MajorAntiplatelet agents (low dose) / NSAIDs (analgesic dose)×Potassium-sparing diuretics (mineralocorticoid receptor antagonists)
Updated · Methodology
Mechanism
Aspirin suppresses renal prostaglandin synthesis that maintains glomerular perfusion. Diuretic and natriuretic effects of spironolactone diminish and potassium accumulates.
Symptoms
Oedema, weight gain, rising blood pressure. Weakness, paraesthesia, and arrhythmias from hyperkalaemia. Reduced diuretic effect emerges within 1–2 weeks of starting aspirin.
Management
At low aspirin doses (75–100 mg for cardioprotection), the clinical effect is minimal; co-prescription is acceptable with potassium and creatinine monitoring. At full anti-inflammatory doses, the diuretic response drops markedly – titrate spironolactone clinically.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- ESC: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– McDonagh TA et al. Eur Heart J 2021;42:3599-3726
- ESC: 2023 Focused Update of the 2021 ESC Guidelines for the treatment of heart failure (2023)– Eur Heart J 2023;44(37):3627–3639
- AHA: Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association (2016)– Circulation 2016;134(6):e32–e69
- AEMPS: Ficha técnica: Espironolactona (nº registro 88191), sección 4.5 (2025)– AEMPS, CIMA, nº registro 88191, revisión 12/2025, sección 4.5