*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Common lithium side effects include diarrhea, nausea, feeling tired, dry mouth, and hand tremors. Serious side effects require medical attention, such as a risk of lithium toxicity, kidney damage, and irregular heart rhythms.
Many people consider stopping their medications because of side effects that don’t go away. If side effects continue to bother you after the first few weeks of treatment, tell your provider as soon as possible. Some side effects may be early signs of lithium toxicity, a serious complication. Your provider may adjust your dose, change the timing of your medication, or consider a different treatment.
If you are considering Lithium or want to discuss your current medication treatment with a provider, online psychiatry platforms, such as Talkiatry and Brightside Health are a good place to start. Their providers offer assessments and prescription consultation, and can answer any questions you have about Lithium side effects.
Boxed Warning: Lithium – Risk of Lithium Toxicity
Lithium has a black box warning for the risk of lithium toxicity. This is the most serious type of warning from the Food and Drug Administration (FDA). Lithium levels should be monitored closesly while on treatment. You should talk with your doctor about risks of lithium toxicity before starting treatment.
Psychiatry for Bipolar Disorder
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Common Lithium Side Effects
The most commonly reported side effects of lithium tend to be different for children and for adults. Initial side effects may go away on their own, but some may require medical attention. Contact your provider if any side effects persist or get worse.
Common side effects of lithium for adults include:1
- Nausea
- Vomiting
- Increased thirst
- Increased urination
- Thyroid problems
- Hand tremors
- Dizziness
- Rash
- Tremors
- Problems with walking
Common side effects of lithium for children (ages 7-17) include:1
- Headache
- Frequent urination and bedwetting
- Increased thirst
- Tremors
- Fatigue
- Nausea
- Vomiting
- Diarrhea
- Drowsiness
- Dizziness
*All medications, including lithium, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.
Serious Lithium Side Effects
Some lithium side effects can be persistent or serious, with some becoming potentially life-threatening. Elevated levels of lithium in the bloodstream can lead to severe side effects. It is crucial to monitor blood lithium levels regularly to avoid toxicity. Seek immediate medical attention if any of these appear.
Severe side effects of lithium include:1
- Kidney damage
- Irregular heart rhythm
- Low heart rate
- Seizures
- Coma
- Delirium
- Allergic reactions
- Blackout spells
- Incontinence of urine or feces
*All medications, including lithium, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.
Lithium Toxicity
One severe and potentially fatal condition associated with lithium use is lithium toxicity. This occurs when the level of lithium in the blood becomes too high, leading to a variety of serious symptoms that require immediate medical attention. Lithium toxicity can occur due to several factors, such as taking too much of the medication, dehydration, interactions with other medications, or impaired kidney function.
Dehydration is a significant risk factor as low blood volume increases the concentration of lithium. For this reason, it is important to avoid dehydration by drinking plenty of fluids. Talk with your healthcare provider when having illnesses that cause vomiting and diarrhea.
Early signs of lithium toxicity include diarrhea, vomiting, drowsiness, and muscular weakness.1 At high levels, symptoms can include giddiness, difficulty with coordination, blurred vision, and excessive urination.1 If there are concerns for lithium toxicity, immediate medical attention is necessary to prevent serious complications.
Symptoms of lithium toxicity include:1
- Diarrhea
- Vomiting
- Drowsiness
- Muscle weakness
- Problems with coordination
- Giddiness
- Excessive urination
- Tremors
- Muscular weakness
- Seizures
- Coma
Long-term Side Effects of Lithium
Long-term use of lithium can also lead to persistent side effects and can impact multiple organ systems. Regular monitoring of lithium levels in the blood is necessary to decrease the possibility of long-term side effects. It is also important to regularly monitor for long-term effects through regular checkups and lab work.
Long-term side effects of lithium include:1
- Thyroid problems (both hypothyroidism and hyperthyroidism)
- Goiter
- Kidney dysfunction
- Parathyroid dysfunction
- Elevated calcium levels
- Diabetes insipidus
- Weight gain
It is important to remember that individual responses to medications vary. If considering lithium treatment, it is essential to discuss the potential side effects with your healthcare provider. They can provide personalized guidance to help you make informed decisions about your treatment plan.
*All medications, including lithium, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.
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What Are the Risks & Warnings for Lithium Carbonate?
