Drug Interaction Report

Acetazolamide and Lithium Carbonate: Interaction Details

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

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Acetazolamide

Diamox® Sequels®
+

Lithium Carbonate

Lithobid
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
LinkedIn
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 lithium6.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 875. However, concurrent use of lithium and diuretics may result in elevated serum levels of lithium 41 due to the reabsorption of sodium and lithium ions at the proximal renal tubule 23.

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 7. An increase in lithium dosage may be required during concurrent administration with urinary alkalinizers.

Common questions

Can I take Acetazolamide and Lithium Carbonate 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 Carbonate 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 Carbonate 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. 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
  2. Singer I & Rotenberg P: Mechanisms of lithium action. N Engl J Med 1973; 289:254. DOI
  3. Davis JM & Fann WE: Lithium. Ann Rev Pharmacol 1971; 11:285.
  4. Product Information: Lithium Carbonate. Roxane Laboratories Inc. Columbus, OH, 2002. DailyMed
  5. McSwiggan C: Interaction of lithium and bicarbonate (letter). Med J Aust 1978; 1:38-39. PubMed
  6. Product Information: Acetazolamide oral extended-release capsules, acetazolamide oral extended-release capsules. Micro Labs USA Inc (per DailyMed), Somerset, NJ, 2022. DailyMed
  7. Thomsen K & Schou M: Renal lithium excretion in man. Am J Physiol 1968; 215:823-827. PubMed
  8. Product Information: Eskalith(R), lithium carbonate. GlaxoSmithKline, Research Triangle Park, NC, 2003. DailyMed
Was this write-up helpful?
Acetazolamide

Keep reading about Acetazolamide

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

Keep reading about Lithium Carbonate

All Lithium Carbonate interactions (317) Lithium Carbonate drug information
Also serious with: Phenelzine Tranylcypromine Zuclopenthixol Feprazone
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.

Check another combination

Our instant two-drug interaction checker is almost here.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

Still have questions about this combination?

Every question gets a real answer from a licensed pharmacist — free, and usually within a day.

Ask the pharmacist
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.