Lithium Interactions and Precautions

Introduction to Lithium Interactions

The American Academy of Child and Adolescent Psychiatry recommends avoiding lithium during electroconvulsive therapy (ECT) treatment when clinically possible 1
The American Academy of Child and Adolescent Psychiatry also reports that acute brain syndrome can occur when lithium is used concurrently with ECT 2
The American Academy of Child and Adolescent Psychiatry advises that monoamine oxidase inhibitors (MAOIs) should be avoided in combination with lithium due to increased risk of serotonin syndrome 3
The American Academy of Child and Adolescent Psychiatry recommends caution when combining lithium with other serotonergic medications due to risk of serotonin syndrome 3

The American Journal of Kidney Diseases recommends regular monitoring of GFR, electrolytes, and drug levels in all patients taking potentially nephrotoxic agents such as lithium 4
The American Journal of Kidney Diseases suggests that lithium should be temporarily discontinued in people with GFR <60 ml/min/1.73 m² who have serious intercurrent illness that increases risk of acute kidney injury 4
The American Family Physician recommends that patients and caregivers should be educated to discontinue lithium and contact their physician if signs of lithium toxicity occur, including tremor 5
The American Family Physician suggests that lower lithium doses (blood levels 0.2-0.6 mEq/L) may be adequate when lithium is used to augment antidepressants 5

The Journal of the American Academy of Child and Adolescent Psychiatry states that patients and caregivers should be educated to discontinue lithium and contact their physician if signs of lithium toxicity occur, including diarrhea and vomiting 3