Lithium and marathon hydration/salt

Hopefully there's someone out there who also takes Lithium and has pondered this same question.

I have been on Lithium a few weeks and am starting to think more critically about marathon racing / jogging for completion / and training and what is required for safe use of Lithium vs water and sodium intake.
I've read a bit online- the main advice I've found is day-to-day to drink plenty of water and to not avoid salty foods. I cannot find much about if you are exercising on Lithium, or guideline for /how much/ water and salt is required.
Before Lithium, I was a big water drinker in marathons, maybe consuming 2-4 litres during the race depending on the temperature, effort, and humidity- all affecting sweat rate. I would consume 1-2 High5 Zero electrolyte tabs and a Powerade after the race.
It would seem to me from my experience of running that sweating in marathons could easily cause dehydration and electrolyte loss- including sodium, leading to a short term rise in Lithium levels. Conversely by over-drinking runners risk the dreaded hyponatremia, and too much salt could cause issues with blood pressure etc.

Anyone got any advice for getting the right balance of hydration/electrolytes in line with Lithium?
For before, during, and after a 'hard effort'.



  • I ran (jogged leisurely for completion) a marathon on Wednesday and drank what I felt I wanted at the time. This turned out to be ::::two Powerades and probably a litre of dissolvable electrolytes and a litre of squash. 

  • Can you do a (naked) weight before and after a long run, whilst keeping track of your intake, and try drinknig to thirst. As long as you have only lost a smal amount of weight, you should be fine.

    This should at least provide some reassurance as to whether your "drinking to thirst" is actually keeping you about right.


  • Thanks for your reply tricialitt.
    Yes I could do a before and after weight test, I might well do that if the opportunity for a non-marathon long run arises. Probably mid September...
    That would help with the water volume I guess, but still some work to do about sodium.

    Problem is Lithium makes me thirsty (known common symptom), but also we're advised to drink more than normal.

    A few quotes specific to Lithium:::

    "Call your doctor if you lose a significant amount of body fluid as a result of sweating,....."

    "Tell your doctor if you have been sweating excessively, ....... Avoid becoming overheated or dehydrated during exercise and in hot weather. Tell your doctor if you are dehydrated or have low levels of sodium in your blood. "

    "Lithium is a metal that has a tendency to deplete sodium levels. Along with drinking a lot of water, ........ and don't spare the salt on meals."

    "Taking this medication can make it easier for you to become dehydrated, especially if .......... you are outdoors in the sun, or if you exercise vigorously or sweat more than usual. Dehydration can increase some of the side effects of lithium."

    "Drink extra fluids each day to keep from getting dehydrated while you are taking lithium. Tell your doctor if you have been sweating excessively ......... for more than a few hours."

    "Make sure you drink a lot of water because you can get dehydrated on Lithium."

    "Drinking water replaces the fluids lost through increased urination caused by lithium. This prevents dehydration which would raise lithium levels. Fluid IN balances the fluid OUT. Several quarts or more per day may be needed."

    "Low sodium diets particularly being a danger of inducing lithium toxicity."

  • My GP bless her doesn't know what to suggest. And my consultant doesn't know either. 

  • I’ve recently started on Lithium to control my bipolar. I’ve been taking 800mg modified release at night for a couple of weeks now, which has been enough to provide a therapeutic dose for me based on blood tests. I was very concerned about Lithium Toxicity and the impact of sweating to start with, and started out taking water with me and drinking every 10 minutes or so. I then experimented with leaving it progressively longer before drinking, and have been able to run for up to 11 miles / 95 minutes without drinking. Yesterday I ran 15 miles without problems taking on water after 10 miles. I had assumed I wouldn’t safely be able to train or race marathon distances safely on Lithium, but have now reinstated my plans to do the Brighton Marathon in April aiming for a sub 3 hour time. I am also taking Quetiapine (normally 300mg MR but currently 600mg) and have been for over a year. This has a sedative effect, but I still find I can train and race to a reasonable standard on this medication too - I take it as soon as I’ve finished a run to ensure as much of it as possible is out of my system before I next train. Like many people, I experienced weight gain on Quetiapine, but found that with a determined effort I can lose it again. The basic equation of calories consumed vs calories burned still applies! Bipolar is a tough condition to live with, and the level of my performance has definitely been lower than before I was diagnosed in 2014. But it is still possible to enjoy running with the condition and to be reasonably competitive. Good luck!
  • There is a place in Bangkok there are more kind of salts if you check.
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