Drug interactions
Ramipril + Spironolactone
Severity: Major
Ramipril 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
The combination can cause serious hyperkalemia and additive hypotension, particularly with renal impairment, diabetes or advanced age. Severe hyperkalemia may cause life-threatening arrhythmias.
What this interaction means in plain words
Ramipril 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.
Ramipril belongs to Cardiovascular; Spironolactone belongs to Cardiovascular.
Why it happens
ACE inhibition reduces aldosterone secretion and spironolactone blocks its receptor, additively decreasing renal potassium excretion.
What to do
Check potassium and creatinine at baseline, within about a week, 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 Spironolactone
- Amiloride + Spironolactone Contraindicated
- Eplerenone + Spironolactone Contraindicated
- Spironolactone + Triamterene Contraindicated
- Abiraterone + Spironolactone Major
- Aceclofenac + Spironolactone Major
- Acemetacin + Spironolactone Major
Other interactions of Ramipril
- Aliskiren + Ramipril Contraindicated
- Protein a column + Ramipril Contraindicated
- Ramipril + Sacubitril / valsartan Contraindicated
- Ramipril + Sacubitril-valsartan Contraindicated
- Amifostine + Ramipril Major
- Amiloride + Ramipril Major
Frequently asked questions
Can I take Ramipril with Spironolactone?
MediHelp rates the interaction as major. Ramipril 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. The combination can cause serious hyperkalemia and additive hypotension, particularly with renal impairment, diabetes or advanced age. Severe hyperkalemia may cause life-threatening arrhythmias.
How serious is the interaction between Ramipril 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: Check potassium and creatinine at baseline, within about a week, and regularly thereafter. Avoid potassium supplements and reduce or stop spironolactone if potassium rises.
What other medicines interact with Spironolactone?
MediHelp also lists interactions of Spironolactone with, for example, Amiloride, Eplerenone, Triamterene. The full list is on the Spironolactone page.
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