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Brand names: Lithobid • Drug class: Mood stabilizer (bipolar disorder)
Lithium is the gold-standard mood stabilizer — and one of the few drugs that can directly damage the kidneys. Chronic use causes nephrogenic diabetes insipidus (excessive thirst/urination) and, in some, slowly progressive CKD. Careful monitoring protects both the mood stability and the kidneys.
Lithium is renally cleared and nephrotoxic with chronic use: it impairs the collecting duct's response to ADH (nephrogenic DI), raising urine output; long-term therapy is associated with interstitial nephritis and CKD. Lithium levels must stay in the narrow therapeutic window (0.6-1.0 mEq/L for maintenance), with creatinine and eGFR checked every 3-6 months. Acute toxicity (levels >1.5) is a medical emergency — dialysis removes lithium in severe cases.
Chronic lithium associated with nephrogenic DI and interstitial nephritis
Nephrology cohort literature, 2023
Lithium is dialyzable; hemodialysis indicated in severe acute toxicity
EXTRIP workgroup, 2015
Renally cleared — maintenance dose titrated to serum level (0.6-1.0 mEq/L), not just by kidney function. Monitor lithium level + creatinine/eGFR every 3-6 months. Hold lithium during dehydration or acute illness. Severe toxicity: hemodialysis.
Check your kidney functionThis page is educational. Medication decisions — especially dosing changes — must be made by your prescribing clinician.
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