Drug interactions
Spironolactone + Tolvaptan
Severity: Moderate
Spironolactone and Tolvaptan: moderate 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
Tolvaptan is a vasopressin antagonist that promotes water excretion without direct potassium retention, and labeling notes that serum potassium may rise with it. Combined with spironolactone, hyperkalemia is possible, and rapid shifts in fluid and sodium also require attention.
What this interaction means in plain words
Spironolactone and Tolvaptan can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Spironolactone belongs to Cardiovascular; Tolvaptan belongs to Endocrine.
Why it happens
Spironolactone causes potassium retention through aldosterone blockade, and tolvaptan may add a modest increase in potassium; the mechanism of the latter is not well established.
What to do
Monitor serum potassium and sodium after starting tolvaptan in patients taking spironolactone. Adjust or stop spironolactone if potassium becomes elevated.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Tolvaptan
- Atazanavir + Tolvaptan Contraindicated
- Ceritinib + Tolvaptan Contraindicated
- Cobicistat + Tolvaptan Contraindicated
- Conivaptan + Tolvaptan Contraindicated
- Darunavir + Tolvaptan Contraindicated
- Idelalisib + Tolvaptan Contraindicated
Frequently asked questions
Can I take Spironolactone with Tolvaptan?
MediHelp rates the interaction as moderate. Spironolactone and Tolvaptan can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Tolvaptan is a vasopressin antagonist that promotes water excretion without direct potassium retention, and labeling notes that serum potassium may rise with it. Combined with spironolactone, hyperkalemia is possible, and rapid shifts in fluid and sodium also require attention.
How serious is the interaction between Spironolactone and Tolvaptan?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor serum potassium and sodium after starting tolvaptan in patients taking spironolactone. Adjust or stop spironolactone if potassium becomes elevated.
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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