Drug interactions
Eplerenone + Sacubitril-valsartan
Severity: Major
Eplerenone and Sacubitril-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
Both drugs reduce aldosterone effects on potassium excretion, so combined use can cause significant hyperkalemia, especially with renal impairment or diabetes. Although the combination is used in heart failure, serious hyperkalemia and renal decline can occur.
What this interaction means in plain words
Eplerenone and Sacubitril-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; Sacubitril-valsartan belongs to Cardiovascular.
Why it happens
Additive suppression of the renin-angiotensin-aldosterone system, reducing renal potassium excretion through angiotensin receptor blockade and mineralocorticoid receptor antagonism.
What to do
Measure potassium and creatinine at baseline, within the first week or so, and regularly after. Reduce or stop eplerenone if potassium rises above the accepted threshold, 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 Sacubitril-valsartan
- Aliskiren + Sacubitril-valsartan Contraindicated
- Benazepril + Sacubitril-valsartan Contraindicated
- Captopril + Sacubitril-valsartan Contraindicated
- Enalapril + Sacubitril-valsartan Contraindicated
- Fosinopril + Sacubitril-valsartan Contraindicated
- Lisinopril + Sacubitril-valsartan Contraindicated
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 Sacubitril-valsartan?
MediHelp rates the interaction as major. Eplerenone and Sacubitril-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. Both drugs reduce aldosterone effects on potassium excretion, so combined use can cause significant hyperkalemia, especially with renal impairment or diabetes. Although the combination is used in heart failure, serious hyperkalemia and renal decline can occur.
How serious is the interaction between Eplerenone and Sacubitril-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: Measure potassium and creatinine at baseline, within the first week or so, and regularly after. Reduce or stop eplerenone if potassium rises above the accepted threshold, and avoid potassium supplements.
What other medicines interact with Sacubitril-valsartan?
MediHelp also lists interactions of Sacubitril-valsartan with, for example, Aliskiren, Benazepril, Captopril. The full list is on the Sacubitril-valsartan page.
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