Drug interactions
Candesartan-hydrochlorothiazide + Spironolactone
Severity: Major
Candesartan-hydrochlorothiazide and Spironolactone: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Candesartan and spironolactone both reduce potassium excretion and can cause clinically significant hyperkalemia, though hydrochlorothiazide offsets this partly. Risk is highest in renal impairment, diabetes and older patients.
What this interaction means in plain words
Candesartan-hydrochlorothiazide and Spironolactone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Candesartan-hydrochlorothiazide belongs to Cardiovascular; Spironolactone belongs to Cardiovascular.
Why it happens
ARB-mediated aldosterone reduction plus mineralocorticoid receptor blockade cause additive potassium retention, partly offset by thiazide kaliuresis.
What to do
Check potassium and creatinine within about a week of starting and regularly thereafter. Avoid potassium supplements and reduce or stop spironolactone if potassium rises.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Candesartan-hydrochlorothiazide
- Aliskiren + Candesartan-hydrochlorothiazide Contraindicated
- Candesartan-hydrochlorothiazide + Dofetilide Contraindicated
- Candesartan-hydrochlorothiazide + Sparsentan Contraindicated
- Acemetacin + Candesartan-hydrochlorothiazide Major
- Amifostine + Candesartan-hydrochlorothiazide Major
- Amiloride + Candesartan-hydrochlorothiazide Major
Other interactions of Spironolactone
- Amiloride + Spironolactone Contraindicated
- Eplerenone + Spironolactone Contraindicated
- Spironolactone + Triamterene Contraindicated
- Abiraterone + Spironolactone Major
- Aceclofenac + Spironolactone Major
- Acemetacin + Spironolactone Major
Frequently asked questions
Can I take Candesartan-hydrochlorothiazide with Spironolactone?
MediHelp rates the interaction as major. Candesartan-hydrochlorothiazide and Spironolactone can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Candesartan and spironolactone both reduce potassium excretion and can cause clinically significant hyperkalemia, though hydrochlorothiazide offsets this partly. Risk is highest in renal impairment, diabetes and older patients.
How serious is the interaction between Candesartan-hydrochlorothiazide and Spironolactone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Check potassium and creatinine within about a week of starting and regularly thereafter. Avoid potassium supplements and reduce or stop spironolactone if potassium rises.
What other medicines interact with Candesartan-hydrochlorothiazide?
MediHelp also lists interactions of Candesartan-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Candesartan-hydrochlorothiazide page.
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