To kick off Mental Health Awareness Month, we are featuring Lithium, a mood stabilizer used for bipolar disorder. Lithium has many side effects, drug interactions, and an FDA Black Box Warning that may affect dental treatment:
Generic Name: Lithium
Brand Name(s): Lithobid
Pronunciation: LITH ee um
About this drug:
Lithium is used to treat and prevent manic episodes of manic-depressive illness (bipolar disorder). Symptoms of a manic episode include hyperactivity, rushed speech, poor judgment, needing little sleep, aggression, and anger.
Dentistry-related tidbits:
This medication may cause xerostomia. Prescribe a fluoride supplement if a patient has a high rate of caries and increase the frequency of dental exams.
Lithium’s side effects that may make the dental procedure more challenging include tremors, impaired coordination, slurred speech, and confusion.
Prescribing narcotics, muscle relaxants, the oxazolidinone antibiotic Linezolid, and the anticonvulsant Carbamazepine in combination with Lithium may increase the risk of serotonin syndrome.
The risk of nephrotoxicity and vestibular/auditory side effects may increase if Lithium is combined with aminoglycoside antibiotics and the glycopeptide antibiotic Vancomycin (especially with renal problems, long course with high Vancomycin dose > 2 g/day, or intestinal inflammation).
Speak with the patient's psychiatrist before prescribing an NSAID, the lincosamide antibiotic Clindamycin, the nitroimidazole antibiotic Metronidazole, or antivirals such as Acyclovir to avoid an increase in the Lithium serum concentration or Lithium toxicity.
Benzodiazepines and anticonvulsants in combination with Lithium may decrease the seizure threshold. Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.
Fun facts:
Bipolar disorder is characterized by extreme mood swings, from mania or hypomania (a milder form of mania) to depression.
Lithium's mechanism of action is unknown but studies show that it alters neuronal sodium transport, resulting in moderating glutamate levels which is the primary excitatory neurotransmitter in the brain that causes mania.
This medication has a Black Box Warning regarding toxic dangerous blood levels being very close to the therapeutic blood level dose.
Over-the-counter supplements such as Calcium, Magnesium, antacids, or Vitamin C in combination may decrease Lithium levels.
The amount of Caffeine consumed may enhance renal excretion, causing the levels and efficacy of Lithium to decrease.
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