The prescription drug lithium is a mineral with antidepressant and antimanic actions. It is
used to treat bipolar disorder
(manic-depression) and severe depression.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
May Be Beneficial:Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them.
Inositol
May Be Beneficial:Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication.
Essential fatty acids*
Inositol
May Be Beneficial:Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better.
Folic acid
L-tryptophan*
Check:Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details.
Coffee
Psyllium
Sodium
Reduced drug
absorption/bioavailability
None known
Adverse interaction
None known
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
Essential fatty acids
In one report, supplementation with essential fatty acids in the form of safflower oil
(3–5 grams per day) reversed symptoms of lithium toxicity such as tremor and ataxia (an
abnormality of gait).1 Controlled studies are needed to confirm the benefit of a
lithium-essential fatty acid combination.
Folic
acid
Some studies have found that people taking lithium long term who have high blood levels of
folic acid respond better to lithium.23 Not all studies have confirmed
these findings, however.4
A double-blind study was conducted combining 200 mcg folic acid per day with lithium
therapy.5 Even though the volunteers in this study were doing well on lithium alone
before the study, addition of folic acid further improved their condition, whereas placebo did
not. There is no evidence that folic acid reduces side effects of lithium. Based on the
available evidence, it is suggested people taking lithium also take at least 200 mcg of folic
acid per day.
Inositol
Lithium therapy has been shown to deplete brain stores of inositol.6 While it has
been suggested that inositol supplementation (e.g., 500 mg three times daily) could reduce
adverse effects of lithium therapy without reducing the drug’s therapeutic
effectiveness,78 the safety and efficacy of this combination has not
been proven.
Treatment with lithium can trigger or worsen
psoriasis. In a double-blind study, supplementing with inositol (6 grams per day) for ten
weeks significantly improved lithium-induced psoriasis, but had no effect on psoriasis in
people who were not taking lithium.9
L-tryptophan
A small double-blind study found that combining 2–4 grams three times per day of
L-tryptophan with lithium significantly improved symptoms in people with bipolar disorder or a
mild form of schizophrenia.10 L-tryptophan is only available from doctors. It
should be taken several hours before or after meals.
Sodium
Lithium may cause sodium depletion, especially during initial therapy until consistent blood
levels are achieved.11 A low-sodium
(salt-restricted) diet can decrease lithium elimination, leading to increased lithium
levels and risk of toxicity in lithium users who reduce their salt intake.12
Changing to a higher salt intake may cause increased losses of lithium, resulting in the
return of mood symptoms.1314 People using lithium therapy should
maintain adequate water intake as well as a normal diet and salt intake. Sodium loss due to diarrhea, illness, extreme sweating, or other
causes may alter lithium levels.
Interactions with Herbs
Psyllium(Plantago ovata)
Addition of psyllium husk two times per day to the regimen of a woman treated with lithium was
associated with decreased lithium blood levels and lithium levels increased after psyllium was
stopped.15
Interactions with Foods and Other Compounds
Food
Lithium should be taken with food to avoid stomach upset.16
Foods that alkalinize the urine may increase elimination of lithium from the body,
potentially decreasing the actions of the drug.17 Urine-alkalinizing foods include
dairy products, nuts, fruits, vegetables (except corn and lentils), and others.
Coffee
Mild hand tremor is a common side effect of lithium therapy. Two cases of women treated with
lithium who experienced increased tremor when they stopped drinking coffee have been reported.18 Lithium levels
increased almost 50% in one of the women, who had been drinking 17 cups of coffee per day,
requiring a 20% reduction in her lithium dose. In 11 people treated with lithium who drank
four to six cups of coffee per day, two weeks without coffee resulted in increased lithium
blood levels, anxiety, and
depression.19 Lithium levels, anxiety, and depression ratings returned to base line
two weeks after resuming coffee consumption. Until more is known, people taking lithium should
avoid abrupt changes in their coffee consumption.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
1. Lieb J. Linoleic acid in the treatment of lithium toxicity and
familial tremor. Prostaglandins Med 1980;4:275–9.
2. Coppen A, Abou-Saleh MT. Plasma folate and affective morbidity during
long-term lithium therapy. Br J Psychiatry 1982;141:87–9.
3. Lee S, Chow CC, Shek CC, et al. Folate concentration in Chinese
psychiatric outpatients on long-term lithium treatment. J Affect Disorders
1992;24:265–70.
4. Stern SL, Brandt JT, Hurley RS, et al. Serum and red cell folate
concentrations in outpatients receiving lithium carbonate. Int Clin Psychopharmacol
1988;3:49–52.
5. Coppen A, Chaudhry S, Swade C. Folic acid enhances lithium
prophylaxis. J Affect Disorders 1986;10:9–13.
6. Silverstone PH, Rotzinger S, Pukhovsky A, Hanstock CC. Effects of
lithium and amphetamine on inositol metabolism in the human brain as measured by 1H and 31P
MRS. Biol Psychiatry 1999;46:1634–1.
7. Colodny L, Hoffman RL. Inositol -- Clinical applications for exogenous
use. Altern Med Rev 1998;3:432–47.
8. Johnson EC, Gray-Keller MP, O’Day PM. Rescue of excitation by
inositol following Li(+)-induced block in Limulus ventral photoreceptors. Vis
Neurosci 1998;15:105–12.
9. Allan SJR, Kavanagh GM, Herd RM, Savin JA. The effect of inositol
supplements on the psoriasis of patients taking lithium: a randomized, placebo-controlled
trial. Br J Dermatol 2004;150:966–9.
10. Brewerton TD, Reus VI. Lithium carbonate and L-tryptophan in the
treatment of bipolar and schizoaffective disorders. Am J Psychiatry
1983;140:757–60.
11. Threlkeld DS, ed. Central Nervous System Drugs, Antipsychotic Agents,
Antimanic Agents, Lithium. In Facts and Comparisons Drug Information. St. Louis, MO:
Facts and Comparisons, May 1998, 268a–8f.
13. Demers RG, Harris RL. The effect of dietary sodium on renal lithium
excretion in the manic-depressive. Dis Nerv Syst 1972;33:372–5.
14. Demers RG, Heninger GR Sodium intake and lithium treatment in mania.
Am J Psychiatry 1971;128:100–4.
15. Perlman BB. Interaction between lithium salt and ispaghula husk.
Lancet 1990;335:416.
16. Threlkeld DS, ed. Central Nervous System Drugs, Antipsychotic Agents,
Antimanic Agents, Lithium. In Facts and Comparisons Drug Information. St. Louis, MO:
Facts and Comparisons, May 1998, 268a–8f.
The information presented in Aisle7 is for informational purposes only.
It is based on scientific studies (human, animal, or in vitro), clinical experience,
or traditional usage as cited in each article. The results reported may not necessarily occur
in all individuals. For many of the conditions discussed, treatment with prescription or over
the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist
for any health problem and before using any supplements or before making any changes in
prescribed medications. Information expires February 2010.
