NutriStack
Eplerenone and Potassium, a conflict.
Eplerenone is a mineralocorticoid receptor antagonist that can raise serum potassium. Adding potassium supplements can push potassium into a dangerous range, especially in kidney disease, diabetes, heart failure, older age, or when ACE inhibitors, ARBs, NSAIDs, or trimethoprim are also used. Severe hyperkalemia can cause weakness, paralysis, dangerous arrhythmias, or cardiac arrest.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Eplerenone and Potassium
- Pair type
- Conflict
- Evidence (highest tier)
- Strong
- Source citations
- 3 sources
- Stack Score effect
- −10 to your Stack Score (per scored conflict row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Conflict · Strong evidence
Conflict
What is happening. Eplerenone is a mineralocorticoid receptor antagonist that can raise serum potassium. Adding potassium supplements can push potassium into a dangerous range, especially in kidney disease, diabetes, heart failure, older age, or when ACE inhibitors, ARBs, NSAIDs, or trimethoprim are also used. Severe hyperkalemia can cause weakness, paralysis, dangerous arrhythmias, or cardiac arrest.
Mechanism. Eplerenone blocks aldosterone signaling at mineralocorticoid receptors in the distal nephron, reducing potassium secretion. Supplemental potassium adds external potassium load on top of reduced renal excretion.
Recommendation. Do not take potassium supplements with eplerenone unless your prescriber specifically orders them and monitors potassium. Avoid potassium-based salt substitutes, and check potassium and kidney function shortly after starting or changing eplerenone.
Sources (3)
- Pitt B, Bakris G, Ruilope LM, DiCarlo L, Mukherjee R; EPHESUS Investigators. Serum potassium and clinical outcomes in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Circulation. 2008;118(16):1643-1650. PMID 18824643
- Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348(14):1309-1321. PMID 12668699
- Ponce SP, Jennings AE, Madias NE, Harrington JT. Drug-induced hyperkalemia. Medicine (Baltimore). 1985;64(6):357-370. PMID 2865667
Stack Score
How this pair moves the number.
Effect on the composite score
If both Eplerenone and Potassium are in the same stack, this pair applies −10 to your Stack Score (per scored conflict row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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