Lithium Toxicity
Lithium has a black box warning for the risk of lithium toxicity. This is the most serious type of warning from the Food and Drug Administration (FDA). Lithium levels should be monitored closesly while on treatment. Talk with your doctor about risks of lithium toxicity before starting treatment.
Brugada Syndrome
Brugada syndrome is a rare heart disorder that can lead to a risk of sudden death. Lithium can worsen or unmask Brugada syndrome. Lithium should be avoided in those with Brugada syndrome or those suspected of having the condition.
Worsened Kidney Functioning
Individuals with kidney disease should not take lithium. Doing so can worsen kidney function, which can increase the concentration of lithium in the blood.
Serotonin Syndrome
Taking Lithium with medications that affect serotonin levels, such as SSRI antidepressants, can cause a rare but potentially life-threatening side effect called serotonin syndrome. Symptoms including agitation, insomnia, confusion, and muscle rigidity.
Lithium Sensitivity for Elderly Patients
Elderly patients can be more sensitive to lithium and may require a lower dose.
Worsened Side Effects in Children
Lithium should be used with caution in children as they tend to have more frequent and severe side effects.
Pregnancy
Lithium can cause harm to a developing fetus and should be avoided during pregnancy.
Breastfeeding
Lithium is excreted in breast milk and should not be taken when breastfeeding.
Allergic Reactions
For some people taking lithium, an allergic reaction may occur which may be dangerous.
Severe allergic reactions to lithium can include:
- Breathing problems
- Swelling
- Rash/hives
- Loss of consciousness
- Rapid heart rate
If you experience wheezing, difficulty breathing, or swelling in the throat, seek immediate medical help.
Drug Interactions
Taking certain medications, herbs, or supplements alongside lithium can change how lithium works in your body or increase the risk for serious side effects. Do not start, stop, or change the dosage of any medicines without your provider’s approval.
Substances you should avoid using while taking lithium include:*
- Diuretics
- NSAIDs – ibuprofen, aspirin, naproxen, etc
- Antipsychotics
- Metronidazole – antibiotic
- Methyldopa (blood pressure medication)
- Phenytoin – anticonvulsant medication for seizures
- Carbamazepine – anticonvulsant medication for seizures
- Neuromuscular blocking agents – used with anesthesia in surgery
- Sodium-glucose cotransporter (SGLT2) inhibitors – used to lower blood sugar
- Medications affecting serotonin (MAOIs, SSRI antidepressants, fentanyl, etc.)
*This is not a comprehensive list of medications that interact with lithium. Be sure to talk with your doctor or pharmacist about any prescription or over the counter medications you take, as well as supplements, herbs, and teas.
Important Things to Know About Taking Lithium
Talk with your provider about what you can expect during your first weeks of taking lithium. Discuss your dosage, how to take your medication, precautions, potential side effects, and what to do if side effects become a problem.
How Long Does It Take for Lithium to Work?
It can take between 1-3 weeks of taking lithium before you may notice symptoms improving.
Can Lithium Make You Feel Worse at First?
Yes, some may begin noticing side effects when starting their lithium prescription. Because lithium toxicity can be severe and potentially fatal, it’s important to note potentially early signs. These include diarrhea, vomiting, drowsiness, and muscular weakness. While not all side effects of lithium may be serious, close monitoring is essential.
Who Experiences Side Effects More?
Individual responses to lithium can vary widely, and some individuals are at an increased risk for side effects. Preexisting conditions, especially those with a history of thyroid or kidney problems, are more likely to experience complications when taking lithium.
Those Taking Other Medications
Lithium can have harmful interactions with medications and other substances. This may include serious reactions requiring medical care or reduced effectiveness of lithium, the other medication, or both.
Medications and substances that may interact with lithium include: 1
- Diuretics
- NSAIDs (ibuprofen, aspirin, naproxen, etc)
- Antipsychotics
- Metronidazole (antibiotic)
- Methyldopa (blood pressure medication)
- Phenytoin (anticonvulsant medication for seizures)
- Carbamazepine (anticonvulsant medication for seizures)
- Neuromuscular blocking agents (used with anesthesia in surgery)
- Sodium-glucose cotransporter (SGLT2) inhibitors (used to lower blood sugar)2
- Medications affecting serotonin (MAOIs, SSRI antidepressants, fentanyl, etc)
This is not a complete list of possible interactions with lithium. Consult with your healthcare provider before combining lithium with any over-the-counter medications, prescription medications, or herbal supplements to ensure safety and effectiveness.
