lisinopril and Bipolar-Disorder

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Antimanic Agents; Bipolar Disorder; Blood Pressure; Brugada Syndrome; Electrocardiography; Female; Heart Rate; Humans; Hypertension; Lisinopril; Lithium Carbonate; Middle Aged; Predictive Value of Tests; Risk Assessment; Risk Factors

A case of acute pancreatitis associated with lisinopril and olanzapine is described.. A 69-year-old woman came to the emergency department after four days of experiencing epigastric pressurelike pain that radiated to the left lower quadrant and worsened with ingestion of food. She had started lisinopril three months prior for treatment of hypertension and had been taking olanzapine regularly for bipolar disorder. Upon admission, she was afebrile and hemodynamically stable and exhibited tenderness of the epigastric region. Elevated pancreatic enzymes and abdominal computed tomography (CT) imaging findings confirmed the diagnosis of pancreatitis. Common causes of pancreatitis were ruled out, and it was determined that the recent combination of lisinopril and olanzapine was the likely cause. Food and liquids were withheld, and all oral medications were stopped at hospital admission. Her pain resolved completely after two days. She was discharged on hospital day 4, and all of her medications except lisinopril and olanzapine were resumed. During a follow-up visit with her primary care physician, she reported to be doing well and had no systemic complaints. Olanzapine was reinitiated at that time but was discontinued a month later by her psychiatrist, who was concerned about the development of recurrent symptoms of pancreatitis. Valsartan was prescribed to achieve optimal blood pressure control three weeks after discharge. A follow-up CT scan of the abdomen a month later found no residual pancreatic abnormalities.. The additive effect of two known pancreatitis-causing medications resulted in increased risk and subsequent acute pancreatitis in this patient.

Topics: Acute Disease; Aged; Angiotensin-Converting Enzyme Inhibitors; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Drug Interactions; Drug Therapy, Combination; Female; Humans; Hypertension; Lisinopril; Olanzapine; Pancreatitis

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Antimanic Agents; Bipolar Disorder; Diuretics; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Hydrochlorothiazide; Hypertension, Renal; Kidney Failure, Chronic; Lisinopril; Lithium; Middle Aged; Renal Dialysis; Risk Factors

There is a small body of literature on the interactions between lithium and angiotensin-converting enzyme inhibitors (ACEIs), but little data documenting the differences between these agents in their impact on serum lithium levels. We present the case of a 46-year-old male who sustained a five-fold increase in his serum lithium level after switching from fosinopril to lisinopril, with a peak serum lithium level of 3.4 meq/l. There was also an increase in serum creatinine from 1.1 on fosinopril to 1.4 after switching to lisinopril. The patient was hospitalized, and intravenously hydrated with 0.5 normal saline, with a reduction of the serum lithium level to 0.7 meq/l by 72 h after admission. The hospital course was marked by two episodes of bradycardia, but was otherwise uneventful, and the patient was discharged without any neurological sequelae. This case demonstrates that ACEIs may have differential effects on renal function, and the potential for significant alterations in lithium clearance that may not be clinically evident for several weeks. Lithium-treated patients who have a change in ACEI, especially those who are older or have below average renal function, must have diligent monitoring for the first 4-6 weeks after switching to detect potentially serious changes in serum lithium levels.

Topics: Angiotensin-Converting Enzyme Inhibitors; Antimanic Agents; Bipolar Disorder; Bradycardia; Fosinopril; Heart Rate; Humans; Lisinopril; Lithium; Male; Middle Aged; Psychotic Disorders

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Antidepressive Agents; Bipolar Disorder; Depressive Disorder, Major; Drug Therapy, Combination; Female; Humans; Hypertension; Lisinopril; Male; Middle Aged