Drug interactions
Lithium + Ramipril
Severity: Major
Lithium and Ramipril: 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
ACE inhibitors can raise serum lithium concentrations and lead to lithium toxicity, with tremor, confusion, ataxia and renal effects. The risk is highest in the first weeks of therapy and in volume-depleted or elderly patients.
What this interaction means in plain words
Lithium and Ramipril 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.
Lithium belongs to Central Nervous System; Ramipril belongs to Cardiovascular.
Why it happens
Reduced renal lithium clearance, probably from sodium depletion and decreased glomerular filtration increasing proximal tubular lithium reabsorption.
What to do
Check lithium levels before starting ramipril, again within about a week, and after dose changes, reducing the lithium dose as needed. Watch for signs of toxicity and maintain hydration.
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 Ramipril
- Aliskiren + Ramipril Contraindicated
- Protein a column + Ramipril Contraindicated
- Ramipril + Sacubitril / valsartan Contraindicated
- Ramipril + Sacubitril-valsartan Contraindicated
- Amifostine + Ramipril Major
- Amiloride + Ramipril 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 Lithium with Ramipril?
MediHelp rates the interaction as major. Lithium and Ramipril 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. ACE inhibitors can raise serum lithium concentrations and lead to lithium toxicity, with tremor, confusion, ataxia and renal effects. The risk is highest in the first weeks of therapy and in volume-depleted or elderly patients.
How serious is the interaction between Lithium and Ramipril?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Check lithium levels before starting ramipril, again within about a week, and after dose changes, reducing the lithium dose as needed. Watch for signs of toxicity and maintain hydration.
What other medicines interact with Ramipril?
MediHelp also lists interactions of Ramipril with, for example, Aliskiren, Protein a column, Sacubitril / valsartan. The full list is on the Ramipril page.
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