Drug interactions
Sacubitril-valsartan + Spironolactone
Severity: Major
Sacubitril-valsartan 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
Combining a mineralocorticoid antagonist with sacubitril/valsartan can cause serious hyperkalemia. The combination is used in heart failure but needs close laboratory follow-up.
What this interaction means in plain words
Sacubitril-valsartan 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.
Sacubitril-valsartan belongs to Cardiovascular; Spironolactone belongs to Cardiovascular.
Why it happens
Additive reduction of aldosterone effect on renal potassium excretion through receptor antagonism and angiotensin receptor blockade.
What to do
Measure serum potassium and creatinine at baseline, within about a week of changes, and regularly thereafter. Reduce or stop spironolactone if potassium rises or renal function worsens.
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 Sacubitril-valsartan
- Aliskiren + Sacubitril-valsartan Contraindicated
- Benazepril + Sacubitril-valsartan Contraindicated
- Captopril + Sacubitril-valsartan Contraindicated
- Enalapril + Sacubitril-valsartan Contraindicated
- Fosinopril + Sacubitril-valsartan Contraindicated
- Lisinopril + Sacubitril-valsartan Contraindicated
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 Sacubitril-valsartan with Spironolactone?
MediHelp rates the interaction as major. Sacubitril-valsartan 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. Combining a mineralocorticoid antagonist with sacubitril/valsartan can cause serious hyperkalemia. The combination is used in heart failure but needs close laboratory follow-up.
How serious is the interaction between Sacubitril-valsartan 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 about a week of changes, and regularly thereafter. Reduce or stop spironolactone if potassium rises or renal function worsens.
What other medicines interact with Sacubitril-valsartan?
MediHelp also lists interactions of Sacubitril-valsartan with, for example, Aliskiren, Benazepril, Captopril. The full list is on the Sacubitril-valsartan page.
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