Generic
Spironolactone
10 brands available in the market
At a glance
Spironolactone is a potassium-sparing diuretic used for hypertension, edema, congestive heart failure, ascites in liver cirrhosis, and primary hyperaldosteronism.
Description
Spironolactone is a competitive antagonist of aldosterone that binds to aldosterone-dependent sodium-potassium exchange sites in the distal convoluted renal tubule. It increases sodium and water excretion while retaining potassium.
Indications
- Edema and ascites in liver cirrhosis
- Nephrotic syndrome
- Edema in congestive heart failure
- Primary hyperaldosteronism
- Hypertension
- Diuretic-induced hypokalemia
Therapeutic class
Potassium-sparing Diuretics
Pharmacological class
Aldosterone Antagonist
Pharmacology
Spironolactone competitively binds to aldosterone receptors in the distal convoluted tubule, blocking sodium-potassium exchange. It increases sodium and water excretion while retaining potassium, reducing blood pressure and edema.
Mechanism of action
Blocks aldosterone receptors to increase sodium and water excretion while retaining potassium.
Dosage
Adult Dose (Oral):
- Edema: Start 100 mg/day; up to 400 mg/day if needed
- Hypertension: 50-100 mg/day (single or divided)
- Severe CHF: 25 mg/day (max 50 mg/day)
- Primary hyperaldosteronism: 100-400 mg/day
- Diuretic-induced hypokalemia: 25-100 mg/day
Pediatric Dose (Oral):
- Start: 3 mg/kg in divided doses
Administration
- Take with food
- Swallow tablet whole; do not chew, crush, or break
- Take at the same time each day (morning is preferred)
Missed dose
If you miss a dose, take it as soon as you remember; if almost time for the next dose, skip it; do not double the dose.
Side effects
Common Side Effects:
- Nausea, vomiting
- Leg cramps, dizziness
- Drowsiness, confusion
- Gynecomastia (breast enlargement in males)
- Increased creatinine levels
Precautions & warnings
- Do not use in anuria, hyperkalemia, acute or progressive renal insufficiency
- Do not use in Addison's disease
- Hyperkalemia: Avoid potassium supplements and potassium-rich foods
- Do not use in severe kidney disease
Contraindications
- Anuria
- Hyperkalemia
- Acute or progressive renal insufficiency
- Addison's disease
Drug interactions
- Other K-sparing diuretics, K supplements, ACE inhibitors: Hyperkalemia risk
- Cyclosporine, NSAIDs: Nephrotoxicity risk
- Lithium: Toxicity risk
- Digoxin: Increased serum levels
- Eplerenone: Enhanced hyperkalemic effect (potentially fatal)
Food interactions
Alcohol is unsafe with Spironolactone.
Use in pregnancy
Use in Pregnancy: May be unsafe; animal studies show harmful effects; use only if clearly needed; consult your doctor.
Pregnancy Category: D — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Safe during breastfeeding; human studies show insignificant passage into breast milk; consult your doctor.
Pediatric use
Indicated for children (weight-based dosing)
Geriatric use
Elderly: Initiate with the lowest dose and titrate upward
Renal / hepatic impairment
Renal Impairment: CrCl >50: 12.5-25 mg/day; CrCl 30-49: 12.5 mg/day or every other day; CrCl <30: avoid use; consult your doctor.
Hepatic Impairment: Limited information; consult your doctor.
Overdose effects
Overdose: Drowsiness, mental confusion, rash, nausea, vomiting, dizziness, diarrhea; hepatic coma in severe liver disease; hyperkalemia may occur (especially in renal impairment); provide symptomatic treatment.
Storage conditions
Keep out of reach of children; store below 30°C in a dry place, protected from light.
Chemical structure
Spironolactone