Drug interactions
Lithium + Sacubitril-valsartan
Severity: Major
Lithium and Sacubitril-valsartan: 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
Sacubitril-valsartan can raise serum lithium concentrations and cause lithium toxicity, with tremor, confusion, ataxia and gastrointestinal symptoms. Lithium has a narrow therapeutic index, so the rise may be clinically important.
What this interaction means in plain words
Lithium and Sacubitril-valsartan 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; Sacubitril-valsartan belongs to Cardiovascular.
Why it happens
Angiotensin receptor blockade reduces renal sodium and lithium clearance, with increased proximal tubular lithium reabsorption.
What to do
Measure lithium levels before and after starting, and regularly thereafter. Reduce the lithium dose as guided by levels and watch for toxicity symptoms, especially with dehydration or renal impairment.
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 Sacubitril-valsartan
- Aliskiren + Sacubitril-valsartan Contraindicated
- Benazepril + Sacubitril-valsartan Contraindicated
- Captopril + Sacubitril-valsartan Contraindicated
- Enalapril + Sacubitril-valsartan Contraindicated
- Fosinopril + Sacubitril-valsartan Contraindicated
- Lisinopril + Sacubitril-valsartan Contraindicated
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 Sacubitril-valsartan?
MediHelp rates the interaction as major. Lithium and Sacubitril-valsartan 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. Sacubitril-valsartan can raise serum lithium concentrations and cause lithium toxicity, with tremor, confusion, ataxia and gastrointestinal symptoms. Lithium has a narrow therapeutic index, so the rise may be clinically important.
How serious is the interaction between Lithium and Sacubitril-valsartan?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Measure lithium levels before and after starting, and regularly thereafter. Reduce the lithium dose as guided by levels and watch for toxicity symptoms, especially with dehydration or renal impairment.
What other medicines interact with Sacubitril-valsartan?
MediHelp also lists interactions of Sacubitril-valsartan with, for example, Aliskiren, Benazepril, Captopril. The full list is on the Sacubitril-valsartan page.
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