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## Aldactone (spironolactone)
### Overview
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist.
### Primary Indications
* Heart failure (NYHA class II-IV) to reduce mortality and hospitalizations
* Hypertension (adjunctive therapy)
* Edema associated with cirrhosis or nephrotic syndrome
* Primary hyperaldosteronism
### Adult Dosing
* **Heart Failure:** Start at 12.5 mg to 25 mg orally once daily. Maximum dose: 25 mg to 400 mg daily, depending on patient response and tolerability.
* **Hypertension:** 25 mg to 100 mg orally once daily. Maximum dose: 400 mg daily.
* **Edema (Cirrhosis/Nephrotic Syndrome):** 25 mg to 100 mg orally once daily. Higher doses may be required. Maximum dose: 400 mg daily.
* **Primary Hyperaldosteronism:** 100 mg to 400 mg orally daily, divided into 1-4 doses.
### Pediatric Dosing
Dosing in pediatric patients is highly variable and often based on specific indications and clinical response. Consult pediatric-specific resources for detailed dosing guidelines.
### Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised and vigilant monitoring is critical due to the risk of hyperkalemia and worsening renal function.
### Contraindications
* Anuria
* Acute renal insufficiency
* Significant and progressive renal impairment
* Hyperkalemia
* Addison's disease
* Hypersensitivity to spironolactone or any component of the formulation
### Adverse Effects
* **Common:** Hyperkalemia, hyponatremia, gynecomastia, menstrual irregularities, decreased libido, fatigue, nausea, vomiting, diarrhea, rash.
* **Serious:** Progressive renal impairment, severe hyperkalemia, Stevens-Johnson syndrome, toxic epidermal necrolysis, tumors (rare, observed in animals).
### Key Drug Interactions
* **Potassium Supplements & Potassium-Sparing Diuretics:** Increased risk of hyperkalemia.
* **ACE Inhibitors & ARBs:** Increased risk of hyperkalemia.
* **NSAIDs:** May reduce diuretic and antihypertensive effect; increased risk of hyperkalemia and renal impairment.
* **Corticosteroids:** May increase risk of hypokalemia.
* **Digoxin:** Spironolactone can increase digoxin levels, potentially leading to toxicity.
* **Lithium:** Spironolactone can decrease lithium clearance, increasing lithium toxicity risk.
### Monitoring
* **Potassium:** Regularly monitor serum potassium levels, especially when initiating therapy, increasing dose, or in patients with risk factors for hyperkalemia.
* **Renal Function:** Monitor serum creatinine and BUN.
* **Electrolytes:** Monitor sodium levels.
* **Blood Pressure:** Monitor for Hypotension.
* **Clinical Signs/Symptoms:** Assess for signs of fluid overload or dehydration, and development of adverse effects.
### Clinical Pearls
* Administer with food to improve absorption and minimize gastrointestinal upset.
* Advise patients to avoid potassium-rich foods and potassium-containing salt substitutes.
* Be aware of potential for drug-induced gynecomastia or menstrual irregularities.
* Efficacy in heart failure is often seen with lower doses, emphasizing the importance of titrating cautiously.
* Can cause false positive results in some laboratory tests (e.g., digoxin assays).
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult current prescribing information and healthcare professionals for personalized guidance.*
