OBJECT DRUGS

• Lithium (Eskalith)

PRECIPITANT DRUGS

Thiazide Diuretics:

• Bendroflumethiazide (Naturetin)
• Benzthiazide (Exna)
• Chlorothiazide (Diuril)
• Chlorthalidone (Hygroton) *
• Hydrochlorothiazide (Hydrodiuril, etc.)
• Hydroflumethiazide (Saluron)
• Indapamide (Lozol) *
• Methyclothiazide (Enduron)
• Metolazone (Zaroxolyn) *
• Polythiazide (Renese)
• Quinethazone (Hydromox) *
• Trichlormethiazide (Diurese)

* Not strictly a thiazide, but has actions similar to the thiazide diuretics.

Comment:

Lithium toxicity has been reported with concurrent use of thiazide diuretics, although the magnitude of the effect is highly variable from patient to patient. The elderly may be at greater risk. In an epidemiologic study ACE inhibitors and loop diuretics were associated with a substantial increase in the risk of hospitalization due to lithium toxicity, but an association with thiazide diuretics and NSAIDs was not found. It may be that only predisposed patients develop lithium toxicity from thiazides.

Class 3: Assess Risk & Take Action if Necessary

• Monitor: Monitor for altered lithium effects if thiazide diuretics are started, stopped, or changed in dosage. 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 and coma.