Lithium and Atacand (hypertension med)

[crazyguest]

I've been on Atacand HCT for over 5 years for mild hypertension and like it a lot, and it works. I used to know how it works, but now I only remember that the HCT part is a diuretic, and so therefore not a good thing to mix with lithium.

My pdoc would like to put me on a low dose of lithium to deal with "breakthrough" depressions that I seem to keep having. The breakthrough depressions aren't terrible and don't last long, but I guess the doc is worried about them morphing into a true major depressive episode.

My diagnosis for years was MDD, but this pdoc thinks it's BP II, and I think he's right. He added lamictal and reduced my wellbutrin, and I do feel better so I think he's on to something.

Has anyone tried lithium with blood pressure meds, especially any type of diuretics? Also, assuming that this is a bad idea, does anyone know of a good replacement for the atacand? I tried several other blood pressure meds when I first started being treated, but don't recall which ones, and how I ended up on atacand, except that it had the least side effects.

[Silver]

the issue with diuretics and lithium is trickier when adding a diuretic to an established dose of lithium, as it will increase the lithium level.

adding lithium to an established diuretic is relatively straightforward, because it is a matter of dosing accordingly. ditto with arbs (which atacand is) and lithium.

aside from having to explain to all pharmacists that you know there's an interaction (it would be good if your psychiatrist wrote on the rx "aware pt is taking atacand hct and have dosed accordingly"), it's not that big a thing, especially at a low dose. now - once you are stable on lithium and then stop the atacand hct, then the lithium level potentially drops, and then you get to check level and adjust dose, etc., and there's risk of destabilization, depending on how much arb/hctz there was and how high a level you were running and so on and so forth. not as big a deal with low-dose, more of an issue up at the higher levels.

hctz is actually sometimes added on if there's renal damage secondary to lithium. fwiw, I've taken hctz/lithium together for quite a while, no problems.

if you're on the arb (atacand) for heart failure as well, it may be the necessary drug.

the ace inhibitors interact with lithium (increase level), but it seems to vary by choice of drug.

the calcium channel blockers have some case reports of increased lithium effects, but, by and large, seem ok; more problems are reported with verapamil, but it's been around a really long time, hence more reports.

beta blockers seem generally ok, but that's a whole other can of worms.

the bottom line here: your psychiatrist seems to be doing a good job, is aware of your meds, and is thinking about things. why not discuss your concerns with him, and monitor appropriately? and make sure that he and your gp are communicating? you can always start out super-low on the lithium and monitor very conservatively.

apologies for the shoddy caps. I have a horrible keyboard; will try to come back and edit this later because it looks horrid.

[crazyguest]

Wow, thanks for a great post!

And please don't trouble about the editing the caps, the main thing is the information!

I am going to talk to my GP as well just so that the GP, the pdoc, and I all understand what's going on. Thanks also for the pointer about the pharmacy - I get tired of explaining things to pharmacy people anyways, and I'm sure this would send them over the edge.

[Silver]

it's ok if it sends pharmacy people over the edge; they're making sure that important stuff isn't getting missed by your assorted physicians and that you don't suffer the consequences. it's just a good thing to let them know that everyone's on the same page and you've been advised [and don't be surprised if you get counseled again anyway.] if the starting dose is low enough, the freak-out factor would probably be minimal.

i am starting to really hate this keyboard.