Quick answer

Ask your pharmacist or doctor before combining. The spironolactone label says potassium supplements taken with it may lead to severe hyperkalemia, meaning blood potassium that is too high, and that people should be advised to avoid potassium supplements and high-potassium foods, including salt substitutes. Any exception is for your prescriber to decide.¹

Key facts

The label says potassium supplementation or drugs that raise potassium taken with spironolactone may lead to severe hyperkalemia.¹
The label's counseling section says patients should be advised to avoid potassium supplements and foods high in potassium, including salt substitutes.¹
MedlinePlus lists potassium supplements among products that may interact with spironolactone and says to avoid potassium-containing salt substitutes.²
NIH says potassium-sparing diuretics such as spironolactone reduce the potassium lost in urine and can cause hyperkalemia.³
NIH says that with ACE inhibitors or potassium-sparing diuretics, even dietary potassium below the adequate intake can cause hyperkalemia.³
The prescription potassium chloride label lists spironolactone among the medicines that cause potassium retention and says to monitor potassium closely.⁴

Avoid the combination unless your doctor advises it

The spironolactone label says potassium supplements taken with it may lead to severe hyperkalemia, and that patients should be advised to avoid potassium supplements and foods high in potassium, including salt substitutes.^1,2

On the medicine's label

Why does the label say to avoid potassium with spironolactone?

MedlinePlus describes spironolactone as a medicine used for high blood pressure, heart failure, fluid retention and too much of the hormone aldosterone. It says the medicine makes the kidneys remove extra water and sodium but reduces the loss of potassium from the body.²

The label's warning on hyperkalemia says the risk rises with impaired kidney function and with potassium supplementation, potassium-containing salt substitutes or drugs that increase potassium, such as ACE inhibitors and angiotensin receptor blockers. For people with heart failure, it says that in general potassium supplementation should be discontinued when spironolactone is started.¹

What does high potassium do, and who is most at risk?

Too much potassium in the blood (hyperkalemia) can cause muscle weakness, paralysis, heart palpitations, a burning or prickling feeling in the hands and feet, and irregular heart rhythms that can be life threatening. It can also cause no symptoms until it is severe.³

NIH says that in people whose kidneys pass less potassium, because of kidney disease or medicines such as ACE inhibitors or potassium-sparing diuretics, even dietary intakes below the adequate intake can cause hyperkalemia. It says people at risk should consult a physician or dietitian about potassium from all sources. Spironolactone is one of the potassium-sparing diuretics NIH names.³

Do potassium chloride, potassium citrate and salt substitutes count?

The label's advice names potassium supplements, potassium-containing salt substitutes and a potassium-rich diet, and it does not limit the advice to one form. NIH says many salt substitutes use potassium chloride, with about 440 to 2,800 mg of potassium per teaspoon, and that supplements also come as citrate, phosphate, aspartate, bicarbonate and gluconate. Most potassium-only supplements sold in the US contain up to 99 mg per serving, but the label sets no amount below which the advice stops applying.^1,3

Prescription potassium chloride is a medicine with its own label. That label lists spironolactone among the drugs that cause potassium retention and says to monitor potassium closely when they are used together. Whether the two are ever combined is a decision for the prescriber.⁴

Is losartan potassium a potassium supplement?

No. Losartan is a blood pressure medicine of the angiotensin receptor blocker kind, and 'potassium' in its name is the salt form of the medicine, as its label describes. It is a separate pairing: the spironolactone label lists angiotensin II antagonists among the drugs that can lead to severe hyperkalemia with spironolactone, and the losartan label says that taking it with other drugs that raise potassium may result in hyperkalemia. Ask your prescriber about two medicines taken together.^1,5

What about high-potassium foods on spironolactone?

The label says people taking spironolactone should be advised to avoid foods containing high levels of potassium. MedlinePlus is less absolute: it says to avoid potassium-containing salt substitutes and to talk with your doctor about how much potassium-rich food, such as bananas, prunes, raisins and orange juice, you may have. Ask your doctor or a dietitian rather than guessing.^1,2

What to ask your pharmacist about potassium and spironolactone

Which of my products contain potassium: supplements, electrolyte drinks or powders, salt substitutes?
When are my next potassium and kidney blood tests?
Has anyone told me to take potassium with this medicine, and does that person know everything I take?
Do I also take an ACE inhibitor, an angiotensin receptor blocker or an anti-inflammatory pain reliever, which the label also lists?¹

Questions people ask

Can you take potassium with spironolactone?

The label says people taking spironolactone should be advised to avoid potassium supplements and foods high in potassium, including salt substitutes, because the combination may lead to severe hyperkalemia. If a doctor has told you to take potassium, that is their decision, so ask before changing anything.¹

Is potassium and spironolactone an interaction?

Yes. The label says the combination may lead to severe hyperkalemia and calls for avoiding potassium supplements, and MedlinePlus lists potassium supplements among products that may interact.^1,2

What happens with high potassium and spironolactone?

NIH says severe hyperkalemia can cause muscle weakness, paralysis, heart palpitations and heart rhythm problems that can be life threatening, and that it may cause no symptoms until it is severe.³

Can you take potassium chloride with spironolactone?

Prescription potassium chloride is a medicine with its own label, which lists spironolactone among the drugs that cause potassium retention and says to monitor potassium closely. Whether the two are used together is for the prescriber to decide.⁴

Can you take losartan potassium with spironolactone?

That is two medicines, not a supplement. The spironolactone label lists angiotensin II antagonists among drugs that can raise potassium, and the losartan label warns about other drugs that raise potassium. Your prescriber manages that pairing.^1,5

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This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.