From the Research
For hypertensive bipolar patients taking lithium, calcium channel blockers and beta-blockers are generally considered safe options, while thiazide diuretics, loop diuretics, and ACE inhibitors should be used with caution due to the risk of lithium toxicity, as evidenced by a case report of chronic lithium toxicity in a patient taking an ACE inhibitor 1. When managing hypertension in patients with bipolar disorder who are taking lithium, it is crucial to consider the potential interactions between lithium and various antihypertensive medications.
- Calcium channel blockers, such as amlodipine, diltiazem, and verapamil, are typically well-tolerated and can be used safely in these patients.
- Beta-blockers, including metoprolol and atenolol, are also generally considered safe options.
- Angiotensin II receptor blockers (ARBs), like losartan and valsartan, are typically well-tolerated as well. However, certain antihypertensive medications can increase the risk of lithium toxicity by reducing its clearance, including:
- Thiazide diuretics, which can increase lithium levels by 25 to 40% 2.
- Loop diuretics, which can also reduce lithium clearance.
- ACE inhibitors, which have been associated with lithium toxicity in some cases, as reported in a study published in 2017 1. If these medications must be used, it is essential to monitor lithium levels more frequently, especially after starting or adjusting the dose of the antihypertensive medication, as recommended in a study published in 2016 3. Patients should be educated about the signs of lithium toxicity, including tremor, confusion, vomiting, diarrhea, and ataxia, and instructed to seek medical attention if these symptoms occur, highlighting the importance of careful monitoring and patient education 4.