4 known interactions • 1 major • 3 moderate • 0 minor
Always disclose all medications to your healthcare providers — prescription medicines, OTC medications, vitamins, and herbal supplements. This list may not include every possible interaction. Use our Medicine Interaction Checker to screen your complete medication list.
Potentially life-threatening or causing permanent damage. Avoid combination.
May worsen condition or require dose adjustment. Monitor closely.
Usually limited clinical effect. Manage with routine monitoring.
ACE inhibitors / ARBs / potassium supplements
Additive hyperkalemia risk — potentially life-threatening combination, especially in renal impairment. However, ACE inhibitor + spironolactone in heart failure (under careful monitoring) is proven to reduce mortality.
Management: Monitor potassium closely when combining. Avoid potassium supplements. Check baseline K+ and renal function before starting. Monitor K+ at 1 week, 1 month, then regularly.
NSAIDs
NSAIDs reduce diuretic efficacy and increase risk of hyperkalemia and acute kidney injury.
Management: Avoid NSAIDs in patients on spironolactone.
Digoxin
Spironolactone interferes with digoxin radioimmunoassay, causing falsely elevated digoxin levels. Some formulations also reduce renal digoxin clearance.
Management: Monitor for digoxin toxicity symptoms. Note that digoxin levels may be falsely reported high.
Lithium
Spironolactone may reduce lithium renal clearance, increasing lithium toxicity risk.
Management: Monitor lithium levels.
Always ask your pharmacist about potential interactions with food, alcohol, and supplements specific to Spironolactone. Some medicines have significant interactions with grapefruit juice, high-fat meals, dairy products, or vitamin K-rich foods.