OBJECT DRUGS
PRECIPITANT DRUGS
Angiotensin Receptor Blockers (ARBs):
- Azilsartan (Edarbi)
- Candesartan (Atacand)
- Eprosartan (Teveten)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Olmesartan (Benicar)
- Telmisartan (Micardis)
- Valsartan (Diovan)
Comment:
Lithium toxicity has been reported when ARBs are used with lithium, although the magnitude of the effect may be highly variable from patient to patient. The elderly appear to be at greater risk. The lithium toxicity can be severe, and there are case reports of lithium toxicity following initiation of one of these drugs.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative: Depending on the indication for ARB use, an alternate agent such as a calcium channel blocker could be considered. The use of an ACE inhibitor in place of ARBs would not circumvent the interaction, since ACE inhibitors also can cause lithium toxicity.
- Monitor: Monitor for altered lithium effects if these agents 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.