Lithium is a mood stabilizer and one of the most effective, time-tested medications for bipolar disorder, used to prevent both manic and depressive episodes. Taken carefully and monitored with simple blood tests, it is safe and highly effective for most people. This page explains why we use lithium, how to take it, and the everyday best practices that keep it working safely.
Why we use lithium
Lithium has been a cornerstone of bipolar treatment for decades, and the evidence behind it remains some of the strongest in all of psychiatry. It stabilizes mood, helps prevent both the highs of mania and the lows of depression, and is the one medication shown in research to reduce the risk of suicide in people with mood disorders (Cipriani et al., 2013). For many people it is a life-changing, life-protecting medication.
How to take your lithium
Consistency is everything with lithium. We typically prescribe an extended-release form, which is usually taken twice a day: a morning dose around 8:00–9:00 a.m. and an evening dose around 8:00–9:00 p.m. Taking your doses at about the same times each day keeps your level steady. If you are taking an immediate-release form instead, it often has to be divided into more frequent doses through the day (commonly three to four times daily), which is one reason we usually prefer the extended-release form. Take lithium with food or after a meal if it upsets your stomach, and never double up if you miss a dose — just ask us what to do.
Getting your lithium level checked
Lithium works in a specific range, so we check the level in your blood with a simple test. The standard, most reliable way to measure it is a 12-hour mid-level — drawn about 12 hours after your last (evening) dose. In practical terms: on the morning of your blood draw, do not take your morning lithium dose first. Have your blood drawn first thing in the morning, and then take your morning dose right afterward. Taking your morning dose before the draw will make the level read falsely high and can lead to the wrong dose change. Maintenance levels are individualized and are commonly in the range of about 0.6–0.8 mmol/L, sometimes adjusted higher or lower based on your response and tolerance (Nolen et al., 2019).
Avoid NSAIDs (and other things that raise your level)
Do not take NSAIDs — such as ibuprofen (Advil, Motrin), naproxen (Aleve), or prescription anti-inflammatories — while on lithium unless we tell you to. NSAIDs reduce how well the kidneys clear lithium and can raise your lithium level by roughly 15–60%, which can push you into the toxic range (Medsafe, 2017). For everyday aches, pains, or fever, acetaminophen (Tylenol) is generally a safer choice — but always check with us first. A few other things can also raise your level: becoming dehydrated, big changes in how much salt you eat, and certain blood-pressure medicines (such as ACE inhibitors, ARBs, and thiazide diuretics). Stay well hydrated, keep your salt intake steady, and tell us before starting any new medication, including over-the-counter products. Just as important, make sure every healthcare provider you see — including dentists, urgent care clinicians, and specialists — knows you take lithium before they write you a single prescription, since many common medications can change your lithium level. Do not take prescription NSAIDs unless we have specifically approved it. If you are ever unsure whether a medication is safe with lithium, reach out to our office before taking it.
Signs of lithium toxicity — when to call us
Because lithium works in a narrow range, it is important to recognize when a level may be too high. Call us, or seek urgent care, if you notice nausea, vomiting, or diarrhea, a new or worsening coarse tremor, unsteadiness or trouble walking, slurred speech, confusion, or unusual drowsiness — especially during an illness with fever, vomiting, or poor fluid intake, which can quickly raise your level. In an emergency, call 911.
Ongoing monitoring
Lithium is easy to live with when it is monitored. Lithium is considered a high-risk medication with a narrow safe range, so verifying the level with a lab test is essential: we check your blood level at least about every three months, along with your kidney and thyroid function, and more often when we adjust your dose, when something changes (a new medication, an illness, or dehydration), or if you have any symptoms of lithium toxicity. Do not stop lithium suddenly on your own; stopping abruptly can trigger a relapse, so we always taper or adjust together.
Culturally grounded care
We care for the whole person, in the spirit of lōkahi — balance and harmony among the body, mind and emotions, spirit, ʻohana (family), and our connection to the ʻāina (land) and community. To mālama (care for and protect) you and to support living pono (in balance), we explain your medication clearly, welcome your ʻohana into your care, and honor the values that ground you. Offering kōkua (help given freely, with aloha) is at the heart of how we practice.
Common questions about lithium
When should I take my lithium each day?
Most people take extended-release lithium twice daily, around 8–9 a.m. and 8–9 p.m. Taking it at consistent times keeps your level steady. Immediate-release lithium is usually divided into more frequent doses through the day.
How do I prepare for a lithium blood test?
Do not take your morning dose before the test. Have your blood drawn first thing in the morning, about 12 hours after your evening dose (a 12-hour mid-level), then take your morning dose afterward. This gives an accurate reading.
Why can’t I take ibuprofen or other NSAIDs with lithium?
NSAIDs make the kidneys hold onto lithium and can raise your level by about 15–60%, risking toxicity. Acetaminophen (Tylenol) is usually a safer option for pain or fever, but check with us before taking anything new.
What are the warning signs of lithium toxicity?
Nausea, vomiting, diarrhea, a coarse tremor, unsteadiness, slurred speech, confusion, or unusual drowsiness. These need prompt attention — contact us right away, and call 911 in an emergency.
How often do I need lithium blood tests?
Because lithium is a high-risk medication with a narrow safe range, we check your blood level with a lab test at least about every three months, and more often if we change your dose, if something changes such as a new medication or illness, or if you have any symptoms of possible toxicity.
Do I need to tell my other doctors I take lithium?
Yes. Every healthcare provider you see, including dentists, urgent care, and specialists, should know you take lithium before they write you any prescription, because many medications can change your lithium level. Avoid prescription NSAIDs unless we have approved them, and reach out to our office with any questions.
This page is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. Do not start, stop, or change any medication without talking with your clinician. In an emergency, call 911.
George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner
References
Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis. BMJ, 346, f3646. https://doi.org/10.1136/bmj.f3646
Nolen, W. A., Licht, R. W., Young, A. H., Malhi, G. S., Tohen, M., Vieta, E., et al. (2019). What is the optimal serum level for lithium in the maintenance treatment of bipolar disorder? A systematic review and recommendations from the ISBD/IGSLI Task Force on treatment with lithium. Bipolar Disorders, 21(5), 394–409. https://doi.org/10.1111/bdi.12805
New Zealand Medicines and Medical Devices Safety Authority (Medsafe). (2017). Drug interactions with lithium. Prescriber Update, 38(3). https://www.medsafe.govt.nz/profs/PUArticles/September2017/Lithium.htm
