Furosemide with Lithium Interaction Details
Brand Names Associated with Furosemide
- Furosemide
- Lasix®
Brand Names Associated with Lithium
- Eskalith®
- Eskalith® CR
- Lithium
- Lithobid®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 21, 2023
Interaction Effect
Lithium toxicity
Interaction Summary
Loop diuretics may affect renal function and increase serum lithium concentrations. Concomitant furosemide and lithium therapy has resulted in sodium loss, reduced excretion of lithium, and symptoms of lithium toxicity. This is especially important in patients who are also sodium restricted, which may lead to a further decline in lithium excretion . If concomitant use is unavoidable, reduce the initial lithium dosage and titrate slowly to clinical response. Monitor serum lithium levels frequently and observe for signs and symptoms of lithium toxicity .
Severity
Major
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Loop diuretics may affect renal function and may increase the risk for lithium toxicity. If concomitant use is necessary, reduce the initial lithium dosage and titrate slowly to clinical response. Monitor serum lithium levels frequently and observe for signs and symptoms of lithium toxicity.
Mechanism Of Interaction
Unknown
Literature Reports
A) Furosemide had no effect on plasma lithium levels during concomitant administration in a 12-week study. The dose of furosemide ranged from 20 mg to 80 mg daily with potassium supplementation. These data indicate the safety of furosemide administration with lithium, unlike thiazides which can precipitate lithium toxicity due to sodium depletion. However, close monitoring of lithium levels is also advised during concomitant furosemide therapy .
B) A 76-year-old woman developed reversible chorea a few weeks after starting furosemide 40 mg once daily and potassium 20 mEq once daily for hypertension. Her chorea was attributed to lithium toxicity. The patient was previously taking lithium 300 mg twice daily and no other regular medications. Upon admission to the emergency room, the patient was lethargic, confused, and dysarthric. Serum laboratory studies revealed a lithium level of 2.2 mEq/L (therapeutic range, 0.6 to 1.2 mEq/L). Approximately 18 hours after admission, the patient became more alert but developed involuntary choreiform movements in her head, neck, trunk, and extremities. Lithium levels declined slowly over the next week, with associated improvement in speech and the chorea .
C) A 65-year-old patient who was previously stabilized on lithium developed trembling, ataxia, and confusion following the addition of bumetanide 0.5 mg daily for one month. Serum lithium was 2.3 mEq/L on admission. The patient was also on a sodium-restricted diet which may have contributed to lithium toxicity. Lithium was discontinued for seven days and reinstated at a lower dosage, even though the patient remained slightly hypomanic .
Furosemide Overview
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Furosemide is used alone or in combination with other medications to treat high blood pressure. Furosemide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease. Furosemide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
Lithium Overview
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Lithium is used to treat and prevent episodes of mania (frenzied, abnormally excited mood) in people with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Lithium is in a class of medications called antimanic agents. It works by decreasing abnormal activity in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.