concomitant use of spironolactone with ACEi or ARB is not routinely recommended because of the risks of severe hyperkalaemia, particularly in patients with marked renal impairment
use the lowest effective doses of spironolactone and ACEi or ARB if coadministration is considered essential
regularly monitor serum potassium levels and renal function
interrupt or discontinue treatment in the event of hyperkalaemia
Reference:
Medicines and Healthcare products Regulatory Agency (MHRA). Drug Safety Update February 2016.
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