Drug Interaction Report

Acetazolamide and Lithium: Interaction Details

A pharmacist-reviewed analysis of the Acetazolamide and Lithium interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Lithium

No brand names on record
+

Acetazolamide

Diamox® Sequels®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Jul 10, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 46 documented Acetazolamide interactions, 36 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
theoretical
Severity
Major

What happens

Decreased lithium effectiveness or increased lithium concentrations

Interaction Deep Dive

Coadministration of acetaZOLAMIDE with lithium may increase lithium excretion and may decrease the lithium1.The administration of acetaZOLAMIDE or sodium bicarbonate has been reported to increase lithium excretion by 27% to 31%. Therapeutically ineffective lithium concentrations, apparently due to this interaction, have been reported 324. However, concurrent use of lithium and diuretics may result in elevated serum levels of lithium 56 due to the reabsorption of sodium and lithium ions at the proximal renal tubule 78.

Why it happens (mechanism)

Increased or decreased lithium clearance

Literature reports

1 report — tap to read

a) Concomitant acetaZOLAMIDE and lithium therapy resulted in antagonism of lithium's clinical effects due to enhanced renal excretion by acetaZOLAMIDE 2. An increase in lithium dosage may be required during concurrent administration with urinary alkalinizers.

Common questions

Can I take Acetazolamide and Lithium together?

Decreased lithium effectiveness or increased lithium concentrations Always confirm with your pharmacist or prescriber before making any change.

How serious is the Acetazolamide and Lithium interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

From our Q&A

Real reader questions about these medications, each personally answered by our pharmacist:

Questions for your pharmacist

  • Does my dose of Acetazolamide or Lithium need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (8)

  1. Product Information: Acetazolamide oral extended-release capsules, acetazolamide oral extended-release capsules. Micro Labs USA Inc (per DailyMed), Somerset, NJ, 2022. DailyMed
  2. Thomsen K & Schou M: Renal lithium excretion in man. Am J Physiol 1968; 215:823-827. PubMed
  3. Product Information: Eskalith(R), lithium carbonate. GlaxoSmithKline, Research Triangle Park, NC, 2003. DailyMed
  4. McSwiggan C: Interaction of lithium and bicarbonate (letter). Med J Aust 1978; 1:38-39. PubMed
  5. Product Information: Lithium Carbonate. Roxane Laboratories Inc. Columbus, OH, 2002. DailyMed
  6. Petersen V, Hvidt S, Thomsen K, et al: Effect of prolonged thiazide treatment on renal lithium clearance. Br Med J 1974; 3:143-145. PubMed
  7. Singer I & Rotenberg P: Mechanisms of lithium action. N Engl J Med 1973; 289:254. PubMed
  8. Davis JM & Fann WE: Lithium. Ann Rev Pharmacol 1971; 11:285.
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Lithium

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All Lithium interactions (71)
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Acetazolamide

Keep reading about Acetazolamide

All Acetazolamide interactions (46) Acetazolamide drug information
Also serious with: Methenamine Methotrexate Injection Lithium Carbonate Aspirin Rectal
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Acetazolamide + 1,4-butanediol Activated Charcoal American Hellebore American Mistletoe Asarabacca Beer Gamma-hydroxybutyrate (ghb) Kava + 276 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.