Drug interactions
Eplerenone + Hydrochlorothiazide-losartan
Severity: Major
Eplerenone and Hydrochlorothiazide-losartan: 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
Both losartan and eplerenone reduce aldosterone effects on the kidney and reduce potassium excretion. Used together they can cause significant hyperkalemia, especially in patients with renal impairment, diabetes or heart failure.
What this interaction means in plain words
Eplerenone and Hydrochlorothiazide-losartan 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 belongs to Cardiovascular; Hydrochlorothiazide-losartan belongs to Cardiovascular.
Why it happens
Additive inhibition of the renin-angiotensin-aldosterone system, with angiotensin receptor blockade plus mineralocorticoid receptor antagonism reducing potassium excretion.
What to do
Measure serum potassium and creatinine at baseline, within the first week or so, and regularly afterwards. Avoid potassium supplements and reduce or stop eplerenone if potassium rises above the acceptable 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 Hydrochlorothiazide-losartan
- Aliskiren + Hydrochlorothiazide-losartan Contraindicated
- Dofetilide + Hydrochlorothiazide-losartan Contraindicated
- Hydrochlorothiazide-losartan + Sparsentan Contraindicated
- Aceclofenac + Hydrochlorothiazide-losartan Major
- Aldesleukin + Hydrochlorothiazide-losartan Major
- Amifostine + Hydrochlorothiazide-losartan 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 Eplerenone with Hydrochlorothiazide-losartan?
MediHelp rates the interaction as major. Eplerenone and Hydrochlorothiazide-losartan 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. Both losartan and eplerenone reduce aldosterone effects on the kidney and reduce potassium excretion. Used together they can cause significant hyperkalemia, especially in patients with renal impairment, diabetes or heart failure.
How serious is the interaction between Eplerenone and Hydrochlorothiazide-losartan?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Measure serum potassium and creatinine at baseline, within the first week or so, and regularly afterwards. Avoid potassium supplements and reduce or stop eplerenone if potassium rises above the acceptable range.
What other medicines interact with Hydrochlorothiazide-losartan?
MediHelp also lists interactions of Hydrochlorothiazide-losartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-losartan page.
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