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Is lithium toxicity occur with lisinopril

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lithium AND ACE inhibitors

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lithium lisinopril interaction toxicity ACE inhibitor official drug label

Yes. Lisinopril can raise lithium levels and may cause lithium toxicity. Lisinopril is an ACE inhibitor, and it can reduce renal lithium clearance, especially if there is dehydration, kidney impairment, low sodium intake, or use of a diuretic or NSAID such as ibuprofen/naproxen.
The lisinopril prescribing information reports this interaction and recommends frequent serum lithium monitoring during co-use, as summarized in the DailyMed label. A psychiatry prescribing reference similarly advises more frequent eGFR and lithium-level monitoring when ACE inhibitors are co-prescribed with lithium - The Maudsley Prescribing Guidelines in Psychiatry, 15th ed.
Possible toxicity symptoms
  • New or worsening hand tremor
  • Nausea, vomiting, diarrhea
  • Drowsiness, confusion, slurred speech
  • Unsteady walking, poor coordination
  • Severe weakness, muscle twitching
What to do
  • Do not start, stop, or change lisinopril or lithium on your own.
  • Contact the prescriber promptly to arrange a lithium level and kidney-function test, particularly after starting lisinopril or changing its dose.
  • Seek urgent care now if there is confusion, severe tremor, repeated vomiting/diarrhea, inability to walk normally, or marked drowsiness.

Which drug potentials lithium toxicity

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lithium AND drug interactions

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lithium carbonate prescribing information drug interactions diuretics NSAIDs ACE inhibitors DailyMed

Drugs that can increase lithium levels and raise the risk of lithium toxicity include:
  1. Thiazide diuretics - highest-risk group
    • Hydrochlorothiazide
    • Chlorthalidone
    • Indapamide
    • Metolazone
  2. ACE inhibitors
    • Lisinopril
    • Enalapril
    • Ramipril
    • Captopril
  3. ARBs
    • Losartan
    • Valsartan
    • Candesartan
  4. NSAID pain medicines
    • Ibuprofen
    • Naproxen
    • Diclofenac
    • Indomethacin
    • Celecoxib
      Avoid regular NSAID use unless the clinician monitoring lithium approves it. Low-dose aspirin is generally less problematic, but still confirm with the prescriber.
  5. Other diuretics
    • Furosemide
    • Spironolactone
    • Torsemide
      Risk is less predictable than with thiazides, but levels can still rise.
Other medicines may not necessarily raise the lithium blood level but can worsen its neurologic adverse effects, such as carbamazepine, antipsychotics, and some antidepressants. Always have a clinician or pharmacist check new medicines, including over-the-counter cold/pain remedies.
Risk is much higher with dehydration, vomiting/diarrhea, fever, low salt intake, older age, or reduced kidney function. NSAIDs reduce lithium excretion, while diuretics and ACE inhibitors can lower renal clearance, as described in The Maudsley Prescribing Guidelines in Psychiatry, 15th ed., and the lithium product label.
If a new interacting drug is necessary, the prescriber usually checks lithium level, creatinine/eGFR, and electrolytes soon after starting or changing it.
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