OBJECT DRUGS

• Lithium (Eskalith)

PRECIPITANT DRUGS

Loop Diuretics:

• Bumetanide (Bumex)
• Ethacrynic Acid (Edecrin)
• Furosemide (Lazix)
• Torsemide (Demadex)

Comment:

Lithium toxicity has been reported when loop diuretics are used with lithium, although the magnitude of the effect may be variable from patient to patient. The elderly may be at greater risk. The lithium toxicity can be severe. In an epidemiologic study loop diuretics were associated with a substantial increase in the risk of hospitalization due to lithium toxicity.

Class 3: Assess Risk & Take Action if Necessary

• Monitor: Monitor for altered lithium effects if loop diuretics are initiated, discontinued, or changed in dosage. Note that—depending on the original lithium serum concentration—it may take up to several weeks for lithium toxicity to become manifest. Lithium toxicity may cause nausea, vomiting, anorexia, diarrhea, slurred speech, confusion, lethargy, coarse tremor, and in severe cases can cause seizures, coma, and death.