The ingestion of marked amounts of sodium can prevent the establishment or maintenance of adequate serum lithium levels.
Warn patients not to take non-prescription antacids or urinary alkalinisers without first seeking informed advice. Sodium bicarbonate comes in various guises and disguises e.g. Alka-Seltzer (55.8%), Andrews Salts (22.6%), Eno (46.4%), Jaap's Health Salts (21.3%), or Peptac (28.8%). Substantial amounts of sodium also occur in some urinary alkalinising agents (e.g. Citralka, Citravescent). An antacid containing aluminium/magnesium hydroxide with simeticone has been found to have no effect on the bioavailability of lithium carbonate, and so antacids of this type may be suitable alternatives.
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