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The Combination of Lithium and ACE Inhibitors: Hazardous, Critical, Possible?

Leif Hommers1,2,3, Matthias Fischer1, Christine Reif-Leonhard4

  • 1Department of Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.

Clinical Drug Investigation
|February 27, 2019
PubMed

Insights

Combining lithium with angiotensin-converting enzyme (ACE) inhibitors is possible for bipolar disorder patients with hypertension. Careful monitoring and avoiding hydrochlorothiazide are key to preventing lithium intoxication.

Area of Science:

  • Pharmacology
  • Nephrology
  • Psychiatry

Background:

  • Lithium is a primary treatment for mood disorders.
  • Angiotensin-converting enzyme (ACE) inhibitors are widely used for cardiovascular conditions.
  • Concurrent use of lithium and ACE inhibitors is cautioned due to potential lithium toxicity.

Observation:

  • Three cases examined lithium use with enalapril, lisinopril, or ramipril.
  • Lithium intoxication was linked to hydrochlorothiazide co-medication or dehydration, not ACE inhibitors alone.

Findings:

  • ACE inhibitors can be safely combined with lithium.
  • Avoiding hydrochlorothiazide and maintaining hydration are key to preventing lithium toxicity.
  • Regular monitoring of lithium levels is recommended.

Implications:

  • This suggests a safer approach to managing co-existing conditions in patients on lithium.
  • Clinical practice can consider lithium-ACE inhibitor combinations under specific conditions.
  • Further research into drug interactions and patient monitoring is warranted.

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