DasGupta K, Jefferson J W, Kobak K A, Greist J H
Department of Psychiatry, University of Wisconsin, Madison.
J Clin Psychiatry. 1992 Nov;53(11):398-400.
Several authors have recently described the development of lithium toxicity after the addition of angiotensin-converting enzyme inhibitors to a stable lithium regimen. This pilot study was designed to systematically investigate the effects of enalapril, an angiotensin-converting enzyme inhibitor, on the serum level of lithium.
In a 26-day outpatient study, nine healthy men took lithium for 10 days, lithium and enalapril for 10 days, and lithium alone again for 6 days. Serum lithium levels were measured while patients were taking lithium alone and while they were taking the lithium/enalapril combination.
There were no statistically significant differences between mean serum lithium level during treatment with lithium alone and during treatment with the lithium/enalapril combination. However, one subject showed a 31% increase in serum lithium level after enalapril was added.
Although no statistically significant differences between mean serum lithium level during treatment either with lithium alone or with lithium/enalapril were found, it is possible that the low dose of enalapril and low serum lithium levels employed for subject safety may have resulted in a type II statistical error. If enalapril doses or initial serum lithium levels were similar to those described in case reports, a significant difference in mean serum lithium levels may have been observed. While a predictable interaction between lithium and enalapril probably does not occur in all patients, factors such as enalapril dose, serum lithium level before addition of enalapril, or the presence of heart disease may make such an interaction more likely. At the levels of lithium and enalapril used in this study, elevated serum lithium concentration does not appear to be a universal event, but physicians must exercise appropriate caution.
最近有几位作者描述了在稳定的锂治疗方案中添加血管紧张素转换酶抑制剂后锂中毒的发生情况。本初步研究旨在系统调查血管紧张素转换酶抑制剂依那普利对锂血清水平的影响。
在一项为期26天的门诊研究中，9名健康男性服用锂10天，服用锂和依那普利10天，然后再次单独服用锂6天。在患者单独服用锂以及服用锂/依那普利组合期间测量血清锂水平。
单独服用锂治疗期间和服用锂/依那普利组合治疗期间的平均血清锂水平之间无统计学显著差异。然而，有一名受试者在添加依那普利后血清锂水平升高了31%。
尽管单独服用锂治疗期间和服用锂/依那普利治疗期间的平均血清锂水平之间未发现统计学显著差异，但为确保受试者安全所采用的低剂量依那普利和低血清锂水平可能导致了II型统计误差。如果依那普利剂量或初始血清锂水平与病例报告中所述相似，可能会观察到平均血清锂水平存在显著差异。虽然锂和依那普利之间可预测的相互作用可能并非在所有患者中都会发生，但依那普利剂量、添加依那普利前的血清锂水平或心脏病的存在等因素可能会使这种相互作用更易发生。在本研究中所使用锂和依那普利的水平下，血清锂浓度升高似乎并非普遍现象，但医生必须谨慎行事。
