Discussion

lithium toxicity occurred in a 77-years old woman following addition of losartan to her drug regimen. her
plasma lithium level had been stable for many years, with a level if 0,63 mmol/L 1 too 2 months prior to
starting losartan. because of persistent high BP, losartan 50 mg/day was administered. five weeks laters,
the patient was hospitalized with a 10 days histort of lithiym toxicity symptoms. her plasma lithium level
was 2 mmol/L. when lithium ans losartan were discontinued, her symptoms disappeared, two days after
stopping both drugs, the plasma lithium level was 0,55 mmol/l. lithium was reinstated with
coadministration of nicardipine (eg. cardene) 100mg/day. lilthium toxiciity did not recur. elevated
lithium plasma levels and toxicity were reported in a 51 year old woman after valsartan was added to
her treatment regimen. she had been taking lithium 750 mg at bedtime for 6 years when valsartan 80
mg/day was started. within 11 days of startin valsartan, her lithium plasma level increased 75% (to 1,4
mmol/L) and she exhibited symptoms of lithium toxicity. valsartan was discontinued and diltiazem was
started. within 5 days, her lithium levels decreased and her symptoms resolved. lithium toxicity (eg.
agitation, ataxia, disorientation, increasing confusion) and elevated lithium levels were reported in a 58
year old woman stabilized on lithium therapy approximately 7 weeks after starting candesartan. both
drugs were stopped, and the patients was treated. lithium treatment was restarted without incidence.