Can lithium (lithium carbonate) cause edema (fluid retention)?

From the Guidelines

Lithium can cause edema as a side effect, although the provided evidence does not directly quantify this risk. The mechanism behind lithium-induced edema is related to its effects on renal function and electrolyte balance, as noted in the study published in the American Journal of Kidney Diseases 1. This study highlights the importance of monitoring patients on lithium for signs of renal tubular dysfunction and electrolyte imbalances, which can contribute to fluid retention. Key points to consider when evaluating the risk of edema in patients taking lithium include:

• The potential for nephrotoxicity and renal tubular dysfunction with prolonged use, even at therapeutic levels 1
• The importance of maintaining hydration, especially during intercurrent illness, to mitigate the risk of lithium toxicity and related side effects
• The need to weigh the risk-benefit of lithium in specific situations, considering its potential effects on renal function and overall health In clinical practice, if a patient experiences edema while taking lithium, it is crucial to consult with a healthcare provider to determine the best course of action, which may include adjusting the lithium dose, managing sodium intake, or considering alternative treatments. Given the potential for lithium to impact renal function and contribute to edema, monitoring and managing patients on lithium requires careful consideration of their overall health status and renal function.

From the FDA Drug Label

Miscellaneous reactions unrelated to dosage are: ... edematous swelling of ankles or wrists...

• Edema is a reported side effect of lithium (lithium carbonate) as evidenced by edematous swelling of ankles or wrists.
• This suggests that lithium can cause fluid retention, leading to edema in some patients.
• The exact mechanism and frequency of this side effect are not specified in the drug label 2.

From the Research

Lithium and Edema

• There is no direct evidence in the provided studies that lithium (lithium carbonate) causes edema (fluid retention) 3, 4, 5, 6, 7.
• However, the studies suggest that long-term lithium treatment can cause renal side effects, including nephrogenic diabetes insipidus, polyuria, and polydipsia, which may lead to dehydration rather than edema 3, 4, 5.
• Lithium treatment has also been associated with a decline in renal function, which may increase the risk of fluid retention and edema in some patients 5, 6, 7.
• The studies recommend regular monitoring of renal function, serum lithium concentrations, and other factors to minimize the risk of renal side effects and prevent chronic kidney disease 3, 4, 5, 6, 7.

Renal Side Effects of Lithium

• Nephrogenic diabetes insipidus, polyuria, and polydipsia are common renal side effects of lithium treatment 3, 4, 5.
• Long-term lithium treatment can cause a decline in renal function, including a decrease in glomerular filtration rate (GFR) 5, 6, 7.
• Chronic kidney disease (CKD) is a rare but potential side effect of long-term lithium treatment, affecting approximately 1% of patients who have taken lithium for over 15 years 5.
• The risk of CKD can be minimized by monitoring renal function, serum lithium concentrations, and other factors, and by adjusting the lithium dose regimen as needed 6, 7.