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# Aldactone (spironolactone)
## Overview
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist.
## Primary Indications
* Heart failure with reduced ejection fraction (HFrEF)
* Hypertension (adjunct therapy)
* Edema associated with cirrhosis or nephrotic syndrome
* Primary hyperaldosteronism
## Adult Dosing
* **HFrEF:** Initiate at 25 mg orally once daily. May be increased to 50 mg orally once daily after 4 weeks. Further titration to 100 mg orally once daily may be considered based on tolerance and response.
* **Hypertension:** 25-100 mg orally daily, divided or once daily.
* **Edema (Cirrhosis/Nephrotic Syndrome):** 25-100 mg orally once daily, may be increased to 200 mg daily.
* **Primary Hyperaldosteronism:** 100-400 mg orally daily, divided.
Dosing may vary based on protocol and patient response.
## Pediatric Dosing
* **Edema/Ascites/Hypertension:** 1-3.3 mg/kg/day orally, divided every 12-24 hours. Maximum dose: 100 mg/day.
* **Hirsutism:** 100-200 mg orally daily, divided.
* **Congestive Heart Failure:** 1-3.3 mg/kg/day orally, divided every 12-24 hours.
* **Primary Hyperaldosteronism:** 0.5-2 mg/kg/day orally, divided every 12-24 hours.
Parenteral formulations are not available for pediatric use. Use with caution in children, and optimal dosing may require specialist consultation.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution and monitor closely.
## Contraindications
* Anuria
* Acute renal insufficiency
* Significant impairment of renal excretory function
* Hyperkalemia
* Addison's disease
* Concomitant use with eplerenone
## Adverse Effects
* **Common:** Hyperkalemia, hyponatremia, gynecomastia, menstrual irregularities, breast tenderness, fatigue, dizziness, headache, gastrointestinal disturbances (nausea, vomiting, diarrhea), rash.
* **Serious:** Severe hyperkalemia, cardiac arrhythmias, renal impairment, Stevens-Johnson syndrome.
## Key Drug Interactions
* **ACE inhibitors, ARBs, potassium supplements, potassium-containing salt substitutes, other potassium-sparing diuretics (e.g., amiloride, triamterene):** Increased risk of severe hyperkalemia.
* **NSAIDs:** May reduce the diuretic, natriuretic, and antihypertensive effects; also increased risk of hyperkalemia.
* **Digoxin:** Aldosterone antagonists can alter digoxin metabolism, potentially increasing digoxin levels.
* **Loflotigrim:** Concomitant use is contraindicated.
## Monitoring
* **Serum electrolytes (potassium, sodium) and renal function (creatinine, BUN):** Frequently, especially at initiation, dose escalation, or with other risk factors for electrolyte imbalance.
* **Blood pressure:** Monitor for hypotension.
* **Signs and symptoms of hyperkalemia:** (e.g., muscle weakness, fatigue, paresthesias, cardiac arrhythmias).
* **Breast tenderness or enlargement.**
## Clinical Pearls
* Administer with food to enhance absorption.
* Monitor potassium closely, especially in patients with renal impairment, diabetes, or those taking concurrent medications that increase potassium.
* Gynecomastia is common and often reversible upon discontinuation, but can be persistent.
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*Please note: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and individual patient factors before making treatment decisions. Local protocols may influence dosing and monitoring.*
