Mitigating acute skin rashes and nausea from lithium

Abstract

Effective in treating and preventing particular types of mental illness, lithium has recently been reported to cut the costs of medical care and improve the quality of life of many appropriately selected patients. 1 Unfortunately, some patients who are selected as appropriate for starting lithium are greatly discomforted by some of its side effects. Prominent among the discomforting effects are resting tremors, nausea and vomiting, and excessive thirst and urination; these are rarely severe enough for the physician to recommend lithium discontinuance. On the other hand, it is common to see patients who have quit their lithium on their own complaining of annoying side effects. Among the few circumstances in which physicians recommend lithium discontinuance is when an intense skin rash appears within a few hours of administration. The life prospects for many patients who cannot or will not take lithium are gloomy: they will likely experience repeated episodes and exacerbations of their psychiatric illness and their careers and personal lives will suffer the discouragements of interruptions. Those who take neuroleptics in place of lithium experience a more subtle handicap, that of mental inertia and emotional blunting from tranquilization. As good medical practice it seems prudent to try to help patients accommodate to lithium with various pharmacological maneuvers when these side effects interfere with reliable lithium administration. In this report some cases will be reviewed in which side effects of an acute skin reaction or nausea threatened to take precedence over lithium's therapeutic effects.