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
Valsartan lowers aldosterone effect and spironolactone blocks the mineralocorticoid receptor, so both reduce renal potassium excretion. The combination is used in heart failure but carries a clear risk of clinically significant hyperkalemia and worsening renal function.
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.
Why it happens
Additive suppression of the renin-angiotensin-aldosterone axis: angiotensin II receptor blockade plus mineralocorticoid receptor antagonism reduces distal potassium secretion.
What to do
Measure potassium and creatinine before starting, within the first week or so, and periodically thereafter. Reduce or hold spironolactone if potassium becomes elevated and avoid additional potassium supplements or potassium-raising drugs.
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
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. Valsartan lowers aldosterone effect and spironolactone blocks the mineralocorticoid receptor, so both reduce renal potassium excretion. The combination is used in heart failure but carries a clear risk of clinically significant hyperkalemia and worsening renal function.
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 potassium and creatinine before starting, within the first week or so, and periodically thereafter. Reduce or hold spironolactone if potassium becomes elevated and avoid additional potassium supplements or potassium-raising drugs.
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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