Compatibility «Perindopril» and «Spironolactone»

• Interactions Perindopril with Spironolactone

  • Dangerous interactions
    • ⓘ Patients taking diuretics, especially those who have recently started treatment, may sometimes experience an excessive decrease in blood pressure after starting therapy with perindopril erbumin.
    • ⓘ The use of a diuretic may further increase the risk of lithium toxicity.
    • ⓘ In the elderly, patients with insufficient BCC (in pm receiving diuretic therapy) or with impaired renal function, the combined use of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including perindopril, may lead to deterioration of renal function, including possible acute renal failure.
    • ⓘ Some drugs or drugs of other pharmacological classes may increase the risk of hyperkalemia: aliskiren and aliskiren‑containing drugs, potassium salts, potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists (ARA II), heparin, immunosuppressants such as cyclosporine or tacrolimus, trimethoprim, drugs containing co-trimoxazole (trimethoprim + sulfamethoxazole).
    • ⓘ In patients receiving diuretics, especially with excessive excretion of fluid and / or electrolytes, at the beginning of perindopril therapy, an excessive decrease in blood pressure may be observed, the risk of which can be reduced by discontinuing the diuretic, replenishing fluid loss (intravenous infusion of 0.9% sodium chloride solution), as well as using perindopril in lower doses.
    • ⓘ Spironolactone and eplerenone in doses of 12.5 mg to 50 mg per day for CHF and low doses of ACE inhibitors: when treating CHF of functional class II-IV according to the NYHA classification with a left ventricular ejection fraction less than 40; and previously used ACE inhibitors and 'loop' diuretics, there is a risk of hyperkalemia (possibly fatal), especially in case of non-compliance with the recommendations regarding this combination of drugs.
    • ⓘ When using diuretics in the case of CHF, an ACE inhibitor should be prescribed at a low dose, possibly after reducing the dose of a potassium-sparing diuretic used simultaneously.
    • ⓘ Simultaneous administration of Spironolactone Medisorb with other potassium-sparing diuretics, ACE inhibitors, ARA II, aldosterone blockers, potassium preparations, as well as adherence to a potassium-rich diet, or the use of potassium-containing salt substitutes, can lead to the development of severe hyperkalemia.
    • ⓘ Since ACE inhibitors reduce the production of aldosterone, drugs of this group should not be used in conjunction with spironolactone on a regular basis, especially in patients with established renal dysfunction.
  • Negative interactions
    • ⓘ However, the bioavailability of perindoprilate was reduced by diuretics, which was associated with a decrease in ACE inhibition in plasma.
    • ⓘ The use of potassium-sparing diuretics (in pm spironolactone, amiloride, triamterene), potassium supplements or other drugs capable of increasing serum potassium levels (in pm indomethacin, heparin, cyclosporine) may increase the risk of hyperkalemia.
    • ⓘ The combined use of ACE inhibitors and potassium-sparing diuretics (for example, spironolactone, triamterene, amiloride, eplerenone (a derivative of spironolactone)), potassium preparations and potassium-sparing products and dietary supplements can lead to a significant increase in serum potassium.
    • ⓘ In patients receiving diuretics that remove fluid and / or salts, at the beginning of Perindopril therapy, there may be a marked decrease in blood pressure, the risk of which can be reduced by discontinuing diuretics, replenishing the loss of fluid or salts before starting Perindopril therapy, as well as using Perindopril at a low dose with a further gradual increase.
    • ⓘ In hypertension in patients receiving diuretics, especially those that remove fluid and/or salts, diuretics should either be discontinued before the use of an ACE inhibitor (while a potassium-sparing diuretic may be prescribed again later), or an ACE inhibitor should be prescribed at a low dose with a further gradual increase.
    • ⓘ ACE inhibitors (C09A) + potassium-sparing diuretics => Severe hypotension, risk of renal failure, hyperkalemia.
    • ⓘ Concomitant administration of ACE inhibitors with potassium-sparing diuretics has been associated with severe hyperkalemia.
    • ⓘ Antihypertensive drugs: spironolactone potentiates the effect of antihypertensive drugs, the dose of which, when taken simultaneously with spironolactone, may need to be reduced and adjusted further if necessary.
  • No interactions
    • ⓘ Concomitant diuretics do not affect the rate and degree of absorption and excretion of perindopril.
  • Unclear interactions
    • ⓘ Diuretics.
    • ⓘ Potassium supplements and potassium-sparing diuretics.
    • ⓘ Potassium-sparing diuretics, potassium preparations and potassium-containing products and dietary supplements.
    • ⓘ Potassium-containing diuretics (eplerenone, spironolactone).
    • ⓘ Potassium-sparing diuretics.
    • ⓘ ACE inhibitors.

Decoding the colors of interactions and contraindications

Dangerous	—	a pronounced negative interaction or contraindication.
Negative	—	negative interaction or side effect that may reduce effectiveness.
Positive	—	the interaction can SOMETIMES be used as a positive (often a dose adjustment is needed), or it is an indication of the drug.
No	—	the drugs do NOT interact, which is separately indicated in the instructions.
Unclear	—	the system failed to pre-assess the danger.

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Additional information

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• The use of information about interactions is only possible as an introduction. This information should not be used to adjust therapy without consulting a specialist.
• The article is written: artificial intelligence Kiberis
• Sources: official instructions for medicines and their active substances, as well as inter-group interactions described in medical studies and textbooks.
• Total analyzed: 169,994,378 possible combinations of drugs and their components were found 412,530 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2024-12-19

Category - medicine