Table 4 Severe adverse drug reactions with lithium as reported probable causative agent 2016 to 2021

1. Li-intoxication (agitation/confusion)

2. Tremor

3. Nausea, vomiting

h: Hydrochlorothiazide

i: Ramipril

• Transfer to ICU

• Discontinuation of Li and Hydrochlorothiazid

1. Blurred vision

2. Diarrhea

3. Vertigo

Li serum level: 2.21 mmol/

i: Haloperidol, Clozapine, Enalapril

• Transfer to internal medicine

• Discontinuation of Li

Agitation

Li serum level: 1.36 mmol/l

i: Olanzapine, Valsartan

• Hospitalization

• Discontinuation of Li

1. Psychomotor retardation

2. EPS

i: Doxepine, Haloperidol

• Biperiden application

• Discontinuation of Li

1. Cognitive deficits

2. diarrhea

Li serum level: 1.56 mmol/l

i: Diltiazem, Candesartan

• Discontinuation of Li

• Reduction of Candesartan

Li-intoxication (restlessness/agitation)

i: Ramipril, Flupentixol

• Discontinuation of Li

Renal dysfunction

i: Clozapine, Haloperidol

• Discontinuation of Li

Renal dysfunction

h: Hydrochlorothiazide

i: Duloxetine, Valsartan, Pipamperone

• Discontinuation of Li

Tremor

i: Sertraline

• Discontinuation of Li

1. Tremor

2. Nausea, vomiting

i: Venlafaxin, Flupentixol

• Reduction of Li and Mirtazapine

• discontinuation of Flupentixol

nausea and vomiting

i: Venlafaxine, Pipamperone

• Reduction of Li dosage

Tremor

i: Piroxicam

• Reduction of Li dosage

Tremor

i: Ramipril

• Reduction of Li dosage

Tremor

i: Ramipril, Duloxetin

• Reduction of Li dosage

Tremor

i: Venlafaxine

• Reduction of Li dosage

Tremor

i: Tapentadol, Etoricoxib, Macrogol

• Reduction of Li dosage

Edema of hands, feet, face

i: Venlafaxine

• Reduction of Li dosage

Renal dysfunction

i: Venlafaxine, Amisulpride

• Consultation with internal medicine

QTc-elongation

i: Duloxetine, Pipamperone

• Ecg control