Abiraterone and Spironolactone: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Spironolactone
Abiraterone
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased PSA levels
Interaction Deep Dive
Concomitant use of spironolactone and abiraterone acetate is not recommended as it may result in increased PSA levels and prostate cancer progression12. Choosing an alternative to abiraterone acetate, such as enzalutamide, may also be considered 3.
Why it happens (mechanism)
Possible androgen receptor modulation by spironolactone
Literature reports
2 reports — tap to read
a) An 67 year-old man receiving abiraterone acetate experienced increased PSA levels and prostate cancer progression shortly after starting spironolactone therapy for heart failure. The patient received abiraterone acetate 1000 mg daily after appearance of new bone lesions at the cervical level and a PSA of 10 nanograms (ng)/mL. His PSA was 0.004 ng/mL 4 months later. Six months after starting abiraterone acetate, the patient was started on spironolactone 25 mg daily after experiencing dyspnea and bibasilar crackles and being diagnosed with incipient heart failure. One month later, his PSA level was 0.93 ng/mL and spironolactone therapy was stopped. His PSA decreased to 0.38 ng/mL initially, however, his PSA then rose again and he started chemotherapy. The Drug Probability Interaction Probability Scale (DIPS) for this interaction was 6 (probable). The second case was a 67 year-old man who was undergoing prostate cancer therapy and received spironolactone 25 mg daily for decreased ventricular function following myocardial infarction. His PSA rose continuously. He started abiraterone acetate 1000 mg daily, but his PSA levels continued to rise to 330 ng/mL 5 months later. He was started on chemotherapy and his PSA levels continued to rise. Spironolactone was never discontinued and he died 5 months later. The DIPS for this interaction was 5 (probable) 3.
b) An 86 year-old man receiving abiraterone acetate therapy for prostate cancer experienced increased PSA levels after starting spironolactone therapy for elevated blood pressure and mild edema. He was receiving androgen deprivation therapy for prostate cancer and responded; his PSA was 2.1 mcg/L. He experienced progression 25 months later (PSA, 278.7 mcg/L) and was started on abiraterone acetate 1000 mg daily; three months later, his PSA significantly increased to 792.7 mcg/L. Upon questioning, it was discovered that he had been taking spironolactone prescribed by his physician. Spironolactone was discontinued and his PSA decreased to 334.2 mcg/L within 1 month. The patient continued to respond to abiraterone acetate therapy thereafter 4.
Common questions
Can I take Abiraterone and Spironolactone together?
Increased PSA levels Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abiraterone and Spironolactone interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Abiraterone or Spironolactone need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Product Information: Aldactazide® oral tablets, spironolactone hydrochlorothiazide oral tablets. Pfizer Labs (per FDA), New York, NY, 2025.
- Product Information: ALDACTONE® oral tablets, spironolactone oral tablets. Pfizer Labs (per FDA), New York, New York, 2025. DailyMed
- Vicente-Valor J, Escudero-Vilaplana V, Collado-Borrell R, et al: Potential negative pharmacodynamic interaction of spironolactone and abiraterone in two prostate cancer patients. J Oncol Pharm Pract 2022; 28(5):1259-1263. PubMed
- Dhondt B, Buelens S, Van Besien J, et al: Abiraterone and spironolactone in prostate cancer: a combination to avoid. Acta Clin Belg 2019; 74(6):439-444. DOI
Keep reading about Spironolactone
Keep reading about Abiraterone
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