Compatibility «Indapamide+Perindopril» and «Eplerenone»

• Interactions Indapamide+Perindopril with Eplerenone

  • Dangerous interactions
    • ⓘ Functional renal insufficiency, which can occur against the background of taking diuretics, especially 'loop' ones, with the combined use of metformin increases the risk of lactic acidosis.
    • ⓘ Dehydration of the body while taking diuretic drugs increases the risk of acute renal failure, especially when using high doses of iodine-containing contrast agents.
    • ⓘ In patients receiving diuretics, especially in patients with hypovolemia and/or reduced salt concentrations, at the beginning of perindopril therapy, there may be an excessive decrease in blood pressure, the risk of development, which can be reduced by discontinuing the diuretic, replenishing the loss of fluid or salts before starting perindopril therapy, as well as prescribing perindopril at a low dose with a further gradual increase.
    • ⓘ When using diuretics in the case of congestive heart failure, an ACE inhibitor should be prescribed at a very low dose, possibly after reducing the dose of a potassium-sparing diuretic used simultaneously.
    • ⓘ Given the increased risk of hyperkalemia, eplerenone should not be prescribed to patients receiving potassium-sparing diuretics and potassium preparations (see 'Contraindications'), Potassium-sparing diuretics may enhance the effects of antihypertensive drugs and other diuretics.
    • ⓘ 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.
    • ⓘ A triple combination of ACE inhibitor, ARA II and eplerenone should not be used.
  • Negative interactions
    • ⓘ If the combined use of indapamide and the above potassium-sparing diuretics is necessary, the potassium content in blood plasma and ECG parameters should be monitored.
    • ⓘ Some drugs or classes of drugs may increase the incidence of hyperkalemia: aliskiren, potassium salts, potassium‑sparing diuretics, ACE inhibitors, ARA II, NSAIDs, heparins, immunosuppressants (such as cyclosporine or tacrolimus), trimethoprim and drugs containing co-trimoxazole (sulfamethoxazole + trimethoprim).
    • ⓘ In hypertension in patients with hypovolemia or reduced salt concentrations during diuretic therapy, diuretics should either be discontinued before the use of an ACE inhibitor (while a potassium-sparing diuretic may later be re-prescribed), or an ACE inhibitor should be prescribed at a low dose with a further gradual increase.
    • ⓘ The use of eplerenone or spironolactone in doses from 12.5 mg to 50 mg per day and low doses of ACE inhibitors.
    • ⓘ If simultaneous use of indapamide with potassium-sparing diuretics is necessary, then the potassium content in blood plasma, ECG readings should be monitored and, if necessary, therapy should be adjusted.
    • ⓘ 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.
    • ⓘ ACE inhibitors and ARA II.
    • ⓘ When using eplerenone with ACE inhibitors or ARA II, the potassium content in the blood serum should be carefully monitored.
  • No interactions
    • ⓘ Concomitant diuretics do not affect the rate and degree of absorption and excretion of perindopril.
    • ⓘ However, cases of increased concentration and lithium intoxication have been described in patients receiving lithium preparations in combination with diuretics and ACE inhibitors.
  • Unclear interactions
    • ⓘ Potassium-sparing diuretics (amiloride, spironolactone, triamterene).
    • ⓘ Potassium-sparing diuretics (e.g. triamterene, amiloride) and potassium (salts).
    • ⓘ Potassium-sparing diuretics.
    • ⓘ Potassium-sparing diuretics (eplerenone, spironolactone).
    • ⓘ The simultaneous use of indapamide with potassium-sparing diuretics is advisable in some patients.
    • ⓘ Diuretics.
    • ⓘ Potassium supplements and potassium-sparing diuretics.
    • ⓘ Potassium-sparing diuretics, potassium preparations and potassium-containing products and dietary supplements.
    • ⓘ Potassium-containing diuretics (eplerenone, spironolactone).

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.
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: 170,027,037 possible combinations of drugs and their components were found 412,563 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2026-01-01

Category - medicine