Those With Certain Health Risks
Individual responses to lithium can vary widely, and some individuals are at an increased risk for side effects. Those with preexisting conditions are more likely to experience complications when taking lithium.
Your provider can help you determine if lithium is suitable for you or if you should avoid it.
Individuals with an increased risk for experiencing side effects include those who:
- Have significant kidney problems
- Have significant cardiovascular disease
- Have thyroid disease
- Have Brugada syndrome or suspected Brugada syndrome
- Are dehydrated or at risk for dehydration
Older Adults
Older adults are at greater risk of side effects from lithium. They can be more sensitive to the medication and may require a lower dose.
Children
Lithium should be used with caution in children as they tend to have more frequent and severe side effects.
Pregnant & Breastfeeding Parents
Lithium can cause harm to a developing fetus and should typically be avoided during pregnancy. Also, lithium is excreted in breast milk and should not be taken when breastfeeding.
How to Cope With Common Lithium Side Effects
Lithium side effects often occur when starting the medication. For some, these symptoms may disappear after a few days or several weeks. But some side effects may last for as long as a person takes the medication. If side effects continue or worsen, speak to your provider for guidance.
Here are some ways to cope with several common lithium side effects:
Tremors
Mild tremors may occur when taking lithium, especially at the beginning of treatment. Tremors are also a symptom of lithium toxicity, so it’s important to contact your provider right away if these occur.1
Drowsiness
Lithium can cause drowsiness, especially when starting treatment. Take note of how it affects your alertness during the first few weeks to understand how it affects you. If you feel drowsy, avoid doing activities that require alertness, such as driving or operating machinery. Your provider may also recommend taking your medication at a certain time of the day.
Digestive Symptoms
Diarrhea, nausea, and vomiting are common digestive side effects during the first few days of taking lithium. These may improve as your body adjusts, but there are several other ways to reduce discomfort.
First, be sure to follow meal timing recommendations for your lithium prescription. Also, drink plenty of water, eat smaller, more frequent meals. Taking lithium with food or a light snack may help reduce stomach irritation. Avoid triggers such as strong odors of certain foods that may worsen nausea.
If you want to consider over-the-counter remedies like ginger or antacids, consult with your prescriber or pharmacist. If your nausea and vomiting become severe or persistent, consult your healthcare providers for further guidance.1
Feeling Thirsty
Lithium can cause increased thirst, especially when you first start taking it. It is also a symptom of lithium toxicity, so it’s important to tell your provider if it occurs and focus on staying hydrated throughout your treatment.
*All medications, including lithium, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.
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More Ways to Manage Lithium Side Effects
Here are more ways to manage and reduce the impact of lithium side effects.
Practice Good Sleep Habits
Your sleep habits play an important role when adjusting to a new medication. Lithium can cause drowsiness for some, especially when first starting the medication, so it’s important to get good rest during this period. Try to wake up and go to bed at the same time every day, and get extra rest as needed. Make sure your sleep environment is dark and comfortable as well.
Be aware of how lithium affects your mental alertness, and avoid activities such as driving or operating machinery until you know how it may affect you.
Healthy Lifestyle Activities
Healthy lifestyle activities support your body as it adjusts to taking a new medication, such as lithium. Side effects can be challenging, especially when they make you feel tired or disrupt your appetite. Do your best to eat healthy meals, get enough sleep, stay physically active, and connect with others for social support.
Follow a Daily Routine
Following your normal daily routine can make it easier to adjust to taking lithium. A consistent schedule will reduce stress on your body and mind as you learn how lithium affects you. Lithium toxicity is a significant risk when taking this medication, so following your provider’s instructions for taking it are essential.
Consider Therapy
Psychotherapy can play an important role in helping you manage the effects of medication and develop healthy coping strategies. For in-person therapy, your primary care provider or insurance company can provide referrals in your local area. You may also want to ask someone you trust for suggestions based on their experience.
To find an online therapist, an online therapist directory is a great starting point. Many online psychiatry platforms, such as Talkiatry and Brightside Health, also offer therapy services.
Should I Stop Taking Lithium If I Start Feeling Side Effects?
