Quick Answer: Common lithium side effects can include a fine hand tremor, mild nausea, increased thirst, and more frequent urination. Lithium toxicity can begin with symptoms that seem similar, but worsening tremor, repeated vomiting or diarrhea, problems with coordination, marked drowsiness, confusion, or other neurologic changes need prompt medical attention.
Lithium requires closer monitoring than many psychiatric medications because the amount needed for treatment can be relatively close to the amount associated with toxicity. Some people can also develop toxic symptoms at lithium concentrations that would usually be considered therapeutic, which makes changes in how you feel important alongside the blood test result.
Here, we’ll cover symptoms and changes to look out for, what to do if lithium side effects suddenly change, and when to contact emergency support.
What Lithium Side Effects Are Common?
Some lithium side effects can appear when treatment begins or after the dose changes without indicating lithium toxicity.
Common effects can include:
- Fine hand tremor
- Nausea
- Increased thirst
- Frequent urination
The important question is whether a symptom is mild and familiar or has become noticeably different. A side effect that persists, worsens, or starts interfering with daily life is worth discussing with the prescribing clinician.
How Can You Tell Lithium Side Effects From Lithium Toxicity?
The distinction between lithium side effects and lithium toxicity isn’t always based on the symptom itself. Sometimes a familiar side effect becomes more pronounced or appears alongside new problems.
Tremor
A fine hand tremor can occur during lithium treatment. A tremor that becomes much stronger, affects more of the body, or appears with weakness or difficulty coordinating movements is more concerning.
Nausea
Mild nausea can occur as a side effect. Repeated vomiting or diarrhea, particularly if other symptoms are developing, deserves faster attention.
Thirst and Urination
Some increase can occur with lithium. A major change becomes more important when you’re also ill, dehydrated, or unable to maintain your usual fluid intake.
Knowing your usual response to lithium can help you recognize when something has changed rather than assuming every symptom is simply part of taking the medication.
What Are the Signs of Lithium Toxicity?
Early signs of lithium toxicity can include nausea, vomiting, diarrhea, shakiness, muscle weakness, drowsiness, and increasing confusion. As toxicity becomes more severe, symptoms may progress to poor coordination, slurred speech, severe tremors, seizures, or loss of consciousness and require urgent medical attention.
Symptoms don’t need to appear in a particular order. A noticeable change from your usual baseline, especially when several symptoms occur together, should be taken seriously.
When Is Lithium Toxicity an Emergency?
Suspected lithium toxicity needs prompt medical evaluation. When the neurological signs above turn severe, such as a seizure, a loss of consciousness, rapidly worsening confusion, or being unable to walk, treat it as an emergency rather than something to watch and wait on.
Do not wait for a routine psychiatry appointment or the next scheduled lithium blood test when symptoms suggest significant toxicity. Emergency clinicians can assess the symptoms, lithium concentration, kidney function, electrolytes, and other factors that may be contributing.
Call 911 or go to the nearest emergency room. For questions about possible toxicity, Poison Control is available 24/7 at 1-800-222-1222.
Can Dehydration or Illness Raise Lithium Levels?
Illness and dehydration can reduce the body’s ability to clear lithium, allowing concentrations to rise even when the prescribed dose hasn’t changed.
Situations that may increase risk include:
- Persistent vomiting or diarrhea
- Fever or illness with significant sweating
- Dehydration
- Reduced fluid intake during illness
- Significant changes in sodium balance
- Reduced kidney function
Current prescribing information specifically identifies dehydration, volume depletion, illness, impaired kidney function, and changes in electrolyte balance as factors that can increase the risk of toxicity.
Which Medications Can Increase the Risk of Lithium Toxicity?
Some prescription and over-the-counter medications can reduce lithium clearance and raise the amount of lithium in the blood.
Important examples include:
- NSAIDs: Medications such as ibuprofen and naproxen can increase lithium concentrations.
- Diuretics: Some water pills can change sodium balance and reduce lithium clearance.
- ACE inhibitors and related blood pressure medications: Drugs that affect the renin-angiotensin-aldosterone system (RAAS) can increase steady-state lithium concentrations.
