Major
Established
Descrição
Thiazide diuretics increase lithium reabsorption in the proximal renal tubule, reliably causing lithium toxicity without dose adjustment.
Mecanismo
Thiazides inhibit sodium reabsorption in the distal tubule, triggering compensatory proximal reabsorption of sodium and lithium; plasma lithium levels typically increase by 25–50%.
Significância Clínica
This is a well-established, clinically significant interaction; lithium toxicity case series commonly involve thiazide initiation.
Conduta
Reduce lithium dose by approximately 25–50% when starting a thiazide; monitor levels within 5–7 days of initiation and regularly thereafter.