Drug interactions
Lithium + Sacubitril / valsartan
Severity: Major
Lithium and Sacubitril / valsartan: 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
Valsartan, an angiotensin receptor blocker, can reduce renal lithium clearance and raise serum lithium, leading to toxicity with tremor, ataxia, confusion and seizures. Cases of lithium toxicity are well recognized with this class.
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.
Why it happens
Reduced renal lithium excretion due to angiotensin II receptor blockade and altered sodium handling.
What to do
Check serum lithium before and soon after starting, and again after dose changes, with dose reduction as needed. Monitor renal function and hydration, and consider an alternative to sacubitril/valsartan if lithium levels stay unstable.
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 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. Valsartan, an angiotensin receptor blocker, can reduce renal lithium clearance and raise serum lithium, leading to toxicity with tremor, ataxia, confusion and seizures. Cases of lithium toxicity are well recognized with this class.
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: Check serum lithium before and soon after starting, and again after dose changes, with dose reduction as needed. Monitor renal function and hydration, and consider an alternative to sacubitril/valsartan if lithium levels stay unstable.
What other medicines interact with Lithium?
MediHelp also lists interactions of Lithium with, for example, Thioridazine, Vandetanib, Aceclofenac. The full list is on the Lithium page.
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