Drug interactions
Diltiazem + Eplerenone
Severity: Major
Diltiazem and Eplerenone: 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
Diltiazem is a moderate CYP3A4 inhibitor and raises eplerenone exposure. This increases the risk of hyperkalemia and hypotension.
What this interaction means in plain words
Diltiazem and Eplerenone 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.
Diltiazem belongs to Cardiovascular; Eplerenone belongs to Cardiovascular.
Why it happens
Diltiazem inhibits CYP3A4-mediated metabolism of eplerenone, increasing its plasma concentrations.
What to do
If the combination is needed, limit the eplerenone dose as recommended in labeling (not above 25 mg daily in post-MI heart failure) and monitor serum potassium and renal function closely. Consider an alternative calcium channel blocker or antihypertensive.
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 Eplerenone
- Amiloride + Eplerenone Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Clarithromycin + Eplerenone Contraindicated
- Cobicistat + Eplerenone Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Eplerenone Contraindicated
- Ensitrelvir + Eplerenone Contraindicated
Other interactions of Diltiazem
- Diltiazem + Flibanserin Contraindicated
- Diltiazem + Ivabradine Contraindicated
- Diltiazem + Lomitapide Contraindicated
- Diltiazem + Lonafarnib Contraindicated
- Acebutolol + Diltiazem Major
- Alfentanil + Diltiazem Major
Frequently asked questions
Can I take Diltiazem with Eplerenone?
MediHelp rates the interaction as major. Diltiazem and Eplerenone 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. Diltiazem is a moderate CYP3A4 inhibitor and raises eplerenone exposure. This increases the risk of hyperkalemia and hypotension.
How serious is the interaction between Diltiazem and Eplerenone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: If the combination is needed, limit the eplerenone dose as recommended in labeling (not above 25 mg daily in post-MI heart failure) and monitor serum potassium and renal function closely. Consider an alternative calcium channel blocker or antihypertensive.
What other medicines interact with Eplerenone?
MediHelp also lists interactions of Eplerenone with, for example, Amiloride, Atazanavir, Clarithromycin. The full list is on the Eplerenone page.
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