Drug interactions
Hydrochlorothiazide-losartan + Lithium
Severity: Major
Hydrochlorothiazide-losartan and Lithium: major interaction.
Last updated
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 thiazide diuretics and angiotensin receptor blockers reduce renal lithium clearance, so serum lithium can rise to toxic levels. Toxicity may present as tremor, confusion, ataxia, vomiting and arrhythmias.
What this interaction means in plain words
Hydrochlorothiazide-losartan 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.
Hydrochlorothiazide-losartan belongs to Cardiovascular; Lithium belongs to Central Nervous System.
Why it happens
Thiazide-induced sodium depletion and reduced angiotensin II effect increase proximal tubular reabsorption of lithium, decreasing its renal clearance.
What to do
Avoid if possible; otherwise reduce the lithium dose and check serum lithium within about a week of starting the combination and after dose changes. Educate the patient on toxicity symptoms and maintain hydration and sodium intake.
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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Other interactions of Hydrochlorothiazide-losartan
- Aliskiren + Hydrochlorothiazide-losartan Contraindicated
- Dofetilide + Hydrochlorothiazide-losartan Contraindicated
- Hydrochlorothiazide-losartan + Sparsentan Contraindicated
- Aceclofenac + Hydrochlorothiazide-losartan Major
- Aldesleukin + Hydrochlorothiazide-losartan Major
- Amifostine + Hydrochlorothiazide-losartan 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 Hydrochlorothiazide-losartan with Lithium?
MediHelp rates the interaction as major. Hydrochlorothiazide-losartan 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 thiazide diuretics and angiotensin receptor blockers reduce renal lithium clearance, so serum lithium can rise to toxic levels. Toxicity may present as tremor, confusion, ataxia, vomiting and arrhythmias.
How serious is the interaction between Hydrochlorothiazide-losartan 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 within about a week of starting the combination and after dose changes. Educate the patient on toxicity symptoms and maintain hydration and sodium intake.
What other medicines interact with Hydrochlorothiazide-losartan?
MediHelp also lists interactions of Hydrochlorothiazide-losartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-losartan page.
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