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# Spironolactone
## 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 due to heart failure, liver cirrhosis, or nephrotic syndrome
* Hypertension (adjunctive therapy)
* Primary hyperaldosteronism
* Hirsutism in women
## Adult Dosing
* **Heart Failure:** Start at 25 mg orally once daily. May increase to 50 mg orally once daily, or titrate up to 100 mg orally once daily as tolerated. Doses typically range from 25-100 mg daily.
* **Edema (Cirrhosis/Nephrotic Syndrome):** Start at 100 mg orally once daily. Doses range from 25-200 mg daily.
* **Hypertension:** Start at 25-50 mg orally once daily. May titrate up to 100 mg daily. Max 200 mg daily.
* **Primary Hyperaldosteronism:** 100-400 mg orally daily in divided doses.
* **Hirsutism:** Start at 100 mg orally once daily. Max 200 mg daily.
## Pediatric Dosing
Dosing varies significantly by indication and patient weight. Consult specific pediatric guidelines or resources. General starting doses can range from 1-3 mg/kg/day divided into 2-4 doses.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Avoid in severe renal impairment. Dose reduction may be necessary based on renal function and potassium levels.
* **Hepatic Impairment:** Use with caution.
## Contraindications
* Anuria
* Acute renal insufficiency
* Significant impairment of renal excretory function
* Hyperkalemia
* Addison's disease
* Concomitant use with eplerenone
## Adverse Effects
* Hyperkalemia
* Hyponatremia
* Gynecomastia, breast tenderness, menstrual irregularities
* Dizziness, headache
* Gastrointestinal upset
* Hypotension
## Key Drug Interactions
* **ACE inhibitors, ARBs, NSAIDs, Potassium supplements, Heparin:** Increased risk of hyperkalemia.
* **Other Diuretics:** Increased risk of dehydration and hypotension.
* **Digoxin:** Spironolactone may increase digoxin levels.
* **Eplerenone:** Contraindicated due to additive hyperkalemic effects.
## Monitoring
* Serum potassium levels
* Renal function (serum creatinine, BUN)
* Electrolytes (sodium)
* Blood pressure
## Clinical Pearls
* Administer with food to minimize gastrointestinal upset and improve absorption.
* Monitor potassium closely, especially when used with other drugs that increase potassium or in patients with renal impairment.
* The anti-androgenic effects in women can take months to manifest and may persist for some time after discontinuation.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information for detailed guidance, contraindications, and adverse effects. Dosing may vary based on individual patient factors and local protocols.
