Patient/Family Teaching

• Instruct patient to take medication as directed, even if feeling well. Take missed doses as soon as remembered unless within 2 hr of next dose (6 hr if extended release)

• Lithium may cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known

• Advise patient that psychotherapy is beneficial in improving coping skills

• Low sodium levels may predispose patient to toxicity. Advise patient to drink 2000–3000 ml fluid each day and eat a diet with consistent and moderate sodium intake. Excessive amounts of coffee, tea, and cola should be avoided because of diuretic effect. Avoid activities that cause excess sodium loss (heavy exertion, exercise in hot weather, saunas). Notify health care professional of fever, vomiting, and diarrhea, which also cause sodium loss

• Advise patient that weight gain may occur. Review principles of a low-calorie diet

• Instruct patient to consult health care professional before taking OTC medications or herbal products concurrently with this therapy

• Advise patient to use contraception and to consult health care professional if pregnancy is suspected

• Review side effects and symptoms of toxicity with patient. Instruct patient to stop medication and report signs of toxicity to health care professional promptly

• Explain to patients with cardiovascular disease or over 40 yr of age the need for ECG evaluation before and periodically during therapy. Patient should inform health care professional if fainting, irregular pulse, or difficulty breathing occurs

• Emphasize the importance of periodic lab tests to monitor for lithium toxicity

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