OBJECT DRUGS
PRECIPITANT DRUGS
ACE Inhibitors (ACEI):
- Benazepril (Lotensin)
- Captopril (Capoten)
- Enalapril (Vasotec, etc.)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, etc.)
- Moexipril (Univasc)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
Comment:
Lithium toxicity has been reported when ACEI are used with lithium, although the magnitude of the effect is highly variable from patient to patient. The elderly appear to be at greater risk. The lithium toxicity can be severe, and there are many case reports of lithium toxicity following initiation of one of these drugs. In an epidemiologic study of elderly patients, ACEI were associated with a substantial increase in the risk of hospitalization due to lithium toxicity.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative: Depending on the indication for ACEI use, an alternate agent such as a calcium channel blocker could be considered. The use of an angiotensin receptor blocker (ARB) in place of the ACEI would not circumvent the interaction, since ARB also can cause lithium toxicity.
- Monitor: Monitor for altered lithium effects if ACEI are initiated, discontinued, changed in dosage, or if the patient is switched from one ACEI to another. 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.