Drug interactions
Hydrochlorothiazide-valsartan + Lithium
Severity: Major
Hydrochlorothiazide-valsartan 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 valsartan and hydrochlorothiazide reduce renal lithium clearance, so serum lithium can rise to toxic levels. Toxicity presents with tremor, confusion, ataxia, vomiting and, in severe cases, seizures or arrhythmias. Thiazides have the stronger effect, and the two together compound the risk.
What this interaction means in plain words
Hydrochlorothiazide-valsartan 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-valsartan belongs to Cardiovascular; Lithium belongs to Central Nervous System.
Why it happens
Increased proximal renal tubular lithium reabsorption from sodium depletion caused by the thiazide and angiotensin receptor blockade.
What to do
Avoid if possible; otherwise check lithium levels before starting and frequently after, and reduce the lithium dose as needed. Teach patients the signs of lithium toxicity and keep them hydrated.
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-valsartan
- Aliskiren + Hydrochlorothiazide-valsartan Contraindicated
- Dofetilide + Hydrochlorothiazide-valsartan Contraindicated
- Hydrochlorothiazide-valsartan + Sparsentan Contraindicated
- Aldesleukin + Hydrochlorothiazide-valsartan Major
- Amifostine + Hydrochlorothiazide-valsartan Major
- Amiloride + Hydrochlorothiazide-valsartan 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-valsartan with Lithium?
MediHelp rates the interaction as major. Hydrochlorothiazide-valsartan 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 valsartan and hydrochlorothiazide reduce renal lithium clearance, so serum lithium can rise to toxic levels. Toxicity presents with tremor, confusion, ataxia, vomiting and, in severe cases, seizures or arrhythmias. Thiazides have the stronger effect, and the two together compound the risk.
How serious is the interaction between Hydrochlorothiazide-valsartan 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 check lithium levels before starting and frequently after, and reduce the lithium dose as needed. Teach patients the signs of lithium toxicity and keep them hydrated.
What other medicines interact with Hydrochlorothiazide-valsartan?
MediHelp also lists interactions of Hydrochlorothiazide-valsartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-valsartan page.
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