Spironolactone and Aliskiren: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Spironolactone
Aliskiren
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
Hyperkalemia
Interaction Deep Dive
Serum potassium increases of greater than 5.5 mEq/L were reported in 0.9% of patients receiving aliskiren alone compared with 0.6% of patients receiving placebo. However, the incidence of hyperkalemia was higher (5.5%) when aliskiren was administered to patients with diabetes on concomitant ACE inhibitor therapy. Use caution when aliskiren is given concomitantly with potassium-sparing diuretics. Monitoring of electrolytes and renal function is recommended, especially in patients with diabetes1.
Why it happens (mechanism)
Additive effects
Common questions
Can I take Spironolactone and Aliskiren together?
Hyperkalemia Always confirm with your pharmacist or prescriber before making any change.
How serious is the Spironolactone and Aliskiren interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Spironolactone or Aliskiren 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 anything you'd monitor while I'm on both?
References (1)
- Product Information: TEKTURNA(R) oral tablets, aliskiren oral tablets. Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2007. DailyMed
Keep reading about Spironolactone
Keep reading about Aliskiren
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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