Drug interactions
Spironolactone + Telmisartan
Severity: Major
Spironolactone and Telmisartan: major interaction.
Last updated Sources: US FDA label
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
Both drugs reduce renal potassium excretion, so combining them can cause clinically significant hyperkalemia. The risk is greatest in patients with renal impairment, diabetes, advanced age or heart failure.
What this interaction means in plain words
Spironolactone and Telmisartan 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; Telmisartan belongs to Cardiovascular.
Why it happens
Additive potassium retention through aldosterone receptor blockade (spironolactone) and reduced aldosterone effect via angiotensin II receptor blockade (telmisartan).
What to do
Check serum potassium and creatinine at baseline, within the first week or so after starting or changing doses, and periodically afterward. Reduce or stop spironolactone if potassium rises above the accepted range, and avoid potassium supplements.
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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References
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 Telmisartan
- Aliskiren + Telmisartan Contraindicated
- Sparsentan + Telmisartan Contraindicated
- Amifostine + Telmisartan Major
- Amiloride + Telmisartan Major
- Amlodipine-benazepril + Telmisartan Major
- Amlodipine-hydrochlorothiazide-valsartan + Telmisartan Major
Frequently asked questions
Can I take Spironolactone with Telmisartan?
MediHelp rates the interaction as major. Spironolactone and Telmisartan 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. Both drugs reduce renal potassium excretion, so combining them can cause clinically significant hyperkalemia. The risk is greatest in patients with renal impairment, diabetes, advanced age or heart failure.
How serious is the interaction between Spironolactone and Telmisartan?
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 at baseline, within the first week or so after starting or changing doses, and periodically afterward. Reduce or stop spironolactone if potassium rises above the accepted range, and avoid potassium supplements.
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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