MajorPotassium-sparing diuretics (mineralocorticoid receptor antagonists)×Angiotensin II receptor blockers (ARBs)
Updated · Methodology
Mechanism
Valsartan (ARB) suppresses the RAAS, while spironolactone blocks aldosterone receptors. Dual aldosterone blockade raises hyperkalaemia risk.
Symptoms
Muscle weakness, paraesthesia in the limbs, slowed pulse, arrhythmias. ECG shows peaked T waves and widened QRS. Severe cases progress to cardiac arrest. Symptoms typically appear within 1–2 weeks of starting the combination.
Management
The combination is appropriate in heart failure with reduced ejection fraction. Check potassium and creatinine 1 week after start, then monthly. If potassium exceeds 5.5 mmol/L, reduce the spironolactone dose.
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
- AEMPS: Ficha técnica: Valsartán (nº registro 70323), sección 4.5 (2025)– AEMPS, CIMA, nº registro 70323, revisión 03/2025, sección 4.5