Drug interactions
Enalapril-hydrochlorothiazide + Eplerenone
Severity: Major
Enalapril-hydrochlorothiazide 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
Eplerenone and enalapril both promote potassium retention, so combining them raises the risk of serious hyperkalemia, especially in renal impairment, diabetes or heart failure. The thiazide partly mitigates this but does not remove the risk.
What this interaction means in plain words
Enalapril-hydrochlorothiazide 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.
Enalapril-hydrochlorothiazide belongs to Cardiovascular; Eplerenone belongs to Cardiovascular.
Why it happens
Additive potassium retention from aldosterone receptor blockade and ACE inhibition.
What to do
Check serum potassium and renal function at baseline, within the first week, and periodically thereafter. Reduce or stop eplerenone if potassium rises above the normal range.
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 Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Protein a column Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
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
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Eplerenone?
MediHelp rates the interaction as major. Enalapril-hydrochlorothiazide 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. Eplerenone and enalapril both promote potassium retention, so combining them raises the risk of serious hyperkalemia, especially in renal impairment, diabetes or heart failure. The thiazide partly mitigates this but does not remove the risk.
How serious is the interaction between Enalapril-hydrochlorothiazide 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: Check serum potassium and renal function at baseline, within the first week, and periodically thereafter. Reduce or stop eplerenone if potassium rises above the normal range.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.
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