Major
Spironolactone × telmisartan
Potassium-sparing diuretics (mineralocorticoid receptor antagonists)×Angiotensin II receptor blocker (ARB)
Mechanism
Additive hyperkalaemia. Both drugs retain potassium: spironolactone directly blocks aldosterone receptors; telmisartan (ARB) reduces aldosterone synthesis.
Symptoms
Muscle weakness, paraesthesia, slowed pulse, arrhythmias. ECG: peaked T waves, widened QRS. Severe cases progress to cardiac arrest.
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 dose of one agent.
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.
Sources
- ESC: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– Eur Heart J 2021;42(36):3599–3726