Please check your internet connection and try again.
# Aldactone (spironolactone)
## Overview
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist.
## Primary Indications
* **Heart Failure:** To reduce morbidity and mortality in patients with New York Heart Association (NYHA) class II-IV heart failure with reduced ejection fraction, when used in addition to standard therapy.
* **Edema/Ascites:** In patients with cirrhotic ascites or edema due to congestive heart failure or nephrotic syndrome.
* **Hypertension:** As adjunctive therapy in patients with primary hyperaldosteronism or as a diuretic in resistant hypertension.
* **Hirsutism (in women):** To manage moderate to severe hirsutism in women.
## Adult Dosing
* **Heart Failure:** Start at 25 mg orally once daily. May increase to 50 mg orally once daily as tolerated. Usual target dose is 50 mg orally once daily. Maximum dose is 100 mg orally once daily.
* **Edema/Ascites (Congestive Heart Failure, Nephrotic Syndrome):** Start at 100 mg orally once daily. Usual range is 25-200 mg orally daily in divided doses.
* **Edema/Ascites (Cirrhosis):** Start at 100 mg orally once daily. Usual range is 25-200 mg orally daily in divided doses.
* **Hypertension:** Initial dose is typically 25-100 mg orally once daily, may be given in divided doses. Maximum dose typically 200 mg orally daily.
* **Hirsutism (Women):** Start at 100 mg orally once daily. May be adjusted by month to 200 mg orally daily in divided doses.
## Pediatric Dosing
Dosing in pediatric patients is variable and depends on indication. Common starting doses for edema/hypertension are 1.5-3 mg/kg/day orally in 2-4 divided doses. Maximum doses are not clearly established and should be guided by clinical response and monitoring.
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment, but caution is advised and careful monitoring is essential due to risk of hyperkalemia.
## Contraindications
* Anuria
* Acute renal insufficiency
* Significant impairment of renal excretory function
* Hyperkalemia
* Addison's disease
* Concomitant use with eplerenone
## Adverse Effects
* **Electrolyte Imbalances:** Hyperkalemia, hyponatremia, hyperchloremic metabolic acidosis.
* **Endocrine:** Female breast tenderness/enlargement, gynecomastia (in males), menstrual irregularities, impotence.
* **Gastrointestinal:** Nausea, vomiting, diarrhea, gastric bleeding, cramping.
* **Central Nervous System:** Drowsiness, confusion, ataxia, headache.
* **Renal:** Increased BUN.
## Key Drug Interactions
* **ACE Inhibitors, ARBs, Potassium Supplements, NSAIDs, Heparin, Trimethoprim:** Increased risk of hyperkalemia.
* **Other Diuretics:** Additive effects, increased risk of electrolyte imbalance.
* **Corticosteroids:** May increase risk of hypokalemia if used with other potassium-wasting diuretics.
* **Lisinopril:** Increased risk of hyperkalemia.
* **Digoxin:** Spironolactone may increase or decrease digoxin levels, and its diuretic effect may alter digoxin clearance. Monitor digoxin levels.
## Monitoring
* **Serum Electrolytes (Potassium, Sodium):** Frequently, especially at initiation of therapy, dose increases, in renal impairment, or with other interacting medications.
* **Renal Function (BUN, Creatinine):** Regularly.
* **Blood Pressure:** Regularly.
* **Urine Output:** Regularly.
* **Signs/Symptoms of Hyperkalemia:** Muscle weakness, fatigue, paresthesias, cardiac arrhythmias.
* **Signs/Symptoms of Hyponatremia:** Headache, confusion, nausea, fatigue.
## Clinical Pearls
* Administer with food to increase absorption.
* Maximal diuretic effect may take several days.
* Hyperkalemia is the most serious potential adverse effect. Avoid concomitant potassium-sparing agents unless essential and with close monitoring.
* In heart failure, spironolactone should be initiated cautiously at a low dose and titrated slowly.
---
*This information is intended for clinical pharmacists and should not replace a thorough review of the current prescribing information and relevant clinical guidelines.*
