NutriStack
Lisinopril and Spironolactone, a caution.
Both ACE inhibitors and spironolactone increase serum potassium through different mechanisms. Combined use significantly increases the risk of life-threatening hyperkalemia, especially in patients with renal impairment.
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
- Lisinopril and Spironolactone
- Pair type
- Caution
- Evidence (highest tier)
- Strong
- Source citations
- 1 source
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Strong evidence
Caution
What is happening. Both ACE inhibitors and spironolactone increase serum potassium through different mechanisms. Combined use significantly increases the risk of life-threatening hyperkalemia, especially in patients with renal impairment.
Mechanism. ACE inhibitors reduce aldosterone secretion, decreasing potassium excretion. Spironolactone blocks the mineralocorticoid receptor, further reducing potassium excretion. Combined effect can cause dangerous hyperkalemia.
Recommendation. While used intentionally in heart failure (RALES trial protocol), requires close potassium and renal function monitoring. Check potassium within 3-7 days of initiation. Avoid in patients with eGFR <30.
Sources (1)
Stack Score
How this pair moves the number.
Effect on the composite score
If both Lisinopril and Spironolactone are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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