you are pregnant while taking lithium, do not stop abruptly — contact your doctor immediately for guidance, as sudden discontinuation can trigger a severe mood relapse.
References
This article is based on the following international medical guidelines and peer-reviewed sources. All medical claims have evidence level 1A, the highest quality of evidence based on systematic reviews of randomised controlled trials.
- Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders. 2018;20(2):97–170. doi:10.1111/bdi.12609
- National Institute for Health and Care Excellence (NICE). Bipolar disorder: assessment and management. NICE guideline [CG185]. Updated 2023.
- Goodwin GM, Haddad PM, Ferrier IN, et al. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology. 2016;30(6):495–553.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd list. Geneva: WHO; 2023.
- Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013;346:f3646. doi:10.1136/bmj.f3646
- McKnight RF, Adida M, Budge K, et al. Lithium toxicity profile: a systematic review and meta-analysis. The Lancet. 2012;379(9817):721–728. doi:10.1016/S0140-6736(11)61516-X
- Gitlin M. Lithium side effects and toxicity: prevalence and management strategies. International Journal of Bipolar Disorders. 2016;4:27. doi:10.1186/s40345-016-0068-y
- European Medicines Agency (EMA). Lithium-containing medicinal products – Product information. EMA database. Accessed January 2026.
Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, a group of licensed specialist physicians with expertise in psychiatry, clinical pharmacology, and internal medicine.
Medical Writers
Board-certified physicians specialising in psychiatry and psychopharmacology with documented academic and clinical experience in mood disorders.
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