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ACE inhibitor, spironolactone and potassium — GPhC CRA MCQ

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HardDrug InteractionsACE inhibitor, spironolactone and potassiumGPhC CRA

A 66-year-old woman takes ramipril 10 mg daily and spironolactone 25 mg daily for heart failure. A discharge prescription adds Sando-K for potassium 3.7 mmol/L after brief diarrhoea; eGFR is 46 mL/min/1.73 m2. What is the most important interaction to flag?

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Correct answer: E — Potassium supplementation with ACE inhibitor and spironolactone may cause hyperkalaemia

ACE inhibitors and mineralocorticoid receptor antagonists both increase potassium. Adding potassium supplementation in a patient with CKD and heart failure can precipitate hyperkalaemia, even if a transient low-normal value occurred during diarrhoea. The prescriber should confirm indication and monitoring before supply.

Reference: BNF; NICE CKS