Trilostane reduces cortisol; spironolactone is an aldosterone antagonist. Combined adrenal suppression risks Addisonian crisis.
Management: Avoid concurrent use unless under specialist supervision with frequent ACTH stimulation testing.
Both cause potassium retention; combined use significantly increases hyperkalemia risk
Management: Monitor serum potassium frequently. Consider alternative diuretic if ARB is required.
Mitotane destroys adrenal cortex. Spironolactone blocks remaining aldosterone activity. Combined: severe mineralocorticoid deficiency (hyperkalemia, hyponatremia, hypotension).
Management: Avoid. If diuretic needed during mitotane therapy, use furosemide (not potassium-sparing diuretic).
Spironolactone (potassium-sparing diuretic) + potassium supplementation: high risk of dangerous hyperkalemia.
Management: Avoid concurrent potassium supplementation. If potassium needed, monitor levels every 3-5 days. Discontinue supplement if K+ >5.5 mEq/L.
ARB (reduces aldosterone) + aldosterone antagonist (spironolactone): additive potassium retention. High hyperkalemia risk.
Management: Monitor potassium closely if combining. Avoid concurrent potassium supplements.
ARB + potassium-sparing diuretic: additive potassium retention causing hyperkalemia.
Management: Monitor potassium closely. Avoid concurrent potassium supplements.
Desoxycorticosterone Pivalate (DOCP)
majorDOCP replaces aldosterone in Addison's disease. Spironolactone blocks aldosterone receptors, directly antagonizing DOCP's mineralocorticoid effect — causes hyperkalemia and sodium loss.
Management: NEVER combine. Spironolactone would negate DOCP treatment for Addison's disease.