Drug interactions
Hydrochlorothiazide-olmesartan + Spironolactone
Severity: Major
Hydrochlorothiazide-olmesartan 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 combined with an angiotensin receptor blocker markedly raises the risk of hyperkalemia, particularly in renal impairment, diabetes or heart failure. Hydrochlorothiazide does not reliably prevent this.
What this interaction means in plain words
Hydrochlorothiazide-olmesartan 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-olmesartan belongs to Cardiovascular; Spironolactone belongs to Cardiovascular.
Why it happens
Aldosterone antagonism plus angiotensin II receptor blockade additively decrease renal potassium excretion.
What to do
Monitor potassium and creatinine at baseline, within a week or so, and regularly thereafter. Avoid potassium supplements and reduce or stop spironolactone if potassium rises.
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-olmesartan
- Aliskiren + Hydrochlorothiazide-olmesartan Contraindicated
- Dofetilide + Hydrochlorothiazide-olmesartan Contraindicated
- Hydrochlorothiazide-olmesartan + Sparsentan Contraindicated
- Acemetacin + Hydrochlorothiazide-olmesartan Major
- Amifostine + Hydrochlorothiazide-olmesartan Major
- Amiloride + Hydrochlorothiazide-olmesartan 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-olmesartan with Spironolactone?
MediHelp rates the interaction as major. Hydrochlorothiazide-olmesartan 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 combined with an angiotensin receptor blocker markedly raises the risk of hyperkalemia, particularly in renal impairment, diabetes or heart failure. Hydrochlorothiazide does not reliably prevent this.
How serious is the interaction between Hydrochlorothiazide-olmesartan 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 potassium and creatinine at baseline, within a week or so, and regularly thereafter. Avoid potassium supplements and reduce or stop spironolactone if potassium rises.
What other medicines interact with Hydrochlorothiazide-olmesartan?
MediHelp also lists interactions of Hydrochlorothiazide-olmesartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-olmesartan page.
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