Can I take Ramipril and Spironolactone together?

Why this happens

Both ramipril (an ACE inhibitor) and spironolactone (a potassium-sparing diuretic) work in ways that reduce the amount of potassium your body gets rid of through your urine. When used together, their effects add up, making it much easier for potassium to build up to unsafe levels.

What you should do

You must have regular blood tests to monitor your potassium levels and kidney function, especially when starting these medicines or changing the dose. Avoid using salt substitutes (like Lo-Salt) or potassium supplements unless your doctor specifically tells you to, as these contain high amounts of potassium. Contact your doctor immediately if you feel unusually tired, have muscle weakness, or feel a fluttering in your chest.

Important precautions

High potassium levels (Hyperkalaemia)

Both medicines increase potassium levels in your blood. Taking them together significantly raises the risk of dangerously high potassium, which can affect your heart rhythm. You will need regular blood tests to monitor this.

Pregnancy

Do not take ramipril if you are pregnant or planning to become pregnant, as it can cause serious harm or death to an unborn baby.

Spironolactone should not be taken during pregnancy as it can interfere with the normal development of a male fetus.

Angioedema (Severe swelling)

If you experience sudden swelling of the face, lips, tongue, or throat (angioedema), stop taking ramipril and seek emergency medical help immediately. This risk is higher in people of African or Caribbean descent.

Food and drink warnings

Alcohol

It is best to avoid or strictly limit alcohol while taking these medicines. Both ramipril and spironolactone lower your blood pressure; combining them with alcohol can cause your blood pressure to drop too low. This may make you feel dizzy, lightheaded, or faint, especially when standing up.

Salt substitutes and high-potassium foods

Avoid using salt substitutes that contain potassium. Both ramipril and spironolactone can increase the levels of potassium in your blood. Using potassium-based salt substitutes alongside these medicines can lead to dangerously high potassium levels (hyperkalaemia), which can affect your heart rhythm.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.