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The Combination of Lithium and ACE Inhibitors: Hazardous, Critical, Possible?

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Abstract

Lithium is a well established therapeutic agent in the treatment of uni- and bipolar affective disorders. Angiotensin-converting enzyme (ACE) inhibitors are the most frequently used class of drugs in the treatment of cardiovascular diseases. Combination therapy with both may be considered in clinical practice on occurrence of arterial hypertension after years of successful lithium therapy, yet an increased risk of lithium intoxication in combination with ACE inhibitors has been described and thus the combination has been warned against. We describe three cases in which enalapril, lisinopril or ramipril was combined with lithium. Either additional co-medication with hydrochlorothiazide or dehydration rather than co-medication with ACE inhibitors could be identified as necessary factors for lithium intoxication. These cases suggest that a combination of lithium with ACE inhibitors is possible when sufficient hydration is ensured and a combination with hydrochlorothiazide is avoided. Lithium concentration should be controlled on a regular level.

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Acknowledgements

The authors gratefully acknowledge the support of MD Prof. Gerald Stöber.

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Authors and Affiliations

  1. Department of Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany

    Leif Hommers, Matthias Fischer, Jürgen Deckert & Stefan Unterecker

  2. Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Würzburg, Germany

    Leif Hommers

  3. Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Würzburg, Germany

    Leif Hommers

  4. Department of Psychiatry, Psychosomatics and Psychotherapy, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany

    Christine Reif-Leonhard

  5. Clinic of Psychiatry and Psychotherapy, Weißer Hirsch, Dresden, Germany

    Bruno Pfuhlmann

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  1. Leif Hommers
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  2. Matthias Fischer
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  3. Christine Reif-Leonhard
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  4. Bruno Pfuhlmann
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  5. Jürgen Deckert
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  6. Stefan Unterecker
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Corresponding author

Correspondence to Stefan Unterecker.

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Funding

No funding has been received for these case reports.

Conflict of interest

Hommers L, Fischer M, Reif-Leonhard C, Pfuhlmann B and Unterecker S declare that they have no conflict of interest. Deckert J is the co-recipient of a grant of the Bavarian State Government to BioVariance and an investigator of the PREDICT study supported by a EU grant to P1Vital.

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Hommers, L., Fischer, M., Reif-Leonhard, C. et al. The Combination of Lithium and ACE Inhibitors: Hazardous, Critical, Possible?. Clin Drug Investig 39, 485–489 (2019). https://doi.org/10.1007/s40261-019-00768-7

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  • DOI: https://doi.org/10.1007/s40261-019-00768-7

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