CriticalSelective mineralocorticoid receptor antagonist×Potassium-sparing diuretics (mineralocorticoid receptor antagonists)
Updated · Methodology
Mechanism
Both drugs are mineralocorticoid receptor antagonists. Concurrent use produces dual aldosterone blockade; renal potassium excretion stops. Severe hyperkalaemia (K+ above 6.5 mmol/L) develops with risk of fatal arrhythmia.
Symptoms
Muscle weakness, paresthesia, bradycardia. ECG shows peaked T waves, QRS widening; in severe cases asystole.
Management
Combination contraindicated. For resistant heart failure choose one: spironolactone if renal function is preserved, or eplerenone if gynaecomastia developed on spironolactone. Check potassium at weeks 1, 2 and 4, then monthly.
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
- FDA: Inspra (eplerenone) prescribing information (2008)– ; DailyMed setid 1a52bedc-8e2c-4116-a296-a87770676b4a
- AEMPS: Ficha técnica: Eplerenona (nº registro 75302), sección 4.3 (2024)– AEMPS, CIMA, nº registro 75302, revisión 06/2024, sección 4.3