The current lithium prescribing information specifically identifies NSAIDs, diuretics, and RAAS medications as clinically important interactions.
Tell your prescriber or pharmacist that you take lithium before starting a new prescription or over-the-counter medication. This gives them a chance to check for interactions and decide whether closer monitoring is needed.
What Do Lithium Blood Levels Tell You?
Lithium blood levels help clinicians check whether the amount of medication in the body is within an appropriate range, but the result needs to be considered alongside symptoms and other lab findings. For routine monitoring, blood is usually drawn about 12 hours after the previous dose and just before the next dose.
Lithium toxicity is often associated with blood levels around 1.5 mEq/L or higher, but there isn’t a single level that separates “safe” from “toxic” for everyone. Some people can develop symptoms even when their lithium level is within the usual therapeutic range, and the severity of symptoms doesn’t always match the blood level, especially with chronic toxicity.
That’s why significant symptoms shouldn’t be dismissed just because a recent lithium blood test was within the expected range.
What Should You Do If Lithium Side Effects Suddenly Change?
A noticeable change in tremor, balance, thinking, stomach symptoms, or alertness deserves attention, particularly after illness, dehydration, a medication change, or a change in lithium treatment.
- For mild but new or persistent symptoms: Contact the prescribing clinician and describe what changed. They can decide whether the medication plan, kidney function, or lithium level needs to be reviewed.
- For possible toxicity or severe symptoms: Call 911 or go to the nearest emergency room. Do not make independent dose changes or wait for a routine follow-up when symptoms suggest lithium toxicity.
What Happens After a Lithium Toxicity Emergency?
Lithium toxicity is a medical problem that may require emergency hospital treatment. Once a person is medically stable, psychiatric follow-up can help address what contributed to the episode, whether lithium remains an appropriate medication, how mood symptoms are being managed, and what monitoring may be needed going forward.
Some people can return to routine outpatient care after a medical emergency, while others may need more psychiatric support during the transition home. The appropriate level of care depends on current symptoms, medication needs, daily functioning, and how much structure and support the person needs after hospitalization.
Our guide to step-down care after psychiatric hospitalization explains how these levels of support can fit into the recovery process.
Contact us today to talk through your options and determine which level of psychiatric care may be appropriate after a lithium toxicity emergency.
FAQs About Lithium Side Effects and Toxicity
Can lithium toxicity happen even if you take the prescribed dose?
Yes. Lithium toxicity can develop during prescribed treatment, particularly when the body’s ability to clear lithium changes. Taking lithium exactly as prescribed doesn’t mean new concerning symptoms should be ignored.
What should you do if you get a stomach bug while taking lithium?
Vomiting, diarrhea, fever, or reduced fluid intake can affect lithium levels. Contact the prescribing clinician for guidance, especially if the illness continues or you develop new tremors, weakness, confusion, or problems with coordination.
Can lithium toxicity develop after years on the same dose?
Yes. A dose that has been stable for years can become problematic if kidney function changes or another illness, medication, or change in fluid balance affects how lithium is cleared.
Does lithium toxicity mean you can never take lithium again?
Not necessarily. Whether lithium is restarted depends on what caused the toxicity, how fully the person recovered, kidney function, psychiatric history, and the prescribing clinician’s assessment.
Can lithium toxicity cause lasting problems?
Lithium toxicity can sometimes cause lasting problems, particularly after severe toxicity that affects the brain or nervous system. Persistent symptoms may include problems with coordination, movement, memory, or other neurological functioning, although many people recover without permanent effects.
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Cole Dyar is the Executive Director & co-founder of Neurish Wellness. He has been working in the behavioral health field in operational, clinical, organizational, and managerial capacities for thirteen years. He holds a degree from the University of California, Santa Cruz in sociology and is a Licensed Advanced Alcohol and Drug Counselor (LAADC) as recognized by CCAPP. Cole holds a Master of Science in Industrial/Organizational Psychology including: Organizational Leadership and Design, a Post-Masters in General Marriage and Family Therapy, and is currently a doctoral candidate in MFT with an emphasis in Systemic Administration & Entrepreneurship.