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# Aldactone (spironolactone)
## Overview
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist.
## Primary Indications
* **Heart Failure:** To reduce mortality in patients with symptomatic heart failure (NYHA class II-IV) with reduced ejection fraction, usually in addition to standard therapy.
* **Edema/Ascites:** Management of edema and ascites in patients with congestive heart failure, cirrhosis of the liver, and the nephrotic syndrome.
* **Hypertension:** As adjunctive therapy in the management of essential hypertension.
* **Hypokalemia:** To correct or prevent hypokalemia in patients receiving diuretics.
## Adult Dosing
* **Heart Failure:** Initiate at 25 mg once daily. May be increased to 50 mg once daily if symptomatic, and further increased to a target dose of 100 mg once daily.
* **Edema/Ascites (Cirrhosis):** Initiate at 100 mg to 200 mg daily in divided doses. Usual maintenance dose is 100 mg daily.
* **Hypertension:** Initiate at 25 mg to 100 mg daily in divided doses. May be given alone or with other antihypertensives.
* **Hypokalemia:** Typically 25 mg to 100 mg daily in divided doses.
## Pediatric Dosing
Dosing in pediatric patients is highly variable and depends on the indication and patient weight. Consult specific pediatric guidelines or institutional protocols. A common starting dose for edema is 1.5 mg/kg/day to 3 mg/kg/day divided into 2 to 4 doses.
## Dose Adjustments
Dose adjustments are typically based on patient response, tolerance, and serum potassium levels.
## Contraindications
* Anuria
* Acute renal insufficiency
* Significant and progressive renal impairment
* Hyperkalemia
* Addison's disease
* Concomitant use with eplerenone
## Adverse Effects
Common adverse effects include hyperkalemia, hyponatremia, gynecomastia, breast tenderness, menstrual irregularities, impotence, nausea, vomiting, diarrhea, and gastric bleeding.
## Key Drug Interactions
* **ACE inhibitors, ARBs, potassium supplements, salt substitutes, eplerenone, heparin, NSAIDs:** Increased risk of hyperkalemia.
* **Digoxin:** Spironolactone may increase or decrease digoxin levels.
* **Lithium:** Spironolactone may reduce renal clearance of lithium.
* **Nonsteroidal anti-inflammatory drugs (NSAIDs):** May reduce diuretic and antihypertensive effect and increase risk of hyperkalemia.
## Monitoring
* **Serum electrolytes:** Particularly potassium and sodium.
* **Renal function:** Serum creatinine and BUN.
* **Blood pressure.**
* **For gynecomastia and breast tenderness in males.**
* **For menstrual irregularities in females.**
## Clinical Pearls
* Administer with food to improve absorption and reduce gastrointestinal upset.
* Monitor potassium closely, especially when used with other agents that increase potassium.
* Dose titration should be gradual to assess tolerance and efficacy.
* Gynecomastia is a common side effect and may be irreversible.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines for complete details and to ensure patient safety.*
