5 Spironolactone Interactions You Should Know About

Spironolactone (Aldactone) is a medication used to treat high blood pressure, heart failure, and swelling in the legs. But you may be familiar with it for other off-label uses, like acne and hair problems.

Spironolactone works by affecting certain hormones in your body. This includes a hormone that helps control electrolyte and water levels in the body. These actions are helpful for some heart-related conditions. Spironolactone can also impact the effects of sex hormones, such as progesterone and testosterone. For some people, this can help with issues like acne.

Because of how it works, spironolactone can interact with certain medications. Depending on the interaction, you may be more likely to experience side effects. In some cases, your medication may not work as well. 

Let’s review a few spironolactone interactions and how to manage them.

1. Medications that can increase potassium levels

On its own, spironolactone can increase potassium levels in your blood. This is because it causes your kidneys to hold onto potassium while removing sodium and water. 

There are many other medications that can also increase potassium levels. Examples include angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Both classes also cause your kidneys to hold onto potassium. 

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Combining an ACE inhibitor or ARB with spironolactone isn’t uncommon. These medications are often prescribed together for heart failure. But this combination can increase the risk of high potassium levels (hyperkalemia). Symptoms of hyperkalemia include muscle weakness, fatigue, and numbness or tingling.

Your healthcare provider will monitor your potassium levels during treatment. But it’s still important to let them know if you develop hyperkalemia symptoms. If needed, they can check your blood and make adjustments to your medications.

Severe cases of hyperkalemia can be life-threatening. Get emergency help right away if you develop symptoms like heart palpitations, chest pain, or shortness of breath.

2. Potassium supplements

Potassium supplements are used to treat or prevent certain medical conditions. One example is potassium chloride (Klor-Con) used for hypokalemia (low potassium levels). Another example is potassium citrate (Urocit-K) used for kidney stones.

Potassium chloride is also available as a salt alternative used to season food. This is sometimes called “potassium salt.” Some people with high blood pressure use it in place of regular salt to lower their sodium intake. 

As their names suggest, these products all contain potassium. And taking them can increase potassium levels in your body. For the same reasons above, the risk of hyperkalemia goes up if they’re taken with spironolactone.

Make sure your healthcare provider knows if you’re using one of these products. They can advise if it’s safe with spironolactone.

3. NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are pain relievers that are available over the counter (OTC) and with a prescription. Examples include naproxen (Aleve, Naprosyn) and ibuprofen (Advil, Motrin). Some NSAIDs, like celecoxib (Celebrex), are only available with a prescription.

When taken with NSAIDs, spironolactone might not work as well. That’s because NSAIDs like ibuprofen can increase your blood pressure, especially if you’re taking it regularly. What’s more, this combination can also increase the risk of kidney damage and stomach bleeds. 

It’s typically recommended to avoid NSAIDs if you have heart failure or high blood pressure. In this case, your healthcare provider may recommend safer alternatives. However, low-dose aspirin may be an exception.

There may be situations where your healthcare provider says it’s OK to take an NSAID. If you’re monitoring your blood pressure at home, let them know if your readings are higher than usual. The same goes for swelling that gets worse. If needed, they can adjust your medications. 

4. Digoxin

Digoxin (Lanoxin) is used to treat heart failure and heart rhythm problems. It can interact with many medications, including spironolactone. In fact, digoxin can interact with spironolactone in a few ways.

First, spironolactone may affect how well your kidneys remove digoxin from your body. This can potentially increase digoxin levels in your blood. And you may be more likely to experience side effects and toxicity. Most commonly, symptoms of high digoxin levels include nausea, vomiting, and diarrhea.

Your digoxin levels are measured regularly during treatment. This is to ensure your dose is safe and effective for you. Spironolactone can potentially interfere with a specific type of blood test for digoxin levels. So, your healthcare provider may need to use a different test if you’re taking this combination.

The significance of these interactions isn’t fully known. Even so, contact your healthcare provider if you notice any new or worsening digoxin side effects. This could be a sign your dose is too high.

5. Lithium

Lithium (Lithobid) is used to treat mental health conditions like bipolar disorder. Like digoxin, your blood levels are regularly monitored while you’re taking it. High lithium levels can increase the risk of side effects and toxicity. If your lithium levels are too low, the medication may not work as well for you.

Diuretics, like spironolactone, can potentially increase lithium levels in your blood. This is because sodium and water — which are removed by diuretics — can affect how your kidneys remove lithium from your body. 

Higher lithium levels can potentially lead to toxic effects. Symptoms of lithium toxicity can include blurry vision, muscle weakness, and lightheadedness. In serious cases, lithium toxicity can be life-threatening.

Your healthcare provider will monitor your lithium levels during treatment. If they’re too high, they’ll adjust your dosage as needed. But it’s still important to contact them right away if symptoms of lithium toxicity develop. If they seem severe or life-threatening, get immediate medical attention.

When should I contact my healthcare provider about side effects from spironolactone?

Chances are your healthcare provider is already aware of interactions with spironolactone. That’s because it’s often prescribed with interacting medications for conditions like heart failure. 

But if you’re ever concerned about an interaction, contact your healthcare provider or pharmacist. This is especially important if you’re starting a new medication or OTC product. Share your current medication list so they can review it for interactions.

As discussed above, there are certain situations that warrant medical attention. Let your healthcare provider know if you develop new or worsening side effects. This may be a sign that your medications need to be adjusted. If any side effects feel severe or life-threatening, get immediate medical attention.

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Written by:

Cydnee Ng, PharmD

Cydnee Ng, PharmD, is a licensed pharmacist in California. After getting licensed in 2019, she began her pharmacy career as a community pharmacist at Walgreens.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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