Spironolactone – Uses, Dosage and Side Effects
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist used to treat heart failure, high blood pressure, and fluid retention.
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Spironolactone is a potassium-sparing diuretic and aldosterone antagonist used to treat heart failure, high blood pressure, and fluid retention.
What is Spironolactone?
Spironolactone is a prescription medication belonging to the class of potassium-sparing diuretics. It acts as an aldosterone antagonist, meaning it blocks the effects of aldosterone, a hormone that regulates the balance of water and salt in the body. Spironolactone has been used in clinical medicine for decades and is included on the World Health Organization (WHO) List of Essential Medicines.
Indications – When is Spironolactone Used?
Spironolactone is prescribed for a wide range of conditions:
- Heart failure: To reduce fluid retention and improve cardiac function
- Arterial hypertension (high blood pressure): As an add-on therapy, especially in primary hyperaldosteronism
- Liver cirrhosis with ascites: To treat fluid accumulation in the abdominal cavity
- Nephrotic syndrome: For fluid retention caused by kidney disease
- Primary hyperaldosteronism (Conn syndrome): Excess aldosterone production from adrenal gland disorders
- Acne and hirsutism in women: Due to its anti-androgenic effects
- Polycystic ovary syndrome (PCOS): To manage symptoms related to elevated androgens
Mechanism of Action
Aldosterone is a hormone produced by the adrenal cortex that signals the kidneys to retain sodium (salt) and water while excreting potassium. Spironolactone blocks the aldosterone receptor in the kidneys (specifically in the distal tubule and collecting duct). This inhibits sodium reabsorption, promotes water excretion, and preserves potassium levels in the body -- hence the name potassium-sparing diuretic.
In addition, spironolactone has anti-androgenic properties because it also binds to androgen receptors, reducing the effects of male sex hormones such as testosterone. This accounts for its use in hormone-related skin conditions in women.
Dosage
The dosage of spironolactone depends on the indication and the individual response of the patient:
- Heart failure: Typically 25--50 mg per day
- Hypertension / hyperaldosteronism: Usually 50--200 mg per day
- Liver cirrhosis with ascites: Often 100--400 mg per day, frequently combined with furosemide
- Acne / hirsutism in women: Commonly 50--200 mg per day
Spironolactone is taken orally (as a tablet) and can be taken with or without food. The exact dosage is always determined by the treating physician.
Side Effects
Like all medications, spironolactone can cause side effects. Common and clinically relevant side effects include:
- Hyperkalemia (elevated potassium levels in the blood): Especially in patients with kidney impairment or those taking other potassium-raising medications -- this can be dangerous
- Gynecomastia (breast tissue enlargement in men): Due to its anti-androgenic and weakly estrogenic properties
- Menstrual irregularities in women
- Dizziness and low blood pressure, especially at the start of treatment
- Gastrointestinal complaints: Nausea, vomiting, stomach pain
- Fatigue and headache
- Reduced libido and erectile dysfunction in men
Drug Interactions
Spironolactone can interact with various other medications:
- ACE inhibitors and ARBs (e.g., ramipril, losartan): Increased risk of hyperkalemia
- Other potassium-sparing diuretics (e.g., amiloride, triamterene): Further increased risk of hyperkalemia
- Potassium supplements and potassium-rich diets: Use with caution
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen: May reduce the diuretic effect
- Digoxin: Spironolactone may increase digoxin plasma levels
Contraindications – When Should Spironolactone Not Be Used?
- Severe renal insufficiency (kidney failure)
- Hyperkalemia (already elevated potassium levels)
- Addison disease (adrenocortical insufficiency)
- Pregnancy and breastfeeding
- Hypersensitivity to spironolactone or any of its excipients
Important Note
Spironolactone is a prescription-only medication and must only be taken under the supervision of a qualified physician. Regular blood tests -- particularly to monitor potassium and kidney function -- are necessary during treatment.
References
- World Health Organization (WHO) -- Model List of Essential Medicines, 23rd Edition (2023). Available at: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.02
- Pitt B. et al. -- The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure. New England Journal of Medicine, 1999; 341(10): 709--717.
- Funder JW. et al. -- The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment. Journal of Clinical Endocrinology and Metabolism, 2016; 101(5): 1889--1916.
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Related search terms: Spironolactone + Spironolacton