n by improving insulin sensitivity. In addition, ARBs have been associated with a reduced incidence in the development of new-onset diabetes in patients with hypertension or other cardiac disease. Patients receiving ARBs concomitantly with linagliptin should be monitored for changes in glycemic control. Angiotensin II receptor antagonists (ARBs) may enhance the hypoglycemic effects of metformin by improving insulin sensitivity. In addition, angiotensin II receptor antagonists have been associated with a reduced incidence in the development of new-onset diabetes in patients with hypertension or other cardiac disease. ARBs may rarely reduce renal function, a risk factor for reduced renal clearance of metformin. Patients receiving these drugs together should be monitored for changes in renal function and glycemic control.
Lisdexamfetamine: Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents. Close monitoring of blood pressure or the selection of alternative therapeutic agents may be needed.
Lisinopril: Sacubitril; valsartan is contraindicated with the concomitant use of angiotensin-converting enzyme inhibitors (ACE inhibitors) due to the increased risk of angioedema. Do not administer sacubitril; valsartan within 36 hours of switching to or from an ACE inhibitor.
Lithium: Angiotensin II receptor antagonists (ARBs) should be used very cautiously, if at all, in patients already receiving lithium. The risk of lithium toxicity is increased in patients receiving medications that may affect kidney function, such ARBs. These drugs decrease lithium clearance, possibly as a result of sodium depletion which leads to increased renal tubular reabsorption of lithium. If combination therapy cannot be avoided, begin with lower doses of lithium and be alert for evidence of lithium toxicity (e.g., nausea, vomiting, anorexia, drowsiness, dysarthria, tremor, confusion, lethargy, ECG changes, etc.). Consider reducing the lithium dosage in previously established patients and monitor lithium concentrations and patient response and tolerability. Conversely, clinicians should be alert to the possibility of loss of lithium effectiveness if ARBs are discontinued in a patient stabilized on lithium. According to the Beers Criteria, concurrent use of lithium and ACE inhibitors may result in a clinically important drug interaction particularly in older adults; the panel recommends avoiding concurrent use due to an increased risk of lithium toxicity. If the combination is medically necessary, monitoring of lithium concentrations is recommended.
Loop diuretics: Coadministration of furosemide and Angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor antagonists may result in severe hypotension and deterioration in renal function, including renal failure. Hyponatremia or hypovolemia predisposes patients to acute hypotensive episodes following initiation of ACE inhibitor therapy. While ACE inhibitors and loop diuretics are routinely administered together in the treatment of heart failure, if an ACE inhibitor is to be administered to a patient receiving furosemide, initial doses should be conservative.
Lopinavir; Ritonavir: Concurrent use of lopinavir with valsartan may result in elevated valsartan serum concentrations. Valsartan is a substrate for the drug transporter organic anion transporting polypeptide (OATP1B1/1B3); lopinavir is a |
