Drug interactions
Eplerenone + Hydrochlorothiazide-valsartan
Severity: Major
Eplerenone and Hydrochlorothiazide-valsartan: 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 valsartan both reduce aldosterone-mediated potassium excretion, so combined use can cause hyperkalemia, especially in renal impairment, diabetes or older age. The thiazide component partly counteracts this, but the risk remains significant.
What this interaction means in plain words
Eplerenone and Hydrochlorothiazide-valsartan 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-valsartan belongs to Cardiovascular.
Why it happens
Additive suppression of the renin-angiotensin-aldosterone axis through mineralocorticoid receptor blockade and angiotensin receptor blockade reduces renal potassium excretion.
What to do
Monitor serum potassium and creatinine within the first week and regularly thereafter, and avoid potassium supplements and salt substitutes. Reduce or stop one agent if potassium becomes elevated.
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-valsartan
- Aliskiren + Hydrochlorothiazide-valsartan Contraindicated
- Dofetilide + Hydrochlorothiazide-valsartan Contraindicated
- Hydrochlorothiazide-valsartan + Sparsentan Contraindicated
- Aldesleukin + Hydrochlorothiazide-valsartan Major
- Amifostine + Hydrochlorothiazide-valsartan Major
- Amiloride + Hydrochlorothiazide-valsartan 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-valsartan?
MediHelp rates the interaction as major. Eplerenone and Hydrochlorothiazide-valsartan 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 valsartan both reduce aldosterone-mediated potassium excretion, so combined use can cause hyperkalemia, especially in renal impairment, diabetes or older age. The thiazide component partly counteracts this, but the risk remains significant.
How serious is the interaction between Eplerenone and Hydrochlorothiazide-valsartan?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor serum potassium and creatinine within the first week and regularly thereafter, and avoid potassium supplements and salt substitutes. Reduce or stop one agent if potassium becomes elevated.
What other medicines interact with Hydrochlorothiazide-valsartan?
MediHelp also lists interactions of Hydrochlorothiazide-valsartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-valsartan page.
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