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# Aldactone (spironolactone)
## Overview
Aldactone is a potassium-sparing diuretic and aldosterone antagonist.
## Primary Indications
* Primary hyperaldosteronism
* Edema associated with congestive heart failure (CHF), cirrhosis, and nephrotic syndrome
* Essential hypertension (adjunctive therapy)
* Hypokalemia (to increase serum potassium)
## Adult Dosing
* **Primary hyperaldosteronism:** 100-400 mg daily, divided BID. Adjust to lowest effective dose.
* **Edema (CHF, cirrhosis, nephrotic syndrome):**
* **CHF:** Initial dose 25-100 mg daily, divided BID. Maximum 400 mg daily.
* **Cirrhosis:** Initial dose 100 mg daily, divided BID. Adjust to lowest effective dose.
* **Nephrotic syndrome:** Typically 100 mg daily, divided BID.
* **Essential hypertension:** Initial dose 25-100 mg daily, divided BID. Can be increased to 200 mg daily.
* **Hypokalemia:** 25-100 mg daily, divided BID.
Dosing is highly individualized and often titrated based on patient response and electrolytes.
## Pediatric Dosing
Dosing is variable and depends on indication and patient weight. Specific protocols may be required for pediatric use.
* **General:** 1.5-3 mg/kg/day in 2-4 divided doses. Maximum adult doses can be used as a guideline for older children.
* **Hypertension:** 3.3 mg/kg/day or 100 mg/m²/day, divided into 1-2 doses.
## Dose Adjustments
Dose adjustments are primarily based on electrolyte levels (potassium, sodium) and renal function.
## Contraindications
* Anuria, acute renal failure, significant impairment of renal excretory function
* Hyperkalemia
* Addison's disease
* Concomitant use with eplerenone
## Adverse Effects
* **Common:** Hyperkalemia, hyponatremia, dizziness, headache, gastrointestinal upset (nausea, vomiting, diarrhea), gynecomastia, menstrual irregularities.
* **Serious:** Severe hyperkalemia, Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatic dysfunction, interstitial nephritis.
## Key Drug Interactions
* **Potassium supplements, ACE inhibitors, ARBs, other potassium-sparing diuretics, NSAIDs, heparin, trimethoprim/sulfamethoxazole:** Increased risk of hyperkalemia.
* **Corticosteroids:** May enhance hypokalemic effects of corticosteroids.
* **Lithium:** Spironolactone may reduce renal clearance of lithium, leading to lithium toxicity.
* **Digoxin:** AUC of digoxin may be increased; monitor closely.
* **Nonsteroidal anti-inflammatory drugs (NSAIDs):** May reduce the diuretic, natriuretic, and antihypertensive effects.
## Monitoring
* Serum electrolytes (potassium, sodium) at baseline and periodically thereafter, especially with dose changes or in patients with impaired renal function.
* Renal function (serum creatinine, BUN) at baseline and periodically.
* Blood pressure.
* Signs and symptoms of fluid overload or dehydration.
* For signs of gynecomastia or menstrual irregularities.
## Clinical Pearls
* Administer with food to enhance absorption and minimize gastrointestinal upset.
* Aldactone is a weak diuretic and its antihypertensive effect may not be seen for several weeks.
* Due to the risk of hyperkalemia, caution is advised in patients with renal impairment or those taking other medications that increase potassium.
* Use cautiously in patients with liver disease.
* Spironolactone can cause breast tenderness and enlargement (gynecomastia) in both men and women; dose reduction or discontinuation may be necessary.
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*Please verify this information with the most current prescribing information and relevant local protocols.*
