Major
Established
Description
ACE inhibitors like lisinopril reduce renal lithium excretion, causing potentially dangerous lithium toxicity.
Mécanisme
Lisinopril reduces glomerular filtration by inhibiting angiotensin II, reducing renal sodium handling and enhancing proximal tubular lithium reabsorption, increasing lithium levels by 30–70%.
Signification clinique
Lithium toxicity is well-documented after ACE inhibitor initiation; symptoms include confusion, tremor, ataxia, and cardiovascular instability.
Prise en charge
Monitor lithium levels within 1 week of initiating or changing lisinopril dose; reduce lithium dose preemptively and adjust based on levels.