NutriStack
Enalapril and Lithium Orotate, a caution.
Enalapril reduces sodium reabsorption and lowers glomerular filtration, which causes the kidney to retain lithium and pushes serum lithium levels up. In prescription-lithium patients started on enalapril, lithium concentrations have risen by roughly a third within weeks. Lithium Orotate doses are much smaller, but the same handling principle applies and the margin between therapeutic and toxic lithium is narrow; older adults, dehydrated patients, and those on diuretics or NSAIDs are most at risk.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Enalapril and Lithium Orotate
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Enalapril reduces sodium reabsorption and lowers glomerular filtration, which causes the kidney to retain lithium and pushes serum lithium levels up. In prescription-lithium patients started on enalapril, lithium concentrations have risen by roughly a third within weeks. Lithium Orotate doses are much smaller, but the same handling principle applies and the margin between therapeutic and toxic lithium is narrow; older adults, dehydrated patients, and those on diuretics or NSAIDs are most at risk.
Mechanism. ACE inhibition reduces angiotensin II and aldosterone, causing natriuresis and a fall in GFR. Lithium is reabsorbed in the proximal tubule in parallel with sodium, so sodium loss and reduced filtration both increase fractional lithium reabsorption.
Recommendation. Avoid Lithium Orotate while taking enalapril. If you must use it, keep the dose low, stay well hydrated, and ask your prescriber to check a serum lithium level after a week or two. Hold lithium during any vomiting, diarrhea, or fever illness.
Sources (2)
- DasGupta K, Jefferson JW, Kobak KA, Greist JH. The effect of enalapril on serum lithium levels in healthy men. J Clin Psychiatry. 1992;53(11):398-400. PMID 1459971
- Finley PR, O'Brien JG, Coleman RW. Lithium and angiotensin-converting enzyme inhibitors: evaluation of a potential interaction. J Clin Psychopharmacol. 1996;16(1):68-71. PMID 8834421
Stack Score
How this pair moves the number.
Effect on the composite score
If both Enalapril and Lithium Orotate are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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