Lithium toxicity has been seen in individual patients given candesartan, losartan, valsartan and possibly irbesartan. Other angiotensin II receptor antagonists would be expected to interact similarly. The risk of lithium toxicity would be expected to increase when risk factors such as advanced age, renal impairment, heart failure and volume depletion are also present.
Even though the interaction appears rare, patients should have their lithium levels monitored to avoid a potentially severe adverse interaction. The development of the interaction may be delayed (up to 7 weeks seen) so that weekly monitoring of lithium levels for several weeks has been advised. Patients taking lithium should be aware of the symptoms of lithium toxicity and told to immediately report them should they occur. This should be reinforced when they are given angiotensin II receptor antagonists.
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