Drug interactions
Enalapril-hydrochlorothiazide + Lithium
Severity: Major
Enalapril-hydrochlorothiazide and Lithium: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Both thiazides and ACE inhibitors reduce renal lithium clearance and can raise serum lithium to toxic concentrations. Toxicity may present as tremor, confusion, ataxia, vomiting or seizures, and the combination is especially risky with dehydration or renal impairment.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Lithium can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Enalapril-hydrochlorothiazide belongs to Cardiovascular; Lithium belongs to Central Nervous System.
Why it happens
Sodium depletion increases proximal tubular reabsorption of lithium, reducing its renal clearance.
What to do
Avoid if possible; otherwise reduce the lithium dose and check serum lithium levels frequently, at initiation and after any dose change. Monitor renal function and hydration status.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Protein a column Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
Other interactions of Lithium
- Lithium + Thioridazine Contraindicated
- Lithium + Vandetanib Contraindicated
- Aceclofenac + Lithium Major
- Acemetacin + Lithium Major
- Amisulpride + Lithium Major
- Amlodipine-benazepril + Lithium Major
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Lithium?
MediHelp rates the interaction as major. Enalapril-hydrochlorothiazide and Lithium can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Both thiazides and ACE inhibitors reduce renal lithium clearance and can raise serum lithium to toxic concentrations. Toxicity may present as tremor, confusion, ataxia, vomiting or seizures, and the combination is especially risky with dehydration or renal impairment.
How serious is the interaction between Enalapril-hydrochlorothiazide and Lithium?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid if possible; otherwise reduce the lithium dose and check serum lithium levels frequently, at initiation and after any dose change. Monitor renal function and hydration status.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.
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