Spironolactone interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Spironolactone is a medication approved by the U.S. Drug and Food Administration (FDA) to treat conditions such as heart failure, high blood pressure (hypertension), and certain cases of hyperaldosteronism. It is a potassium-sparing diuretic that works by blocking the effects of a hormone called aldosterone, which can cause your body to retain salt and may also cause water retention. Spironolactone is typically taken by mouth and is available under the brand names Aldactone and Carospir. 

While spironolactone can be an effective medication, it may interact with other substances. These interactions can range from mild to severe and may affect the drug’s effectiveness or increase the risk of side effects. For instance, spironolactone can interact with other medications that affect potassium levels in the body, such as angiotensin-converting enzyme (ACE) inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs). 

Continue reading to learn more about spironolactone interactions and ways to lower the risk of adverse effects.

Spironolactone drug interactions

Spironolactone may interact with various medications, including prescription, OTC, and herbal substances. These interactions may affect drug efficacy and increase the risk of adverse effects like hyperkalemia, which may cause symptoms such as muscle weakness or an irregular heartbeat. Depending on the severity of the interaction, a healthcare provider might adjust dosages or suggest alternative medications.

ACE inhibitors

Spironolactone and ACE inhibitors can increase potassium levels in the blood, leading to hyperkalemia. This interaction may be serious, and patients should monitor their potassium levels regularly. Common ACE inhibitors include:

• Zestril (lisinopril)
• Vasotec (enalapril)
• Altace (ramipril)

Angiotensin receptor blockers (ARBs)

Taking spironolactone with an ARB may increase the risk of increased potassium levels. This can cause serious heart problems; patients should be alert for symptoms like muscle pain or weakness. Examples of ARBs are:

• Cozaar (losartan)
• Diovan (valsartan)
• Atacand (candesartan)

NSAIDs

NSAIDs are widely used for pain relief, inflammation, and fever. Combining NSAIDs with spironolactone may reduce the diuretic’s effectiveness and increase the risk of kidney problems. It can also increase potassium levels, leading to serious health issues. Common NSAIDs include: 

• Advil, Motrin (ibuprofen) 
• Aleve, Naprosyn (naproxen) 
• Celebrex (celecoxib)
• Aspirin (acetylsalicylic acid)

Heparin 

Heparin and low molecular weight heparin (LMWH) are blood thinners (anticoagulants) used to prevent and treat blood clots. When used with spironolactone, there is a higher risk of increased potassium levels in the blood. Heparin and spironolactone used together can lead to higher potassium levels. Patients should be aware of the signs of hyperkalemia (and hypokalemia) and seek immediate medical attention if they experience any of them.

• Hep-Lock (heparin)
• Lovenox (enoxaparin) 
• Fragmin (dalteparin)
• Innohep (tinzaparin)

Lithobid (lithium)

Lithium is a mood stabilizer commonly used to treat bipolar disorder. Spironolactone can increase the blood levels of lithium, potentially leading to lithium toxicity. Symptoms of lithium toxicity include nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, and confusion. Monitoring lithium levels is recommended when taken with spironolactone.

Lanoxin (digoxin)

Digoxin is used to treat heart failure and an irregular heart rhythm (atrial fibrillation) by helping to strengthen the heart muscle. Spironolactone may increase digoxin levels in the blood and increase the risk of digoxin toxicity. Toxicity can lead to symptoms such as nausea, vomiting, dizziness, and heart rhythm problems. 

Questran (cholestyramine)

Cholestyramine, when taken alongside spironolactone, may cause people to experience an imbalance in their blood chemistry, known as hyperkalemic metabolic acidosis. Hyperkalemic metabolic acidosis is a condition where there’s too much potassium in the blood, and the blood becomes too acidic, which can disrupt heart and muscle function and requires medical treatment.

Zytiga (abiraterone)

Abiraterone is a prescription medication used to treat prostate cancer. It belongs to a class of drugs known as anti-androgens or anti-testosterones. Patients being treated for prostate cancer with abiraterone should be cautious about using spironolactone, as it can bind to the same receptor and potentially raise PSA levels, a marker used to monitor prostate cancer. Healthcare providers generally recommend not combining spironolactone and abiraterone to avoid this interaction.

Primsol (trimethoprim)

Trimethoprim is an antibiotic commonly combined with sulfamethoxazole and used to treat bacterial infections such as urinary tract infections. Taking spironolactone with trimethoprim may raise potassium levels in the blood, potentially leading to life-threatening hyperkalemia.

Inspra (eplerenone)

Eplerenone and spironolactone are aldosterone antagonists. Because they work in identical ways and may carry a risk of hyperkalemia, it’s not recommended to take eplerenone while taking spironolactone. 

Spironolactone food interactions

Spironolactone can be taken with or without food. However, eating food may increase how much spironolactone the body absorbs. Therefore, taking spironolactone consistently with or without food is key. In addition, certain foods and beverages may affect how spironolactone works in the body.

Spironolactone and alcohol

Caution is advised when drinking alcohol while taking spironolactone. Although there is no direct interaction between spironolactone and alcohol, they both have diuretic effects. Combining spironolactone with alcohol may worsen spironolactone’s possible side effects, such as dizziness, headache, and dehydration. Limiting alcohol consumption with spironolactone may help reduce the risk. 

