Drug & supplement interaction

Lithium + Enalapril Maleate, Hydrochlorothiazide

Enalapril Maleate, Hydrochlorothiazide brand name: Vaseretic.

Major Interaction
Medically reviewed by · Updated September 2026
The bottom line Major

Enalapril Maleate, Hydrochlorothiazide falls into 2 drug categories that Lithium can interact with; the most serious is rated major. Theoretically, taking lithium supplements with loop diuretics might increase lithium levels and adverse effects.

Read the full interaction report
SeverityMajor
LikelihoodProbable
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Lithium and Enalapril Maleate, Hydrochlorothiazide

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Lithium interacts with whole categories of medication. Enalapril Maleate, Hydrochlorothiazide falls into 2 of those categories, so it can interact with Lithium in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Major).

Major

DIURETIC DRUGS

1 of 2

Why this applies to Enalapril Maleate, Hydrochlorothiazide

Enalapril Maleate, Hydrochlorothiazide falls under DIURETIC DRUGS — the group Lithium interacts with.

Theoretically, taking lithium supplements with loop diuretics might increase lithium levels and adverse effects.
Thiazide diuretics and loop diuretics might reduce lithium excretion, particularly in sodium-restricted patients. If lithium is clinically indicated and other treatment options are unavailable or inadequate in patients using diuretics, lithium treatment can be initiated with extreme caution. Serum lithium should be measured frequently and the doses used should be the lowest dose ordinarily tolerated. It is unclear if this interaction would be clinically significant with the smaller doses found in lithium supplements.
Severity Major Likelihood Probable Evidence D

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the thing with this combo pill: it contains hydrochlorothiazide, a water pill. Thiazide diuretics make your kidneys flush out water and salt, and that same process can slow how your body clears lithium. The result is that lithium can quietly build up in your blood. Because lithium has a very narrow safe range, even a small rise matters. Warning signs of too much lithium include nausea, tremor or shakiness, confusion, slurred speech, and unsteadiness.

To be fair, this is based on how the drugs work rather than strong human studies, and it's unclear whether the tiny amounts in lithium supplements would do much. Still, I'd treat it seriously. Please check with your pharmacist or doctor before combining them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Martindale W. Martindale the Extra Pharmacopoeia. Pharmaceutical Press, 1999.
  2. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.
  3. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/017812s028,018421s027lbl.pdf. Accessed Nov. 21, 2018
Moderate

ACE INHIBITORS (ACEIs)

2 of 2

Enalapril Maleate, Hydrochlorothiazide also falls under ACE INHIBITORS (ACEIs).

Theoretically, taking lithium supplements with ACEIs might increase levels and adverse effects of lithium.
Concomitant administration of ACEIs with lithium may increase lithium concentrations. It is unclear if this interaction would be clinically significant with the smaller doses found in lithium supplements.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist for Vaseretic, which combines enalapril (an ACE inhibitor) with hydrochlorothiazide (a water pill). Both of these can affect how your kidneys handle salt and water, and that's exactly how they can nudge lithium levels upward. When your body holds onto less sodium, the kidneys tend to hang onto more lithium instead, so lithium can quietly build up in your system.

If lithium climbs too high, you might notice things like hand tremor, nausea, unusual thirst, confusion, or feeling unsteady. This concern is mostly theoretical and based on how these drugs work, not strong studies, and tiny amounts in lithium orotate supplements may not matter much. Still, because lithium has a narrow safety window, please check with your pharmacist or doctor before combining them. Don't change anything on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Martindale W. Martindale the Extra Pharmacopoeia. Pharmaceutical Press, 1999.
  2. McEvoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Lithium Also Interacts With Other Medications

Lithium has 258 major, 256 moderate known drug interactions in our database — the Enalapril Maleate, Hydrochlorothiazide one above is among them. If you take anything else, check it against the full list below.

Major 258 Moderate 256 No known interaction 2,316 (incl. Enalapril Maleate, Hydrochlorothiazide)
Taking anything else?

Check Another of Your Medications Against Lithium

Covers the 2,830 medications we’ve checked against Lithium. Pick one to open its full report.

