MAJOR — Use With Caution
FDA-documented interaction. Monitor lithium levels when starting or adjusting enalapril.
Evidence level: STRONG
Enalapril (an ACE inhibitor) can raise lithium blood levels by affecting your kidney function. Because lithium has such a narrow safety margin, this can push you into toxic territory.
ACE inhibitor reduces renal lithium clearance via aldosterone suppression and decreased GFR. FDA lithium label warns about ACE inhibitors.
Get lithium levels checked when starting enalapril. Stay well hydrated. Report any worsening tremor, nausea, or confusion.
Take Enalapril at the same time daily. Lithium follows its prescribed schedule. ACE inhibitors can be taken with or without food. If you develop a persistent dry cough, report it to your prescriber.
Higher risk for: those with renal impairment, hyperkalemia risk, concurrent potassium-sparing diuretics or potassium supplements, elderly, dehydrated patients, or those with bilateral renal artery stenosis.
Tremor, nausea, vomiting, diarrhea, drowsiness, confusion, muscle twitching
Monitor lithium levels. Discuss calcium channel blocker alternatives for blood pressure that have less lithium interaction.
ACE inhibitor interactions often involve potassium levels or blood pressure effects. Ask your doctor about ARBs as alternatives, or adjust the timing of the interacting substance. Monitor potassium levels and blood pressure regularly.
Enalapril (an ACE inhibitor) can raise lithium blood levels by affecting your kidney function. Because lithium has such a narrow safety margin, this can push you into toxic territory.
Take Enalapril at the same time daily. Lithium follows its prescribed schedule. ACE inhibitors can be taken with or without food. If you develop a persistent dry cough, report it to your prescriber.
Tremor, nausea, vomiting, diarrhea, drowsiness, confusion, muscle twitching
ACE inhibitor interactions often involve potassium levels or blood pressure effects. Ask your doctor about ARBs as alternatives, or adjust the timing of the interacting substance. Monitor potassium levels and blood pressure regularly.
Monitor lithium levels. Discuss calcium channel blocker alternatives for blood pressure that have less lithium interaction.
Or browse the full interaction database (121,000+ pairs).