SPIRONOLACTONE+ HYDROCHLORTHIAZIDE

Indications & Dose:

Oedema | Ascites in cirrhosis of the liver

• BY MOUTH

Adult: 100–400 mg daily, adjusted according toresponse

Malignant ascites

• BY MOUTH

Adult: Initially 100–200 mg daily, then increased if necessary to 400 mg daily, maintenance doseadjusted according to response

Nephrotic syndrome

• BY MOUTH

Adult: 100–200 mg daily 

Oedema in congestive heart failure 

• BY MOUTH

Adult: Initially 100 mg daily, alternatively initially25–200 mg daily, dosemay be taken as a singledose or divided doses, maintenance dose adjusted according to response

Moderate to severe heart failure (adjunct) 

• BY MOUTH

Adult: Initially 25 mg once daily, then adjusted according to response to 50 mg once daily

Resistant hypertension (adjunct)

• BY MOUTH

Adult: 25 mg once daily

Primary hyperaldosteronism in patients awaiting surgery

• BY MOUTH

Adult: 100–400 mg daily, may be used for long- term maintenance if surgery inappropriate, use lowest effective dose

Contraindications:

Addison’s disease .anuria. hyperkalaemia

Side Effects:

Acute renal failure  agranulocytosis

 alopeci benign breast tumour breast pain changes in libido  confusion dizziness . drowsiness . electrolyte disturbances . gastro-intestinal disturbances gynaecomastia  hepatotoxicity . hyperkalaemia (discontinue) . hypertrichosis . hyperuricaemia.

hyponatraemia . leg cramps . leucopenia malaise menstrual disturbances . rash . Stevens-Johnson syndrome . thrombocytopenia 

PREGNANCY Use only if potential benefit outweighs risk— feminisation of male fetus in animal studies.

BREAST FEEDING Metabolites present in milk, but amount probably too small to be harmful.

RENAL IMPAIRMENT Avoid in acute renalinsufficiency or severe impairment. Monitor plasma-potassium concentration (high risk of hyperkalaemia in renal impairment).

Cautions:

Acute porphyrias p. 930 . elderly .metabolic products carcinogenic in rodents

Precautions:

Interaction:

Potassium supplements must not be given with potassium-sparing diuretics.

Administration of a potassium-sparing diuretic to a patient receiving an ACE inhibitor or an angiotensin-II receptor antagonist can also cause severe hyperkalaemia.

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: