Aldactone%2525252525252525252525252525252525252525252525252525252525252525252520%2525252525252525252525252525252525252525252525252525252525252525252528spironolactone%2525252525252525252525252525252525252525252525252525252525252525252529

# Spironolactone (Aldactone) ## Overview Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. ## Primary Indications * **Heart Failure:** Reduce mortality and hospitalizations in patients with symptomatic systolic heart failure (NYHA Class II-IV) with reduced ejection fraction, usually in addition to standard therapy. * **Edema:** Treatment of edema associated with congestive heart failure, hepatic cirrhosis, and nephrotic syndrome. * **Hypertension:** Adjunctive therapy in patients with essential hypertension, particularly those resistant to other antihypertensives or those with primary hyperaldosteronism. * **Primary Hyperaldosteronism:** Diagnosis and treatment. * **Hypokalemia:** Correction of hypokalemia when diuretic-induced. ## Adult Dosing * **Heart Failure:** * Initiate at 25 mg orally once daily (or twice daily if patient tolerates). * May titrate up to 50 mg orally once daily (or twice daily) within one week. * If further diuresis is needed and tolerated, may titrate up to 100 mg orally once daily (or twice daily) after 4 weeks. * Target dose: 100 mg orally once daily (or twice daily). * **Edema (Cirrhosis/Nephrotic Syndrome):** * Start with 100 mg orally once daily or in divided doses. * May be adjusted up to 200 mg/day. * For resistant edema, doses up to 400 mg/day have been used. * **Hypertension:** * Start with 25-100 mg orally once daily or in divided doses. * Maximum dose: 400 mg/day. * **Primary Hyperaldosteronism:** * Doses vary widely; typically 100-400 mg/day orally in divided doses. ## Pediatric Dosing * No established pediatric dosing for *all* indications. * For hypertension, doses of 1.5-3 mg/kg/day orally in 2-4 divided doses have been reported. Use with caution and close monitoring. ## Dose Adjustments * **Renal Impairment:** Use with caution. Avoid in severe renal impairment. * **Hepatic Impairment:** Use with caution; monitor for adverse effects. ## Contraindications * Anuria. * Acute renal insufficiency. * Significant impairment of renal excretory function. * Hyperkalemia. * Addison's disease. * Concomitant use with eplerenone. ## Adverse Effects * **Common:** Hyperkalemia, hyponatremia/hypovolemia, menstrual irregularities, gynecomastia, erectile dysfunction, breast tenderness, hypertriglyceridemia, fatigue, lethargy, headache, GI disturbances (nausea, vomiting, diarrhea, abdominal cramps). * **Serious:** Severe hyperkalemia, Stevens-Johnson syndrome, toxic epidermal necrolysis, dehydration, renal failure. ## Key Drug Interactions * **ACE inhibitors, ARBs, NSAIDs, potassium supplements, heparin, direct renin inhibitors:** Increased risk of hyperkalemia. * **Cardiovascular drugs (e.g., digoxin, diltiazem, verapamil, beta-blockers):** Spironolactone can alter digoxin levels. * **Cholinesterase inhibitors:** May antagonize aldosterone's effect and increase risk of hyperkalemia and hyponatremia. * **Lithium:** Risk of lithium toxicity. * **Tricycloantidepressants, antipsychotics:** Increased risk of hyperkalemia. ## Monitoring * **Serum potassium:** Crucial, especially with concomitant medications that increase potassium. Monitor frequently after initiation, dose increases, and in patients with renal impairment. * **Renal function (serum creatinine, BUN):** Monitor frequently. * **Electrolytes (sodium):** Monitor for hyponatremia. * **Blood pressure:** Especially in hypertension and heart failure. * **Signs/symptoms of hyperkalemia:** Nausea, fatigue, muscle weakness, paresthesias, bradycardia. * **Gynecomastia/breast tenderness:** In men and women. ## Clinical Pearls * Administer with food to improve absorption. * Most common cause of hyperkalemia in patients taking spironolactone. * Monitor potassium closely in patients with renal impairment or those taking other potassium-increasing agents. * Consider dose titration based on patient response and tolerability, particularly for heart failure. * A dose of 25 mg daily is often sufficient for mild hypokalemia prevention or treatment in hypertensive patients. *** **Disclaimer:** This information is for educational purposes and does not substitute professional medical advice. Always consult the most current prescribing information and relevant guidelines for complete details before making clinical decisions.