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# Aldactone (spironolactone)
## Overview
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist.
## Primary Indications
* Heart failure (NYHA class II-IV) with reduced ejection fraction
* Hypertension
* Edema associated with hepatic cirrhosis or nephrotic syndrome
* Primary hyperaldosteronism
## Adult Dosing
* **Heart failure:** Initiate at 25 mg once daily. May titrate up to 100 mg once daily.
* **Hypertension:** Initiate at 25-100 mg once daily, divided into 1-2 doses. Maximum 400 mg daily.
* **Cirrhosis with edema:** Initiate at 25-100 mg once daily, divided into 1-2 doses. Maximum 400 mg daily.
* **Primary hyperaldosteronism:** 100-400 mg daily, divided into 2-4 doses.
## Pediatric Dosing
Dosing in pediatric patients is less established and often requires individualized titration based on clinical response and serum potassium. General guidelines are available, but exact doses depend on local protocol and patient-specific factors. A common starting point may be 1-3 mg/kg/day divided into 2-4 doses.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Anuria
* Addison's disease
* Hyperkalemia
* Concomitant use with eplerenone
## Adverse Effects
* **Common:** Hyperkalemia, gynecomastia, menstrual irregularities, erectile dysfunction, diarrhea, nausea, vomiting, fatigue.
* **Serious:** Hyponatremia, dehydration, hyperchloremic acidosis, Stevens-Johnson syndrome.
## Key Drug Interactions
* **ACE inhibitors, ARBs, potassium supplements, NSAIDs, heparin:** Increased risk of hyperkalemia.
* **Diuretics (other than potassium-sparing):** Increased risk of dehydration and hypotension.
* **Lithium:** Spironolactone may reduce renal clearance of lithium, increasing lithium toxicity risk.
* **Digoxin:** Spironolactone may increase digoxin levels.
## Monitoring
* Serum electrolytes (especially potassium and sodium)
* Renal function (serum creatinine/eGFR)
* Blood pressure
* Signs and symptoms of hyperkalemia
* For patients with heart failure, regular monitoring of potassium and renal function is crucial, especially during dose titration.
## Clinical Pearls
* Administer with food to improve absorption.
* Monitor potassium closely, especially in patients with renal impairment or those taking concomitant medications that increase potassium.
* Gynecomastia and menstrual irregularities are common and dose-dependent.
* Effectiveness in hypertension may take several weeks.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making treatment decisions.
