Drug interactions
Hydrochlorothiazide-irbesartan + Tolvaptan
Severity: Moderate
Hydrochlorothiazide-irbesartan and Tolvaptan: moderate 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
Tolvaptan is a vasopressin antagonist that causes aquaresis and can raise serum potassium, while irbesartan also raises potassium and hydrochlorothiazide lowers it. Net potassium effects are unpredictable, and excessive fluid loss can add to volume depletion and hypotension.
What this interaction means in plain words
Hydrochlorothiazide-irbesartan and Tolvaptan can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Hydrochlorothiazide-irbesartan belongs to Cardiovascular; Tolvaptan belongs to Endocrine.
Why it happens
Additive pharmacodynamic effects on potassium handling and fluid balance from ARB-mediated aldosterone suppression, thiazide kaliuresis and tolvaptan aquaresis.
What to do
Monitor serum potassium, sodium, volume status and blood pressure during initiation and dose changes. Adjust therapy if hyperkalemia, hypokalemia or hypovolemia develops.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Tolvaptan
- Atazanavir + Tolvaptan Contraindicated
- Ceritinib + Tolvaptan Contraindicated
- Cobicistat + Tolvaptan Contraindicated
- Conivaptan + Tolvaptan Contraindicated
- Darunavir + Tolvaptan Contraindicated
- Idelalisib + Tolvaptan Contraindicated
Frequently asked questions
Can I take Hydrochlorothiazide-irbesartan with Tolvaptan?
MediHelp rates the interaction as moderate. Hydrochlorothiazide-irbesartan and Tolvaptan can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Tolvaptan is a vasopressin antagonist that causes aquaresis and can raise serum potassium, while irbesartan also raises potassium and hydrochlorothiazide lowers it. Net potassium effects are unpredictable, and excessive fluid loss can add to volume depletion and hypotension.
How serious is the interaction between Hydrochlorothiazide-irbesartan and Tolvaptan?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor serum potassium, sodium, volume status and blood pressure during initiation and dose changes. Adjust therapy if hyperkalemia, hypokalemia or hypovolemia develops.
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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