Angiotensin-converting enzyme with lithium

The most potentially serious drug interactions include the concomitant use of NSAIDs with lithium, warfarin, oral hypoglycemics, high-dose methotrexate, antihypertensives, angiotensin-converting enzyme inhibitors, fi-blockers, and diuretics. 

Angiotensin-converting enzyme inhibitors can increase plasma lithium concentrations add with caution to patients stabilized on lithium... 

Renal function should be closely monitored when patients on lithium treatment are given angiotensin converting enzyme inhibitors. Doses of both drugs should be chosen with caution to avoid serious drug interaction [27]. 

Most of the renal tubular reabsorption ofU occurs in the proximal tubule. Nevertheless, Id retention can be increased by any diuretic that leads to depletion of Na, particularly the thiazides (see Chapter 28). Renal excretion can be increased by administration of osmotic diuretics, aceta-zolamide or aminophylline, and triamterene. Spironolactone does not increase the excretion of LiL Some nonsteroidal anti-inflammatory agents can facilitate renal proximal tubular resorption of Id and thereby increase concentrations in plasma to toxic levels. This interaction appears to be particularly prominent with indomethacin, but also may occur with ibuprofen, naproxen, and COX-2 inhibitors, and possibly less so with sulindac and aspirin. A potential drug interaction can occur with angiotensin-converting enzyme inhibitors, causing lithium retention (see Chapter 29). 

No adverse interactions have been reported in patients treated with lithium and P-adrenoreceptor antagonists, whereas methyidopa has been reported to induce neurotoxic symptoms in some lithium-treated patients.There is a risk of lithium intoxication with simultaneous administration of angiotensin-converting enzyme inhibitors (ACEIs) lithium clearance may be reduced by up to 25%. ° Losartan, an angiotensin II antagonist, was anecdotally reported to induce lithium intoxication. ... 

---