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# Spironolactone (Aldactone)
## Overview
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist.
## Primary Indications
* Hypertension
* Edema associated with heart failure, cirrhosis, and nephrotic syndrome
* Primary hyperaldosteronism
* Hirsutism in women
## Adult Dosing
* **Hypertension:** 25-100 mg orally once or twice daily. May increase up to 200 mg/day.
* **Heart Failure:** 25 mg orally once daily. May increase to 50 mg once daily as tolerated. If necessary, further increase to a maximum of 100 mg once daily.
* **Edema (Cirrhosis/Nephrotic Syndrome):** 25-100 mg orally once or twice daily. May increase up to 200 mg/day.
* **Primary Hyperaldosteronism:** 100-400 mg orally once or twice daily.
* **Hirsutism:** 100-200 mg orally once daily.
Dosing is often initiated at the lower end and titrated based on patient response and tolerability.
## Pediatric Dosing
* **Hypertension/Edema:** 1.5-3 mg/kg/day orally divided into 2-4 doses. Maximum: 100 mg/day.
* **Hirsutism:** Dosing is less established in pediatrics and typically starts at 25-50 mg orally once daily, titrating as needed.
Dosing in children often depends on local protocols and specific clinical guidelines.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary. Avoid in severe renal insufficiency.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary.
## Contraindications
* Addison's disease
* Hyperkalemia
* Anuria
* Concomitant use of eplerenone
## Adverse Effects
* **Common:** Hyperkalemia, dizziness, fatigue, headache, nausea, vomiting, diarrhea.
* **Less Common:** Gynecomastia, menstrual irregularities, breast tenderness, impotence, lethargy, confusion, rash, gastrointestinal bleeding, drug-induced hepatitis.
## Key Drug Interactions
* **ACE Inhibitors/ARBs/Potassium Supplements/NSAIDs:** Increased risk of hyperkalemia.
* **Thiazide or Loop Diuretics:** Increased risk of hyperkalemia.
* **Digoxin:** Spironolactone may increase digoxin levels.
* **Lithium:** Spironolactone may decrease lithium clearance, increasing the risk of lithium toxicity.
* **Norepinephrine/Angiotensin II:** Spironolactone may reduce the response to these vasopressors.
## Monitoring
* Serum potassium levels (frequently, especially at initiation and dose changes)
* Renal function (serum creatinine, BUN)
* Blood pressure
* Electrolytes
## Clinical Pearls
* Administer with food to improve absorption and reduce gastrointestinal upset.
* Monitor potassium closely, especially in patients with renal impairment or those taking other medications that increase potassium.
* Gynecomastia is common and may be dose-dependent and reversible upon discontinuation.
* Can be used in combination with other diuretics but monitor electrolytes carefully.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for complete details before making clinical decisions.*