Do not stop taking lithium suddenly if you are bothered by side effects. Discontinuation (withdrawal) symptoms are uncommon when stopping lithium. However, stopping abruptly may lead to a relapse of symptoms and may increase the risk of suicide.3 It is recommended to gradually wean off the medication over a 3-month period to avoid relapse.3
When Should I Call My Doctor About Lithium Side Effects?
Contact your doctor as soon as possible if you experience side effects. While not all side effects may be serious, there is a risk of lithium toxicity, which can be severe and potentially fatal. Closely monitor any reaction you have to lithium to reduce this risk.
When Should I Seek an Alternative to Lithium Due to Side Effects?
You may notice some side effects of lithium within the first few days or weeks of using it. Each person has a unique response to medication so this timeframe may vary. Some side effects may go away on their own, especially when first starting lithium. Others may persist or worsen while taking the medication.
If you’re considering a change in your medication, talk with your provider. There are many lithium alternatives available and they can help you determine which one may be a good fit. Several types of mood stabilizers can help reduce bipolar disorder symptoms, so it’s important to understand the potential risks and benefits of each option.
Lamictal, Tegretol, and other anticonvulsant medications can be used instead of lithium for bipolar disorder. They act as mood stabilizers, reducing episodes of mania and maintaining a more consistent mood.
Atypical antipsychotics, including Latuda and Seroquel, are also used to stabilize mood. They are often used for those with psychotic symptoms, such as hallucinations or paranoia. These medications reduce agitation, delusions, hallucinations, paranoia, and confusion. They are often used in combination with another mood stabilizer.
How to Get a Prescription for Lithium or Alternative Medications
To get a lithium prescription or alternative in person, your healthcare provider will review your symptoms and medical history. Your primary care provider, who may be a physician, nurse practitioner, or PA, can help you start this process. Based on this discussion, they may write the prescription themselves or refer you to a specialist for further care.
Online psychiatric platforms offer virtual appointments with licensed providers. These professionals can evaluate your needs, prescribe medications such as lithium, and arrange for follow-up care. We have carefully reviewed Talkiatry and Brightside and determined they are both good places for such an evaluation.
Their providers can also prescribe mood stabilizers, such as lithium or an alternative, if they deem the medication helpful for your symptoms. Both platforms offer assessments and prescription management
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Questions to Ask Your Provider
Your provider will discuss possible side effects of lithium with you. They will highlight any side effects that may appear when starting lithium and those that require medical treatment. They can also discuss what to do if side effects persist or become difficult to manage.
Also, many online psychiatry platforms make it convenient to get mental health care for bipolar disorder. You’ll get a mental health evaluation, diagnosis, and personalized treatment plan from one of their providers. Some platforms also allow you to change providers, if needed.
Bulleted list:
- What common side effects will I likely experience when I start my lithium medication?
- How long will the medication’s side effects last?
- Am I at risk for more severe side effects if I am already taking medication for anxiety, depression, or other mental health conditions?
- When should I reach out to you if I am experiencing side effects?
- What should I do if lithium does not work for me?
- What will happen if I suddenly stop my medication?
- What is the best dosage to ensure fewer side effects?
- Are there drugs I am taking that could have negative interactions?
- Can the side effects of lithium interfere with my daily activities, such as work, school, or driving?
- What are some ways to manage hand tremors without reducing how effective lithium is for my symptoms?
- How frequently will I need to follow up with my provider?
- How often will I need blood tests to monitor my lithium levels?
- What steps can I take to decrease the risk of lithium affecting my thyroid or kidneys?
- What are the long-term benefits and risks for taking lithium?
- Are there any dietary considerations I should be aware of while taking lithium?
- Can anticonvulsants be used in combination with other medications or therapies for a more comprehensive treatment approach?
Prescriber’s Tips
Before starting lithium, your provider will give you important instructions. They’ll discuss how to take your medication, what to avoid when taking it, and how to store it properly. They’ll also talk through what to do if side effects occur. Follow these tips for safe and effective use of lithium.
- Take your medication as prescribed unless your prescriber tells you otherwise. Keeping a consistent dosing schedule reduces the chance of unwanted side effects.1
- Do not change your dose on your own. Your provider will change your dose if needed.
- Talk with your provider about what to do if you miss a dose. Do not take a double dose if you miss one.
