Selected ACE Inhibitors/Potassium Sparing Diuretics Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, your body may not process potassium properly.

What might happen:

Your blood levels of potassium may increase and cause toxic effects.

What you should do about this interaction:

If you experience breathing difficulties, chest pain, irregular heartbeat, confusion, or muscle weakness, contact your doctor. If your doctor prescribes these two medicines together, you may need to check your blood level of potassium. The dose of your medicines may need adjusting. This interaction may be worse if you have kidney disease or diabetes.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this drug interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

View Reference
  • 1.Cleary JD, Taylor JW. Enalapril: a new angiotensin converting enzyme inhibitor. Drug Intell Clin Pharm 1986 Mar;20(3):177-86.
  • 2.Grossman A, Eckland D, Price P, Edwards CR. Captopril: reversible renal failure with severe hyperkalaemia. Lancet 1980 Mar 29;1(8170):712.
  • 3.Warren SE, O'Connor DT. Hyperkalemia resulting from captopril administration. JAMA 1980 Dec 5;244(22):2551-2.
  • 4.Maslowski AH, Ikram H, Nicholls MG, Espiner EA. Haemodynamic, hormonal, and electrolyte responses to captopril in resistant heart failure. Lancet 1981 Jan 10;1(8211):71-4.
  • 5.Textor SC, Bravo EL, Fouad FM, Tarazi RC. Hyperkalemia in azotemic patients during angiotensin-converting enzyme inhibition and aldosterone reduction with captopril. Am J Med 1982 Nov;73(5):719-25.
  • 6.Burnakis TG, Mioduch HJ. Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med 1984 Dec; 144(12):2371-2.
  • 7.Atlas SA, Case DB, Sealey JE, Laragh JH, McKinstry DN. Interruption of the renin-angiotensin system in hypertensive patients by captopril induces sustained reduction in aldosterone secretion, potassium retention and natruiresis. Hypertension 1979 May-Jun;1(3):274-80.
  • 8.Schuna AA, Schmidt GR, Pitterle ME. Serum potassium concentrations after initiation of captopril therapy. Clin Pharm 1986 Nov;5(11):920-3.
  • 9.Radley AS, Fitzpatrick RW. An evaluation of the potential interaction between enalapril and amiloride. J Clin Pharm Ther 1987 Oct;12(5):319-23.
  • 10.Cozaar (losartan potassium) US prescribing information. Merck & Co., Inc. October, 2021.
  • 11.Diovan (valsartan) US prescribing information. Novartis Pharmaceuticals Corporation June, 2019.
  • 12.Saito M, Takada M, Hirooka K, Isobe F, Yasumura Y. Serum concentration of potassium in chronic heart failure patients administered spironolactone plus furosemide and either enalapril maleate, losartan potassium or candesartan cilexetil. J Clin Pharm Ther 2005 Dec;30(6):603-10.
  • 13.Fujii H, Nakahama H, Yoshihara F, Nakamura S, Inenaga T, Kawano Y. Life-threatening Hyperkalemia during a Combined Therapy with the Angiotensin Receptor Blocker Candesartan and Spironolactone. Kobe J Med Sci 2005;51(1):1-6.
  • 14.Phakdeekitcharoen B, Leelasa-nguan P. Effects of an ACE inhibitor or angiotensin receptor blocker on potassium in CAPD patients. Am J Kidney Dis 2004 Oct;44(4):738-46.
  • 15.Kauffmann Q R, Orozco B R, Venegas G JC. Severe hyperkalemia associated to the use of losartan and spironolactone: Case report. Rev Med Chil 2005 Aug;133(8):947-52.
  • 16.Venzin RM, Cohen CD, Maggiorini M, Wuthrich RP. Aliskiren-associated acute renal failure with hyperkalemia. Clin Nephrol 2009 Mar;71(3):326-8.
  • 17.Yamauchi J, Shibagaki Y, Uehara K, Yasuda T, Kimura K. Aliskiren-associated acute kidney injury in a patient with pre-existing chronic kidney disease and dilated cardiomyopathy. Clin Exp Nephrol 2012 Apr;16(2):333-6.
  • 18.Tekturna (aliskiren) US prescribing information. Novartis Pharmaceuticals Corporation November, 2017.
  • 19.Inspra (eplerenone) US prescribing information. Pfizer, Inc. May, 2018.
  • 20.Abbas S, Ihle P, Harder S, Schubert I. Risk of hyperkalemia and combined use of spironolactone and long-term ACE inhibitor/angiotensin receptor blocker therapy in heart failure using real-life data: a population- and insurance-based cohort. Pharmacoepidemiol and Drug Saf 12 Feb 2015;24:406-413.
  • 21.Villa-Zapata L, Carhart BS, Horn JR, Hansten PD, Subbian V, Gephart S, Tan M, Romero A, Malone DC. Serum potassium changes due to concomitant ACEI/ARB and spironolactone therapy: a systemic review and meta-analysis. Am J Health-Syst Pharm 15 December 2021;78(24):2245-2255.
  • 22.An J, Niu F, Sim JJ. Cardiovascular and kidney outcomes of spironolactone or eplerenone in combination with ACEI/ARBs in patients with diabetic kidney disease. Pharmacotherapy October 2021;41:998-1008.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.