Linda asked
Can you take Aldactone (spironolactone) 50 mg with 25 mg of Losartan?
Answer
Taking spironolactone (Aldactone) and losartan (Cozaar) can cause an increased risk for high potassium levels. This is especially true in elderly patients or patients with decreased renal function. Despite this risk, taking these two medications together is common for heart failure patients. It is important to have electrolyte levels and renal function labs monitored routinely in order to avoid adverse reactions related to this combination therapy. Below we will discuss more information regarding these two medications.
Information About Spironolactone
Spironolactone is a type of medication known as a potassium-sparing diuretic. Spironolactone works in the kidney to help increase the amount of fluid excreted, but maintains potassium levels better than loop diuretics such as furosemide (Lasix). Spironolactone does have modest effects on blood pressure, as well as its improvement of heart failure symptoms.
Spironolactone has a half life of about 1-2 hours, but also has an active metabolite known as canrenone that has a half-life up to 35 hours. The peak concentration of spironolactone occurs in about 2-5 hours.
Information About Losartan
Losartan is a type of medication known as an angiotensin receptor blocker (ARB). ARBs have benefit over a similar medication known as ACE inhibitors because of the reduced likelihood of developing dry cough. ARBs do not inhibit kinase II which is thought to be responsible for the cough caused by ACE inhibitors.
Losartan has a half-life around 2-6 hours including its active metabolite. Losartan should be cleared completely in about 12-36 hours. The maximal effect of losartan takes place in about one week, but may take up to 6 weeks.
Losartan has cardiac
protective effects outside of the impact on blood pressure. Although ACE
inhibitors can cause a slight worsening in your serum creatinine in the near
term, they are thought to be renal
protective over the long term.
Summary
Both potassium-sparing diuretics and ARBs are known to
increase the risk of having hyperkalemia, or high potassium. The normal range
for potassium is 3.5 to 5.0 mEq/L, but your physician may allow for variances
to this range depending on your situation. Sometimes, potassium levels will be
increased when beginning therapy, but may improve over time.
While both of these medications have the potential to cause
an increase in potassium, appropriate monitoring of potassium and kidney
function can ensure the safe use of these medications together. Utilizing both
of these together can improve blood pressure and reduce the risk of heart
failure complications.
