Lithium and Alcohol

What is Lithium?

Lithium (lithium carbonate) is a mood stabilizer medication prescribed to treat mental disorders, including bipolar disorder, depression, and schizophrenia. Lithium is an antimanic agent, and it works to treat affective disorders by decreasing abnormal activity in the brain. Lithium is available as a tablet, capsule, extended-release (long-acting) tablet, and solution (liquid) to take by mouth. The brand names of lithium include Eskalith and Lithobid.

To treat bipolar disorder, also known as manic depression, lithium is used alone or with other medications such as benzodiazepines, Risperdal, or citalopram. Lithium is often prescribed as maintenance therapy in between manic episodes in patients with bipolar disorder.

Research shows that lithium can significantly reduce suicide risk in patients with mood disorders. 

Side Effects of Lithium

Some patients who take lithium for bipolar disorder experience side effects. These side effects may subside or decrease in severity as the patient’s body gets used to the drug. Common side effects of lithium include:

• Acne or rash
• Changes in the ability to taste
• Changes in appetite
• Constipation
• Depression
• Dry mouth
• Excessive salivation
• Gas
• Headache
• Indigestion
• Itching
• Joint or muscle pain
• Paleness
• Restlessness
• Stomach Pain
• Swollen lips
• Thinning or brittle fingernails 
• Thinning of hair or hair loss
• Unusual discomfort in cold temperatures
• Weight gain or loss

In rare cases, lithium may cause a reversible condition known as diabetes insipidus. If this occurs, patients will notice a significant increase in thirst and frequency of urination. Patients who experience these symptoms should talk to their healthcare provider to check for and prevent this condition.

Symptoms of Lithium Toxicity

Lithium toxicity, also called lithium overdose and lithium poisoning, is a potentially deadly condition of having dangerously high levels of lithium in the blood. Drug interactions in the body also cause this condition.

Symptoms of lithium toxicity include: 

• Blackouts
• Confusion
• Crossed Eyes
• Diarrhea
• Dizziness or drowsiness
• Fainting
• Hallucinations
• Hand tremors
• Headache
• Irregular heartbeat
• Loss of coordination
• Muscle weakness
• Nausea or vomiting
• Painful, cold, or discolored fingers and toes
• Pounding noises inside the head
• Seizures
• Shortness of breath or chest tightness
• Swelling of the feet, ankles, or lower legs
• Unusual tiredness or weakness
• Vision changes

These symptoms indicate that lithium levels are dangerously high. Patients who experience these symptoms should stop taking lithium and seek medical care immediately. Lithium toxicity is a potentially life-threatening event and should be attended to urgently by a healthcare professional. If untreated, lithium toxicity can result in death.

Some medications can increase the levels and effects of lithium and cause lithium toxicity, including:

• Angiotensin-converting enzyme (ACE) inhibitors (such as lisinopril)
• Angiotensin receptor blockers
• Certain blood pressure medications
• Diuretics
• Monoamine oxidase inhibitors (MAOIs), a class of antidepressants
• Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and other over-the-counter pain medications

Patients taking these medications should not take lithium. 

Lithium should generally not be prescribed to patients with significant kidney or heart disease, severe debilitation or dehydration, sodium depletion, and patients receiving diuretics. The risk of lithium toxicity is greatly increased in these patients.

Some medications and substances may decrease the levels and effectiveness of lithium. Patients should avoid the following medications and substances while taking lithium:

• Caffeine
• Sodium chloride (table salt)
• Theophylline (Theo–Dur®, Slo–Bid®)

Patients should disclose any medications and substances they take to their doctor prior to taking lithium to prevent any harmful drug or substance interactions.

Is Lithium Addictive?

Lithium is not addictive except in the sense that anything can become psychologically addictive. Even though lithium is not a naturally addictive substance, it can still be used improperly or mixed with addictive substances which can cause dangerous interactions, and in some cases, death. 

Is it Safe to Mix Lithium and Alcohol?

Drinking alcohol while on lithium is not safe. For patients on lithium, alcohol may decrease the benefits and increase the adverse effects of the medication.

Because Lithium is typically prescribed to patients with bipolar disorder, it is not recommended to mix lithium with alcohol, because ethanol, the primary ingredient in alcohol, also causes mood-altering effects. Both of these drugs affect the central nervous system. When lithium and alcohol interact, they can counterbalance each other. Someone who mixes the two may find that their mental state gets worse as a result.

There are other considerations with mixing lithium and alcohol. One of these is the fact that alcohol is dehydrating. Because alcohol dehydrates the body, it can lead the amount of lithium in the blood to rise and become toxic.

People on lithium are advised to maintain a balanced diet, which can be interrupted by alcohol. Because of how heavily lithium affects sodium levels in the blood, it’s essential to be vigilant with salt consumption.

Lithium use is also associated with an increased risk of hypothyroidism. Drinking alcohol also harms thyroid levels.

Other illicit drugs, including marijuana and cocaine, can cause dangerous interactions with lithium. Individuals with substance use disorders should not be prescribed lithium.

Lithium and Alcohol Side Effects & Risks

When alcohol and lithium mix, they may cause:

• Dizziness
• Drowsiness
• Impaired thinking and judgment
• Impaired motor functions
• Increased depression
• Liver Damage
• Nausea and Vomiting
• Restlessness
• Sedation
• Tremors
• Joint pain
• Muscle pain

Alcohol abuse complicates the management of bipolar disorder and other mood disorders. Drinking impairs judgment and makes the user more impulsive and more prone to injury or risky behavior.

Alcohol and lithium also increase the risk of suicide. The risk of suicide is nearly doubled in patients with bipolar disorder who abuse alcohol compared with patients who don’t. 

Treatment for Lithium & Alcohol Abuse

Patients being treated with lithium who also abuse alcohol will likely be prescribed another mood stabilizer that does not interact with alcohol. They will also be referred to alcohol treatment, either inpatient, outpatient, or partial hospitalization, depending on their abuse severity.