Moderate
Probable
Description
NSAIDs reduce the natriuretic and diuretic efficacy of spironolactone, potentially leading to sodium retention and worsening edema or hypertension.
Mechanism
Spironolactone's diuretic effect is partially prostaglandin-dependent; naproxen-mediated prostaglandin inhibition attenuates this mechanism and promotes sodium reabsorption.
Clinical Significance
The interaction may be particularly significant in patients with heart failure or hepatic cirrhosis where diuretic response is already reduced.
Management
Avoid NSAIDs in patients taking spironolactone for heart failure or liver disease; monitor weight, edema, and renal function.