Major
Established
Descripción
Ramipril, an ACE inhibitor, reduces lithium renal clearance through decreased glomerular filtration, leading to potentially toxic lithium accumulation.
Mecanismo
ACE inhibition reduces angiotensin II-driven efferent arteriolar tone, lowering GFR and reducing lithium clearance; proximal tubular lithium reabsorption increases compensatorily.
Relevancia clínica
Lithium levels can increase by 30–75% after ACE inhibitor initiation; toxicity (neurotoxicity, cardiac arrhythmias) may occur rapidly.
Manejo clínico
Check lithium levels within 1 week of ramipril initiation or dose change; preemptive lithium dose reduction is recommended.