SPIRONOLACTONE

Indications & Dose:

Edema, hypertension, CHF, diuretic-induced hypokalemia, primary hyperaldosteronism, nephrotic syndrome, cirrhosis of the liver with ascites, polycystic ovary disease, * premenstrual syndrome,* female hirsutism*

DOSAGE

Adult

Initially 100-200mg daily, increased to 400mg if required.

• Edema or hypertension: PO 25-200 mg/day in single or divided doses


• Hypokalemia: PO 25-100 mg/day in single or divided doses CHF: PO 25 mg/day


• CHF: PO 25 mg/day


• Primary hyperaldosteronism diagnosis: PO 400 mg/day for 4 days (short test) or 4 wk (long test), then 100-400 mg/day maintenance


• Polycystic ovary disease or hirsutism: PO 100-200 mg/da

Child

Initially 3mg/kg in divided doses per day.

• Diuretic or antihypertensive or ascites: PO 1-3 mg/ kg/day in single or divided doses 

Contraindications:

Anuria, severe renal disease, hyperkalemia, anti kaliuretic therapy (including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers’ and potassium supplements)

Side Effects:

CNS: Ataxia, confusion, drowsiness, headache, lethargy

CV: Bradycardia, CHF, hypotension

GI: Anorexia, bleeding, constipation, cramps, diarrhea, gastritis, nausea, vomiting

GU: Amenorrhea, deepening voice, gynecomastia, hirsutism, impotence, irregular menses, postmenopausal bleeding

METAB: Hyperchloremic metabolic acidosis, hyperkalemia, hyponatremia

SKIN: Pruritus, rash, urticaria

MISC: Breast cancer

Cautions:

Precautions:

Dehydration, diabetes, hepatic disease, hyponatremia, renal insufficiency, potassium supplements, menstrual abnormalities, gynecomastia, acidosis, elderly

Interaction:

Drugs

Ammonium chloride: Combination may produce systemic acidosis

Angiotensin-converting enzyme inhibitors: Concurrent mechanisms to decrease potassium excretion; increased risk of hyperkalemia

Angiotensin IIreceptor antagonists: Concurrent mechanisms to decrease potassium excretion; increased risk of hyperkalemia

Digitalis glycosides: False or true increase in digoxin concentrations

qyramide: Increased potassium concentrations may enhance disopyramide effects on myocardial conduction

Mitotane: Spironolactone antagonizes the activity of mitotane

Potassium: Increased risk of hyperkalemia

Salicylates: Decreased diuretic (not antihypertensive effect) due to decreased tubular secretion of active metabolit 

Warnings:

Adverse Effects:

Lactations:

Pregnancy category D; feminization occurs in male rat fetuses; active metabolite excreted in breast milk; compatible with breast feeding but alternate options preferred; therapy for existing hypertension can be continued throughout pregnancy with minimal risk; initiating for simple edema not recommended; few unequivocal indications for diuretic therapy in pregnancy except for pulmonary edema or congestive heart failure

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: