| Management |
Given the narrow therapeutic index of lithium, caution is advised during coadministration with ACE inhibitors, particularly in the elderly or patients with other risk factors (e.g., sodium restriction, renal impairment, congestive heart failure, dehydration, concomitant use of diuretics or NSAIDs). Pharmacologic response and serum lithium levels should be monitored more closely whenever an ACE inhibitor is added to or withdrawn from therapy, and the lithium dosage adjusted as necessary. Empiric reductions of both drugs may be appropriate during initial therapy. Renal function should also be monitored regularly. Patients should be advised to seek medical attention if they experience potential signs and symptoms of lithium toxicity such as drowsiness, dizziness, confusion, muscle weakness, vomiting, diarrhea, polydipsia, polyuria, tinnitus, tremor, ataxia, and blurred vision. |
