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Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitorsDiuretic agents and ACE inhibitors reduce the renal clearance of lithium and pose a high risk of lithium toxicityThe combination of lisinopril and hydrochlorothiazide with lithium is therefore not recommended and careful monitoring of serum lithium levels should be performed if the combination proves necessarysee section 4.4
Clinical trial data has shown that dual blockade of the renin-angiotensin-aldosterone systemRAASthrough the combined use of ACE-inhibitorsangiotensin II receptor blockers or aliskiren is associated with a higher frequency of adverse events such as hypotensionhyperkalaemia and decreased renal functionincluding acute renal failurecompared to the use of a single RAAS-acting agentsee sections 4.34.4 and 5.1
In patients with heart failurehypotension following the initiation of therapy with ACE inhibitors may lead to some further impairment in renal functionAcute renal failureusually reversiblehas been reported in this situation.
Tell your doctor right away if you have any serious side effectsincludingfaintingsymptoms of a high potassium blood levelsuch as muscle weaknessslow/irregular heartbeatsigns of kidney problemssuch as change in the amount of urinedecrease in visioneye pain.
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