Drug interactions
Diflunisal + Spironolactone
Severity: Major
Diflunisal and Spironolactone: major interaction.
Last updated Sources: EMA SmPC
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
NSAIDs can blunt the diuretic and antihypertensive effect of spironolactone and, together with it, raise serum potassium. Hyperkalemia and acute kidney injury are most likely in older patients, diabetics and those with renal impairment or heart failure.
What this interaction means in plain words
Diflunisal 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.
Diflunisal belongs to Musculoskeletal; Spironolactone belongs to Cardiovascular.
Why it happens
NSAID inhibition of renal prostaglandins and renin release adds to aldosterone antagonism, reducing potassium excretion and renal perfusion.
What to do
Avoid the combination in patients with renal impairment; otherwise monitor serum potassium and creatinine early after starting and periodically thereafter, and watch fluid status and blood pressure.
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 Diflunisal
- Diflunisal + Ketorolac Contraindicated
- Diflunisal + Ketorolac intranasal Contraindicated
- Acemetacin + Diflunisal Major
- Acetazolamide + Diflunisal Major
- Alteplase + Diflunisal Major
- Amiloride + Diflunisal 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 Diflunisal with Spironolactone?
MediHelp rates the interaction as major. Diflunisal 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. NSAIDs can blunt the diuretic and antihypertensive effect of spironolactone and, together with it, raise serum potassium. Hyperkalemia and acute kidney injury are most likely in older patients, diabetics and those with renal impairment or heart failure.
How serious is the interaction between Diflunisal 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: Avoid the combination in patients with renal impairment; otherwise monitor serum potassium and creatinine early after starting and periodically thereafter, and watch fluid status and blood pressure.
What other medicines interact with Diflunisal?
MediHelp also lists interactions of Diflunisal with, for example, Ketorolac, Ketorolac intranasal, Acemetacin. The full list is on the Diflunisal page.
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