Lithium and Lisinopril: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lithium
No brand names on recordLisinopril
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.
Lithium and lisinopril can be a tricky pair. Lithium is a mood-stabilizing medicine that has a narrow safe range, meaning the amount in your blood can't go too high before it starts causing problems. Lisinopril is a blood pressure medicine (an ACE inhibitor) that can affect how your kidneys handle lithium, which may let lithium build up in your body.
Too much lithium can cause things like shaky hands, nausea, confusion, or feeling unusually drowsy. Please don't stop or change either medicine on your own. The good news is your care team can manage this by checking your lithium levels and adjusting your dose so both drugs work safely together.
Effect: Increased risk of lithium toxicity when coadministered with lisinopril (ACE inhibitor). Neither agent is metabolized in a way that drives this; the proposed mechanism (unknown, likely reduced renal lithium clearance via ACE-inhibitor effects on renal hemodynamics/sodium handling) increases lithium exposure.
- Direction: Higher serum lithium concentrations, potential toxicity.
- Onset: Delayed.
- Evidence: Theoretical.
- NTI drug: Lithium; small changes are clinically significant.
Management: If concomitant use is required, reduce initial lithium dose, titrate slowly, and monitor serum lithium levels frequently plus watch for tremor, GI upset, ataxia, confusion.
What happens
Increased risk of lithium toxicity
Interaction Deep Dive
Using lithium together with this drug may raise the likelihood of lithium toxicity. When these agents must be given together, the starting lithium dose should be lowered, titration should proceed gradually, and both lithium concentrations and indicators of lithium toxicity should be monitored1.
Why it happens (mechanism)
Unknown
How to manage this interaction
This combination can be used safely with the right monitoring. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Your care team may start lithium at a lower dose and increase it slowly.
- Expect more frequent blood tests to check your lithium level, especially when either medicine is started or changed.
- Your lithium dose may need to be adjusted and individualized by your care team.
Tell your pharmacist or doctor promptly if you notice new tremor, nausea, vomiting, diarrhea, drowsiness, confusion, or unsteadiness, as these can be signs of too much lithium.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A 51-year-old woman experienced severe lithium toxicity (including diarrhea, dyspnea, drowsiness, confusion, peripheral vasodilation, and hyperreflexia) after taking perindopril 8 mg/day and bendrofluazide 5 mg/day for 3 months to treat hypertension. She had received lithium carbonate 1.6 grams daily for 7 years to manage manic depression. Over a 2-week span, she developed diarrhea, dyspnea, confusion, and hypotension. At the time of hospital admission, her lithium level measured 4.28 mmol/L. Her alertness improved once the lithium level fell to 1.6 mmol/L after 3 hemodialysis sessions 2.
Common questions
Can I take Lithium and Lisinopril together?
Lisinopril can raise lithium levels and increase the risk of lithium toxicity, so your team may lower the lithium dose and check your levels more often. Keep taking both as prescribed and report tremor, nausea, or confusion. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lithium and Lisinopril 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 is the Lithium and Lisinopril interaction managed?
This combination can be used safely with the right monitoring. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Your care team may start lithium at a lower dose and increase it slowly. Expect more frequent blood tests to check your lithium level, especially when either medicine is started or changed. Your lithium dose may need to be adjusted and individu… Management is individual — always follow your own care team's guidance.
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 Lithium or Lisinopril 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 (2)
- Product Information: LITHOBID(R) oral extended release tablets, lithium carbonate oral extended release tablets. ANI Pharmaceuticals, Inc. (per FDA), Baudette, MN, 2016. DailyMed
- Vipond AJ, Bakewell S, Telford R, et al: Lithium toxicity. Anaesthesia 1996; 51:1156-1158.
Keep reading about Lithium
Keep reading about Lisinopril
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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