Drug interactions
Sacubitril-valsartan + Trimethoprim
Severity: Major
Sacubitril-valsartan and Trimethoprim: 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
Trimethoprim blocks epithelial sodium channels in the distal nephron in a manner similar to amiloride, reducing potassium excretion. Combined with an angiotensin receptor blocker such as valsartan, this can cause significant hyperkalemia, particularly in patients with renal impairment, diabetes, older age or on high trimethoprim doses.
What this interaction means in plain words
Sacubitril-valsartan and Trimethoprim 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; Trimethoprim belongs to Anti Bacterial.
Why it happens
Additive potassium retention: valsartan reduces aldosterone-mediated potassium excretion while trimethoprim blocks distal ENaC channels.
What to do
Check serum potassium and creatinine within the first few days of co-therapy and periodically thereafter. Prefer an alternative antibiotic in high-risk patients.
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 Trimethoprim
Frequently asked questions
Can I take Sacubitril-valsartan with Trimethoprim?
MediHelp rates the interaction as major. Sacubitril-valsartan and Trimethoprim 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. Trimethoprim blocks epithelial sodium channels in the distal nephron in a manner similar to amiloride, reducing potassium excretion. Combined with an angiotensin receptor blocker such as valsartan, this can cause significant hyperkalemia, particularly in patients with renal impairment, diabetes, older age or on high trimethoprim doses.
How serious is the interaction between Sacubitril-valsartan and Trimethoprim?
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 serum potassium and creatinine within the first few days of co-therapy and periodically thereafter. Prefer an alternative antibiotic in high-risk patients.
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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