Drug interactions
Hydrochlorothiazide-telmisartan + Spironolactone
Severity: Major
Hydrochlorothiazide-telmisartan 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 telmisartan both reduce renal potassium excretion, so combined use can cause clinically significant hyperkalemia, particularly in renal impairment or diabetes. Hydrochlorothiazide lowers potassium and may partly offset the effect but does not remove the risk.
What this interaction means in plain words
Hydrochlorothiazide-telmisartan 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-telmisartan belongs to Cardiovascular; Spironolactone belongs to Cardiovascular.
Why it happens
Additive potassium retention from aldosterone receptor antagonism and angiotensin II receptor blockade, partially opposed by thiazide kaliuresis.
What to do
Measure serum potassium and creatinine at baseline, within the first 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-telmisartan
- Aliskiren + Hydrochlorothiazide-telmisartan Contraindicated
- Dofetilide + Hydrochlorothiazide-telmisartan Contraindicated
- Hydrochlorothiazide-telmisartan + Sparsentan Contraindicated
- Aldesleukin + Hydrochlorothiazide-telmisartan Major
- Amifostine + Hydrochlorothiazide-telmisartan Major
- Amiloride + Hydrochlorothiazide-telmisartan 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-telmisartan with Spironolactone?
MediHelp rates the interaction as major. Hydrochlorothiazide-telmisartan 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 telmisartan both reduce renal potassium excretion, so combined use can cause clinically significant hyperkalemia, particularly in renal impairment or diabetes. Hydrochlorothiazide lowers potassium and may partly offset the effect but does not remove the risk.
How serious is the interaction between Hydrochlorothiazide-telmisartan 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: Measure serum potassium and creatinine at baseline, within the first week or so, and regularly thereafter. Avoid potassium supplements and reduce or stop spironolactone if potassium rises.
What other medicines interact with Hydrochlorothiazide-telmisartan?
MediHelp also lists interactions of Hydrochlorothiazide-telmisartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-telmisartan page.
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