From our Q&A

Questions About Lithium or Enalapril Maleate, Hydrochlorothiazide

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Lithium or Enalapril Maleate, Hydrochlorothiazide, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Enalapril Maleate, Hydrochlorothiazide

This page covers Lithium only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Enalapril Maleate, Hydrochlorothiazide page lists 238 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), American Mistletoe (major), Asarabacca (major) and Dolomite (major).

By severity: 11 major · 200 moderate · 27 minor.

From our pharmacist’s overview on the Enalapril Maleate, Hydrochlorothiazide page

“If you take Vaseretic (enalapril with hydrochlorothiazide) for blood pressure, check this list carefully before adding any supplement; 11 of the 238 entries are rated major. Most run one of two ways: herbs that also drop blood pressure and can take it too low, or ones that raise it and fight the medicine.”

Reviewed by 2 · Jul 18, 2026

Open the Enalapril Maleate, Hydrochlorothiazide interaction page

One more smart check

Taking Lithium as Part of a Dietary Supplement Product? Check It for Interactions

We hold 330 real supplement products containing Lithium, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Lithium. Your product may carry other ingredients that interact with Enalapril Maleate, Hydrochlorothiazide too, on top of Lithium — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Lithium and Enalapril Maleate, Hydrochlorothiazide Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Lithium
Top 25%

#296 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Enalapril Maleate, Hydrochlorothiazide
Top 25%

#570 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Lithium

What is Lithium?

Lithium
  • Mood support
  • Bipolar disorder (prescription)
  • Healthy mental function
  • Irritability or stress
  • Sleep support

Lithium is a naturally occurring metal that, in prescription form (lithium carbonate or citrate), is an FDA-approved, well-proven treatment for bipolar disorder. Low-dose supplement forms like lithium orotate are sold for mood support, but there is very little reliable evidence that they work, and even small amounts of lithium can be risky for some people. Always talk to a pharmacist or doctor before taking any lithium product.

Read the full Lithium monograph & all interactions
Medication

About Enalapril and Hydrochlorothiazide

What Is Enalapril and Hydrochlorothiazide Used For?

Brand name: Vaseretic

Enalapril and hydrochlorothiazide tablets — sold under brand names including Vaseretic and Enalapril maleate and hydrochlorothiazide — are used to treat high blood pressure (hypertension). This combination is not meant as the first treatment tried; it's generally used when a single blood pressure medicine hasn't done the job on its own.

Because this is a fixed-dose combination, your doctor will typically adjust each medicine separately first, then switch you to the combination tablet once the right doses are found.

See full Enalapril and Hydrochlorothiazide drug information
Keep checking

Other Drugs & Lithium

Browse every other medication we’ve checked against Lithium — both the ones with a known interaction and the ones without. Select any drug for the full detail.

258Major
256Moderate
0Minor
2,315No known interaction
258 Major 256 Moderate 2,315 No interaction
Major

258 interactions

Showing 60 of 258 major interactions — see all 258 on the Lithium page.

Moderate

256 interactions

Showing 60 of 256 moderate interactions — see all 256 on the Lithium page.

No interaction 2,315 drugs checked — show the list

We also checked Lithium against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,315 medications checked with no known interaction — see the full Lithium list.

See the full Lithium interactions page
See every supplement checked against Enalapril Maleate, Hydrochlorothiazide, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Lithium monograph › Uses, safety, and every drug interaction in one place Enalapril Maleate, Hydrochlorothiazide supplement interactions › Every supplement checked against Enalapril Maleate, Hydrochlorothiazide, ranked by severity Enalapril and Hydrochlorothiazide drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Lithium and Enalapril Maleate, Hydrochlorothiazide Together: Common Questions

Can you take Lithium with Enalapril Maleate, Hydrochlorothiazide?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Lithium and Enalapril Maleate, Hydrochlorothiazide?
Enalapril Maleate, Hydrochlorothiazide belongs to more than one drug category, and Lithium interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Lithium and Enalapril Maleate, Hydrochlorothiazide interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Enalapril Maleate, Hydrochlorothiazide and Lithium?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.