Drug interactions
Enalapril-hydrochlorothiazide + Spironolactone
Severity: Major
Enalapril-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
Spironolactone and enalapril both raise potassium, and hydrochlorothiazide lowers it, so the net effect varies. Hyperkalemia can be severe, especially with renal impairment, diabetes or older age.
What this interaction means in plain words
Enalapril-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.
Enalapril-hydrochlorothiazide belongs to Cardiovascular; Spironolactone belongs to Cardiovascular.
Why it happens
Additive potassium retention from aldosterone antagonism and reduced aldosterone production via ACE inhibition, partly offset by thiazide kaliuresis.
What to do
Check potassium and creatinine within the first week 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 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 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 Enalapril-hydrochlorothiazide with Spironolactone?
MediHelp rates the interaction as major. Enalapril-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. Spironolactone and enalapril both raise potassium, and hydrochlorothiazide lowers it, so the net effect varies. Hyperkalemia can be severe, especially with renal impairment, diabetes or older age.
How serious is the interaction between Enalapril-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 the first week and regularly thereafter. Avoid potassium supplements and reduce or stop spironolactone if potassium rises.
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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