Department of Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Würzburg, Germany.
Clin Drug Investig. 2019 May;39(5):485-489. doi: 10.1007/s40261-019-00768-7.
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.
锂是治疗单相和双相情感障碍的一种成熟的治疗药物。血管紧张素转换酶（ACE）抑制剂是治疗心血管疾病最常用的一类药物。在锂治疗成功多年后发生动脉高血压的情况下，在临床实践中可能会考虑联合使用这两种药物，但已描述了与 ACE 抑制剂联合使用锂会增加锂中毒的风险，因此联合使用受到警告。我们描述了三种锂与依那普利、赖诺普利或雷米普利联合使用的情况。锂中毒的必要因素可能是联合使用氢氯噻嗪或脱水而不是 ACE 抑制剂进行额外的合并治疗。这些病例表明，当确保充足的水合作用并避免与氢氯噻嗪联合使用时，锂与 ACE 抑制剂的联合使用是可能的。应定期控制锂的浓度。
