Drug interactions
Hydrochlorothiazide-irbesartan + Spironolactone
Severity: Major
Hydrochlorothiazide-irbesartan and Spironolactone: major interaction.
Last updated
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 irbesartan both reduce potassium excretion, creating a meaningful risk of hyperkalemia, particularly in older patients and those with renal impairment or diabetes. Hydrochlorothiazide's potassium loss only partly mitigates this.
What this interaction means in plain words
Hydrochlorothiazide-irbesartan 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.
Hydrochlorothiazide-irbesartan belongs to Cardiovascular; Spironolactone belongs to Cardiovascular.
Why it happens
Spironolactone blocks mineralocorticoid receptors and irbesartan blocks angiotensin II-driven aldosterone release, additively retaining potassium.
What to do
Monitor serum potassium and creatinine at baseline, within the first week or so, and regularly thereafter. Reduce or stop spironolactone if potassium rises significantly.
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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Other interactions of Hydrochlorothiazide-irbesartan
- Aliskiren + Hydrochlorothiazide-irbesartan Contraindicated
- Dofetilide + Hydrochlorothiazide-irbesartan Contraindicated
- Hydrochlorothiazide-irbesartan + Sparsentan Contraindicated
- Aldesleukin + Hydrochlorothiazide-irbesartan Major
- Amifostine + Hydrochlorothiazide-irbesartan Major
- Amiloride + Hydrochlorothiazide-irbesartan 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 Hydrochlorothiazide-irbesartan with Spironolactone?
MediHelp rates the interaction as major. Hydrochlorothiazide-irbesartan 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 irbesartan both reduce potassium excretion, creating a meaningful risk of hyperkalemia, particularly in older patients and those with renal impairment or diabetes. Hydrochlorothiazide's potassium loss only partly mitigates this.
How serious is the interaction between Hydrochlorothiazide-irbesartan 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: Monitor serum potassium and creatinine at baseline, within the first week or so, and regularly thereafter. Reduce or stop spironolactone if potassium rises significantly.
What other medicines interact with Hydrochlorothiazide-irbesartan?
MediHelp also lists interactions of Hydrochlorothiazide-irbesartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-irbesartan page.
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