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# Spironolactone (Aldactone) ## Overview Spironolactone is a potassium-sparing diuretic and a competitive aldosterone antagonist. ## Primary Indications * Heart failure (NYHA class II-IV) with reduced ejection fraction * Edema associated with cirrhosis or nephrotic syndrome * Essential hypertension * Primary hyperaldosteronism * Hirsutism in women ## Adult Dosing * **Heart Failure:** Initiate at 25 mg once daily, may titrate to 50 mg daily or up to 100 mg daily based on response and tolerability. * **Cirrhosis (Edema/Ascites):** Initiate at 100 mg/day in divided doses, adjust as needed, typically between 25 mg and 400 mg per day. * **Nephrotic Syndrome:** Initiate at 100 mg/day in divided doses, adjust as needed, typically between 25 mg and 400 mg per day. * **Hypertension:** Initiate at 25 mg to 100 mg once daily in a single or divided dose, may be increased up to 400 mg/day. Often used in combination therapy. * **Primary Hyperaldosteronism:** Initiate at 100 mg to 400 mg per day in divided doses. * **Hirsutism:** Initiate at 100 mg once daily, may increase to 200 mg daily. ## Pediatric Dosing Dosing in children can vary significantly. Consult specific pediatric guidelines or protocols. Generally: * **Diuretic/Antihypertensive:** 1.5-3.5 mg/kg/day divided into 2-4 doses. Maximum 100 mg/day. * **Edema:** 1.5-3.5 mg/kg/day