Spironolactone and caffeine

Caffeine is a stimulant that may have a diuretic effect, similar to spironolactone. Consuming foods or beverages with caffeine could potentially increase spironolactone’s effects on clearing water and salt from the body. While caffeine in small amounts is unlikely to cause severe side effects, limiting caffeine intake while taking spironolactone is recommended to avoid dehydration or other side effects. 

Other spironolactone interactions

Spironolactone can also interact with certain supplements. These interactions might affect the drug’s effectiveness or lead to unwanted side effects.

Supplements that increase potassium

Supplements containing potassium should be used cautiously, as they can increase the risk of hyperkalemia with spironolactone. People on spironolactone may need to limit or avoid additional potassium sources to prevent serious complications. Supplements that contain potassium include the following: 

• Noni (Morinda citrifolia)
• Dandelion (Taraxacum officinale) 
• Alfalfa (Medicago sativa) 
• Nettle (Urtica dioca)
• Horsetail (Equisetum arvense) 

In addition, salt substitutes that contain potassium chloride may increase the risk of hyperkalemia while taking spironolactone. 

Supplements with diuretic effects

When taking a water pill like spironolactone, you may need to limit taking supplements with diuretic effects. Combining spironolactone with supplements with diuretic effects may increase the risk of dehydration and electrolyte imbalances. Supplements with diuretic effects include: 

• Fennel (Foeniculum vulgare)
• European Ash (Fraxinus excelsior)
• Roselle (Hibiscus sabdariffa)
• Parsley (Petroselinum crispum)
• Purple sand spurrey (Spergularia purpurea)

Not all the potential supplements and herbal substances can interact with spironolactone. Consult your healthcare provider if you take herbal supplements before taking spironolactone. 

Other considerations

While spironolactone carries a risk of serious interactions with other medications, there are other potential warnings and precautions to consider, especially in people with certain health conditions. Here are some key points to consider before taking spironolactone:

• Kidney problems: Although hyperkalemia is a potential risk from spironolactone interactions, the risk of hyperkalemia may be increased in people with kidney problems. In addition, the use of spironolactone may worsen kidney problems, potentially even causing kidney disease or kidney failure. 
• Liver disease: Those with liver conditions, such as cirrhosis, need to use caution while taking spironolactone. The medicine could cause sudden changes in the body’s fluid and electrolyte balance, and, for someone with liver disease, this can lead to serious issues such as worsened brain function or even coma. Therefore, spironolactone should be started under close medical supervision in a hospital setting if you have severe liver disease.

• Gynecomastia: Males may experience breast enlargement and should discuss any concerns with their healthcare provider.
• Addison’s disease: Because it lowers aldosterone levels, spironolactone is not recommended for use in patients with Addison’s disease as it can worsen the condition.
  Pregnancy: Those who are pregnant, may become pregnant, or are breastfeeding should consider the potential risks and discuss them with their healthcare provider.

Spironolactone may not be suitable for everyone. People with any medical condition should consult their healthcare provider to determine whether spironolactone is appropriate for their health needs. 

How to minimize spironolactone interactions

Spironolactone interactions are often manageable and preventable with the right support and knowledge. You can use some of the following tips to reduce the risk of a serious or life-threatening drug interaction while taking spironolactone.

Consult a healthcare professional: Before starting treatment, discuss your medical history and current medication list with a healthcare provider. This list should include:

• Prescription drugs
• OTC medications
• Herbal supplements
• Vitamins and minerals

Review drug information: Healthcare providers and pharmacists can provide drug information regarding specific dosage limits to prevent serious side effects. For example, potassium supplements generally recommend not exceeding 25 mg daily of spironolactone to reduce the risk of hyperkalemia.

Keep follow-up visits: Follow up regularly with healthcare professionals to monitor your condition and adjust medications if necessary. They can also provide medical advice to help you recognize potential interaction signs, which may include:

• Unexpected side effects, such as dizziness or fatigue.
• Changes in effectiveness, noting if symptoms worsen or improve unexpectedly.
• Emerging new symptoms or unexplained changes in health status.

Stay up-to-date: Educate yourself on your condition and medications, and ask your healthcare provider about spironolactone’s interactions with other drugs, diseases, and foods. Knowing the potential interactions could help you minimize serious complications. 

When to talk to a healthcare provider about spironolactone interactions

If you’ve been prescribed spironolactone, you may want to consult your healthcare provider in the following situations when it comes to possible interactions:

• Starting a new medication: Discuss the potential risk for adverse interactions between spironolactone and new prescriptions, over-the-counter drugs, or supplements.
• Experiencing side effects: If symptoms such as fatigue, muscle weakness, or irregular heartbeat occur, you may have increased potassium levels, which require immediate medical attention.
• Having certain medical conditions: Those with kidney problems, liver disease, or heart conditions should regularly review their medications with their healthcare provider.
• Taking potassium supplements or substitutes: Spironolactone can increase potassium in the blood, so combining it with additional potassium sources might be risky.
• Noticing health changes: Any serious health changes, including unexpected weight gain or swelling, may require a visit to a healthcare provider.

This article does not list all possible spironolactone interactions. Before taking spironolactone, consult a healthcare provider about other medications, supplements, and underlying health conditions.