What are the contraindications of taking Yaz (drospirenone) with 50 mg of spironolactone?

Contraindications of Taking Yaz with 50 mg Spironolactone

The combination of Yaz (drospirenone/ethinyl estradiol) with 50 mg spironolactone is contraindicated in patients with renal insufficiency, adrenal insufficiency, hepatic dysfunction, or those taking other medications that can increase potassium levels, due to the increased risk of potentially life-threatening hyperkalemia. 1, 2

Mechanism of Concern

• Both drospirenone (in Yaz) and spironolactone are potassium-sparing diuretics with antimineralocorticoid properties that can elevate serum potassium levels 3
• Drospirenone is structurally related to spironolactone (a 17α-spirolactone derivative) and shares similar pharmacological properties 3
• The combined effect of both medications can potentially lead to additive potassium retention 1

Specific Contraindications

Absolute Contraindications:

• Renal dysfunction (creatinine >2.5 mg/dL or GFR <30 mL/min) 1, 2
• Hepatic dysfunction 1
• History of hyperkalemia 1
• Adrenal insufficiency 1
• Concomitant use of:
  • ACE inhibitors 2, 4
  • Angiotensin receptor blockers (ARBs) 1, 4
  • Potassium supplements 1
  • Other potassium-sparing diuretics 1
  • NSAIDs (long-term use) 1
  • Digoxin 1

Relative Contraindications (Requiring Careful Monitoring):

• Age >65 years 1
• Diabetes mellitus 2
• Mild to moderate renal impairment 1
• Risk for dehydration 2
• Heart failure 2
• High potassium diet 1

Safety Considerations

Despite theoretical concerns, some evidence suggests this combination may be safer than initially thought in young, healthy women:

• A study of 27 women with acne treated with drospirenone 3 mg/ethinyl estradiol 30 μg plus spironolactone 100 mg daily showed no significant elevations in serum potassium 1
• A retrospective database review found that only 0.75% of potassium measurements exceeded 5.0 mmol/L in women aged 18-45 years taking spironolactone 50-200 mg daily for acne 1
• The risk of clinically significant hyperkalemia appears low in young, healthy women without other risk factors 1, 5

Monitoring Recommendations

If the combination must be used in patients without absolute contraindications:

• Check baseline renal function and serum electrolytes before initiating therapy 1
• Monitor serum potassium at 1 week and 4 weeks after starting treatment 1
• Continue monitoring at 1,2,3, and 6 months after achieving maintenance dose 1
• More frequent monitoring is required in patients with any risk factors 1
• Educate patients about avoiding high-potassium foods 1

Management of Hyperkalemia

• If potassium rises to >5.5 mmol/L, reduce spironolactone dose (e.g., to 25 mg on alternate days) 1
• If potassium rises to ≥6.0 mmol/L, immediately discontinue both medications 1, 2
• Specific treatment for hyperkalemia may be needed in severe cases 1

Clinical Implications

• Despite package warnings, physicians often prescribe these medications together without adequate monitoring 5
• Only 6.5% of patients taking drospirenone and spironolactone had serum potassium measured within 180 days of starting concomitant therapy 5
• The risk of serious complications increases with age, renal dysfunction, and concomitant medications 2

The combination of Yaz and spironolactone requires careful patient selection and monitoring to prevent potentially serious adverse effects, particularly in patients with risk factors for hyperkalemia 1, 2.