Drug interactions
Eplerenone + Hydrochlorothiazide-telmisartan
Severity: Major
Eplerenone and Hydrochlorothiazide-telmisartan: 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 telmisartan both reduce potassium excretion, so combined use raises the risk of hyperkalemia, especially with renal impairment or diabetes. The thiazide partly offsets this but does not remove the risk.
What this interaction means in plain words
Eplerenone and Hydrochlorothiazide-telmisartan 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-telmisartan belongs to Cardiovascular.
Why it happens
Additive suppression of aldosterone-mediated potassium excretion through mineralocorticoid receptor antagonism and angiotensin receptor blockade.
What to do
Check potassium and renal function at baseline, within the first week, and periodically; reduce or stop eplerenone if potassium rises significantly and avoid potassium supplements.
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-telmisartan
- Aliskiren + Hydrochlorothiazide-telmisartan Contraindicated
- Dofetilide + Hydrochlorothiazide-telmisartan Contraindicated
- Hydrochlorothiazide-telmisartan + Sparsentan Contraindicated
- Aldesleukin + Hydrochlorothiazide-telmisartan Major
- Amifostine + Hydrochlorothiazide-telmisartan Major
- Amiloride + Hydrochlorothiazide-telmisartan 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-telmisartan?
MediHelp rates the interaction as major. Eplerenone and Hydrochlorothiazide-telmisartan 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 telmisartan both reduce potassium excretion, so combined use raises the risk of hyperkalemia, especially with renal impairment or diabetes. The thiazide partly offsets this but does not remove the risk.
How serious is the interaction between Eplerenone and Hydrochlorothiazide-telmisartan?
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 renal function at baseline, within the first week, and periodically; reduce or stop eplerenone if potassium rises significantly and avoid potassium supplements.
What other medicines interact with Hydrochlorothiazide-telmisartan?
MediHelp also lists interactions of Hydrochlorothiazide-telmisartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-telmisartan page.
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