Safer lithium therapy

Some patients taking lithium have been harmed because they have not had their dosage adjusted based on recommended regular blood tests. If patients are not informed of the known side effects or symptoms of toxicity, they cannot manage their lithium therapy safely.

Regular blood tests are important. Clinically significant alterations in lithium blood levels occur with commonly prescribed and over-the-counter medicines. The blood level of lithium is dependent on kidney function and lithium has the potential to interfere with kidney (renal) and thyroid functions.

All healthcare organisations in the NHS where lithium therapy is initiated, prescribed, dispensed and monitored are asked to ensure that by 31 December 2010:

• patients prescribed lithium are monitored in accordance with NICE guidance;

• there are reliable systems to ensure blood test results are communicated between laboratories and prescribers;

• at the start of lithium therapy and throughout their treatment patients receive appropriate ongoing verbal and written information and a
  record book to track lithium blood levels and relevant clinical tests*; 

• prescribers and pharmacists check that blood tests are monitored regularly and that it is safe to issue a repeat prescription and/or
  dispense the prescribed lithium; 

• systems are in place to identify and deal with medicines that might adversely interact with lithium therapy.

* The NPSA has developed a patient information  booklet, lithium alert card and record book for tracking blood tests.