Adjustment of lithium dose during lithiumchlorothiazide therapy

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Abstract
There has been a long-held belief that lithium salts cannot be used in the presence of thiazide diuretics. Recently, however, thiazldes have been demonstrated to be not only safe, but actually indicated in two situations in which lithium salts are used. The first is in the treatment of lithium-induced nephrogenic diabetes insipidus and the second is in severe manic depressive illness in whicli high doses of lithium do not produce therapeutic serum or intraerythrocytic lithium concentrations . This new information now makes it possible for some manic depressive patients with serious medical illnesses (such as hypertension or congestive heart failure), in whom thiazide diuretics are routinely used, to be treated cautiously with lithium carbonate. This paper analyzes data from 13 patients taking lithium carbonate and varying doses of chlorothiazide in order to indicate the approximate magnitude of down ward adjustment of daily lithium dose which the clinician must make to safely give 500, 750, and 1,000 mg/day of chlorothiaride.

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