- Your healthcare provider will do certain blood tests before starting and during treatment with lithium carbonate capsules.
- Report any early signs of lithium toxicity to your provider immediately. These symptoms may include diarrhea, vomiting, drowsiness, and muscle weakness.
- Drink plenty of fluids throughout the day when taking lithium. Dehydration makes the kidneys less efficient at filtering waste products from your blood, including lithium. This can cause lithium levels to rise in your body, which can lead to toxicity (a medical emergency).
- Do not stop lithium without first talking to a healthcare provider. Stopping lithium abruptly can lead to a relapse of symptoms and may increase the risk of suicide.2,3
- Take your medication at the same time each day. Doing so can help you remember to take it and make your treatment as effective as possible. Your healthcare provider can determine the best time to take your medication based on how you respond to it.
- Lithium can increase sun sensitivity, making you more susceptible to sunburn. Use protective clothing, broad-spectrum sunscreen with SPF 30 or higher, and seek shade during peak sun hours.
- Ask your provider if it’s safe to drink alcohol while taking lithium.
- Tell your prescriber about all medications and supplements you take, including over-the-counter treatments. Many over-the-counter medications and supplements can interact with prescription medications.
Frequently Asked Questions
What Is Lithium & What Is It Used For?
Lithium is a mood stabilizer used in the management of mood disorders. Lithium is FDA-approved to treat acute manic and mixed episodes of bipolar disorder in adults and children ages 7 and older. It is also FDA-approved as a maintenance treatment for bipolar disorder within the same age range.
How Does Lithium Work?
The exact way lithium works to improve bipolar symptoms is unknown. It likely alters the breakdown of certain chemicals in the brain involved in mood regulation. 1,3
How Does Lithium Make You Feel?
When starting lithium, some people may notice side effects early on. It’s important to note that some side effects can be early signs of lithium toxicity, including nausea, vomiting, and increased urination. Even if these are mild, be sure to report them to your provider right away.
Can I Take Lithium While Pregnant?
Lithium can cause fetal harm when taken during pregnancy. Also, lithium is present in breast milk and should not be taken when breastfeeding.
Do Older People Have a Higher Risk of Side Effects From Lithium?
Yes, older patients can be at greater risk of side effects while on lithium. They can be more sensitive to the medication and may require a lower dose.
Should I Stop Taking Lithium If I Experience Side Effects?
No, do not stop taking lithium unless your provider tells you to do so. If you experience side effects or have other reasons to consider stopping lithium, talk to your provider as soon as possible.1
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Lithium carbonate capsule. (March 10, 2025). DailyMed.nlm.nih.gov. Retrieved from https://dailymed.nlm.nih.gov/dailymed/lookup.cfm
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Lithium oral solution, Lithium carbonate tablets, Lithium carbonate capsules. (October, 2022). AccessData.fda.gov. Retrieved from https://www.accessdata.fda.gov/drugsatfda
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Stahl S. M. & Grady M. M. (2017). Stahl’s essential psychopharmacology : prescriber’s guide (Sixth). Cambridge University Press.
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: No Change
Reviewer: No Change
Primary updates: Added “Key Takeaways” feature. Edited for clarity. Condensed “What is Lithium” and moved to FAQs. Revised sections covering common, serious, and long-term side effects. Revised and moved content from “Other Warnings & Precautions For Taking Lithium”, “Allergic Reactions” and “Interactions With Lithium” to new “What Are the Warnings & Risks of Lithium?” feature. Revised “Who Experiences the Most Side Effects on Lithium?” Retitled “Can Stopping Lithium Cause Withdrawal Symptoms?” to “Should I Stop Taking Lithium If I Start Feeling Side Effects?” Added new sections “Important Things to Know About Taking Lithium”,”How to Cope With Common Lithium Side Effects”, “More Ways to Manage Lithium Side Effects”,“When Should I Call My Doctor About Lithium Side Effects?”, “When Should I Seek an Alternative to Lithium Due to Side Effects?”, “How to Get a Prescription for Lithium or Alternative Medications” and all included subsections. Revised and moved FAQ section to the end. Retitled “Questions to Ask Your Health Team” to “Questions to Ask Your Provider”. Replaced “Final Thoughts” with “Prescriber’s Tips” feature. Removed “For Further Reading”
Author: Luke Prest, MD
Medical Reviewer: Heidi Moawad, MD
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