MAJOR — Use With Caution
FDA-documented interaction. Hyperkalemia risk is significant, especially in patients with renal impairment, diabetes, or older age. Potassium monitoring essential.
Evidence level: STRONG
Both spironolactone and lisinopril independently raise potassium levels. Together, they can cause dangerously high potassium (hyperkalemia), which can cause fatal heart rhythm disturbances.
Spironolactone is a potassium-sparing diuretic (aldosterone antagonist). ACE inhibitors also increase potassium by reducing aldosterone. Combined use significantly increases hyperkalemia risk. FDA labels for both drug classes warn.
If prescribed both (which is sometimes appropriate for heart failure), regular potassium blood tests are essential. Avoid potassium-rich salt substitutes. Report any muscle weakness, numbness, or irregular heartbeat.
Take Lisinopril at the same time daily. Spironolactone follows its prescribed schedule. ACE inhibitors can be taken with or without food. If you develop a persistent dry cough, report it to your prescriber.
Higher risk with: kidney impairment, diabetes, older age, dehydration, concurrent ACE inhibitor or ARB use.
Muscle weakness, numbness or tingling, irregular or slow heartbeat, nausea, fatigue, chest pain, difficulty breathing
Request baseline and regular potassium monitoring. Avoid potassium supplements and potassium-containing salt substitutes. Monitor renal function. Know that this combination is used intentionally in heart failure but requires careful monitoring.
ACE inhibitor interactions often involve potassium levels or blood pressure effects. Ask your doctor about ARBs as alternatives, or adjust the timing of the interacting substance. Monitor potassium levels and blood pressure regularly.
Both spironolactone and lisinopril independently raise potassium levels. Together, they can cause dangerously high potassium (hyperkalemia), which can cause fatal heart rhythm disturbances.
Take Lisinopril at the same time daily. Spironolactone follows its prescribed schedule. ACE inhibitors can be taken with or without food. If you develop a persistent dry cough, report it to your prescriber.
Muscle weakness, numbness or tingling, irregular or slow heartbeat, nausea, fatigue, chest pain, difficulty breathing
ACE inhibitor interactions often involve potassium levels or blood pressure effects. Ask your doctor about ARBs as alternatives, or adjust the timing of the interacting substance. Monitor potassium levels and blood pressure regularly.
Request baseline and regular potassium monitoring. Avoid potassium supplements and potassium-containing salt substitutes. Monitor renal function. Know that this combination is used intentionally in heart failure but requires careful monitoring.
Or browse the full interaction database (121,000+ pairs).