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## Aldactone (spironolactone)
### Overview
Spironolactone is a potassium-sparing diuretic and a competitive aldosterone antagonist.
### Primary Indications
* **Heart Failure:** Treatment of chronic heart failure (NYHA class II-IV) to reduce mortality and hospitalizations.
* **Edema:** Management of edema secondary to heart failure, cirrhosis, or nephrotic syndrome in patients unresponsive to other diuretics.
* **Hypertension:** Adjunctive therapy in essential hypertension.
* **Hypokalemia:** Treatment of hypokalemia in patients unable to be treated with potassium supplements.
* **Primary Hyperaldosteronism:** Diagnosis and treatment.
### Adult Dosing
* **Heart Failure:** 25 mg to be titrated up to 50 mg orally once daily or in divided doses. Max 100 mg daily.
* **Edema (Cirrhosis/Nephrotic Syndrome):** 100 mg orally once daily, may range from 25 mg to 200 mg daily in divided doses.
* **Hypertension:** 50 mg to 100 mg orally once daily or in divided doses. Max 200 mg daily.
* **Hypokalemia:** 25 mg to 100 mg orally once daily or in divided doses.
* **Primary Hyperaldosteronism (pre-operative):** 100 mg to 400 mg orally daily in divided doses.
### Pediatric Dosing
* No established pediatric dosing. Dosing is typically based on clinical response and tolerance, often at lower doses than adults. Consult specific pediatric guidelines or pharmacist consultation.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Monitor potassium levels closely.
### Contraindications
* Hyperkalemia.
* Addison's disease.
* Concomitant use of eplerenone.
* Anuria.
* Clinically significant renal impairment or renal failure.
* Hypersensitivity to spironolactone.
### Adverse Effects
* **Common:** Hyperkalemia, gynecomastia, menstrual irregularities, nausea, vomiting, diarrhea, abdominal discomfort.
* **Serious:** Lethargy, confusion, dehydration, hyponatremia, renal dysfunction, Stevens-Johnson syndrome, toxic epidermal necrolysis.
### Key Drug Interactions
* **Potassium Supplements, ACE Inhibitors, ARBs, NSAIDs, Potassium-Containing Salt Substitutes, Heparin, Trimethoprim:** Increased risk of hyperkalemia.
* **Other Diuretics (especially thiazides, loop diuretics):** Additive diuretic effect, increased risk of dehydration and electrolyte imbalances.
* **Corticosteroids:** May increase risk of hypokalemia.
* **Digoxin:** Reduced clearance and increased digoxin levels, leading to increased toxicity.
* **Lithium:** Reduced renal clearance, increased risk of lithium toxicity.
### Monitoring
* Serum potassium levels.
* Renal function (serum creatinine, BUN).
* Electrolytes (sodium).
* Blood pressure.
* Signs and symptoms of hyperkalemia.
* For heart failure: clinical signs of fluid overload, cardiac function.
* For gynecomastia/menstrual irregularities.
### Clinical Pearls
* Administer with food to enhance absorption and reduce gastrointestinal upset.
* Onset of action for edema can take several days.
* Risk of hyperkalemia is significant, especially in patients with renal impairment or those taking other medications that increase potassium.
* May cause gynecomastia in males and menstrual irregularities in females.
* Withdrawal of the drug may be necessary if hyperkalemia or significant adverse effects develop.
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**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always verify current prescribing information and guidelines before making treatment decisions.
