Drug interactions
Spironolactone + Tacrolimus
Severity: Major
Spironolactone and Tacrolimus: 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
Tacrolimus causes hyperkalemia through reduced renal potassium excretion, and spironolactone adds to this by blocking aldosterone. The combination can produce clinically important hyperkalemia, especially with renal impairment.
What this interaction means in plain words
Spironolactone and Tacrolimus 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 belongs to Cardiovascular; Tacrolimus belongs to Miscellaneous.
Why it happens
Additive pharmacodynamic hyperkalemia from aldosterone antagonism and calcineurin inhibitor-induced reduction of renal potassium secretion.
What to do
Monitor serum potassium and renal function closely, particularly at initiation and with dose changes. Avoid potassium supplements and consider an alternative if hyperkalemia develops.
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 Tacrolimus
- Adenovirus types 4 and 7 live + Tacrolimus Contraindicated
- Bcg vaccine live + Tacrolimus Contraindicated
- Cidofovir + Tacrolimus Contraindicated
- Cyclosporin + Tacrolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Tacrolimus Contraindicated
- Measles mumps and rubella vaccine live + Tacrolimus Contraindicated
Frequently asked questions
Can I take Spironolactone with Tacrolimus?
MediHelp rates the interaction as major. Spironolactone and Tacrolimus 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. Tacrolimus causes hyperkalemia through reduced renal potassium excretion, and spironolactone adds to this by blocking aldosterone. The combination can produce clinically important hyperkalemia, especially with renal impairment.
How serious is the interaction between Spironolactone and Tacrolimus?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor serum potassium and renal function closely, particularly at initiation and with dose changes. Avoid potassium supplements and consider an alternative if hyperkalemia develops.
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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