What are the common side effects of spironolactone. How to manage spironolactone side effects. When to seek medical attention while taking spironolactone. What are the serious risks associated with spironolactone use. How does spironolactone work in the body. What conditions is spironolactone prescribed for. What precautions should be taken when using spironolactone.

Understanding Spironolactone: Uses and Mechanism of Action

Spironolactone is a versatile medication used to treat various conditions. It belongs to a class of drugs called potassium-sparing diuretics. But how does it work in the body?

Spironolactone acts as an aldosterone antagonist. It blocks the effects of aldosterone, a hormone that regulates salt and water balance in the body. By doing so, spironolactone helps the body eliminate excess water and sodium while retaining potassium.

Healthcare providers prescribe spironolactone for several conditions, including:

• Edema (fluid retention) associated with heart failure, liver disease, or kidney disorders
• High blood pressure (hypertension)
• Primary hyperaldosteronism
• Hormonal acne in women
• Hirsutism (excessive hair growth in women)

Is spironolactone effective for all these conditions? While its efficacy can vary depending on the individual and the specific condition, many patients experience significant benefits from this medication when used as directed by their healthcare provider.

Common Side Effects of Spironolactone: What to Expect

Like all medications, spironolactone can cause side effects. It’s important to note that not everyone experiences these effects, and many people tolerate the medication well. What are the most common side effects of spironolactone?

• Dizziness
• Nausea and vomiting
• Muscle or leg cramps
• Fatigue or low energy
• Breast pain and enlargement (including in men)

These side effects often occur when first starting spironolactone and may improve as your body adjusts to the medication. How long do these side effects typically last? In many cases, they subside within a few days to weeks. However, if they persist or worsen, it’s crucial to consult your healthcare provider.

Managing Dizziness and Fatigue

Dizziness and fatigue are common side effects that can impact daily activities. How can you manage these symptoms?

• Rise slowly from sitting or lying positions
• Avoid driving or operating machinery until you know how the medication affects you
• Maintain a regular sleep schedule
• Engage in light exercise, as approved by your doctor
• Stay hydrated and eat a balanced diet

Coping with Gastrointestinal Side Effects

Nausea and vomiting can be uncomfortable side effects of spironolactone. What strategies can help alleviate these symptoms?

• Take spironolactone with or just after meals
• Opt for simple, bland foods and avoid rich or spicy cuisine
• Stay hydrated by taking small, frequent sips of water
• Consider asking your doctor about anti-nausea medications if symptoms persist

Serious Side Effects and Warning Signs

While less common, spironolactone can cause serious side effects that require immediate medical attention. What are the warning signs to watch for?

• Yellowing of the skin or eyes (jaundice)
• Slow or irregular heartbeat
• Muscle weakness or tingling sensations
• Severe dehydration symptoms
• Signs of kidney problems

If you experience any of these symptoms, it’s crucial to contact your healthcare provider or seek emergency medical care immediately. Why are these symptoms concerning? They may indicate serious complications such as liver problems, electrolyte imbalances, or kidney dysfunction.

Allergic Reactions: A Rare but Serious Concern

Although rare, some individuals may experience a severe allergic reaction to spironolactone. What are the signs of a serious allergic reaction?

• Sudden swelling of the lips, mouth, throat, or tongue
• Difficulty breathing or wheezing
• Tightness in the throat or trouble swallowing
• Skin color changes (blue, grey, or pale)
• Sudden confusion or dizziness
• Fainting or unresponsiveness

If you or someone you’re with experiences these symptoms, call emergency services immediately. Anaphylaxis is a life-threatening condition that requires urgent medical intervention.

Drug Interactions and Precautions

Spironolactone can interact with various medications and medical conditions. Why is it important to be aware of these interactions? They can alter the effectiveness of spironolactone or increase the risk of side effects.

What medications may interact with spironolactone?

• Other potassium-sparing diuretics
• ACE inhibitors
• Angiotensin receptor blockers (ARBs)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Lithium
• Digoxin

Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking before starting spironolactone. They can assess potential interactions and adjust your treatment plan accordingly.

Special Precautions for Certain Medical Conditions

Some medical conditions may require special precautions when using spironolactone. What conditions should be discussed with your healthcare provider?

• Kidney disease
• Liver disease
• Diabetes
• Hyperkalemia (high potassium levels)
• Pregnancy or breastfeeding

Your doctor will consider these factors when determining if spironolactone is appropriate for you and may adjust the dosage or recommend alternative treatments if necessary.

Monitoring and Follow-up: Ensuring Safe and Effective Treatment

Regular monitoring is essential when taking spironolactone to ensure its safety and effectiveness. What types of monitoring might your healthcare provider recommend?

• Blood tests to check potassium levels and kidney function
• Blood pressure measurements
• Electrolyte balance assessments
• Liver function tests

How often should these tests be performed? The frequency of monitoring can vary depending on your individual circumstances, but typically, more frequent checks are done when first starting the medication or adjusting the dose.

The Importance of Open Communication

Maintaining open communication with your healthcare provider is crucial for successful treatment with spironolactone. Why is this so important?

• It allows for timely adjustment of your treatment plan if needed
• Helps identify and address any side effects or concerns promptly
• Ensures you’re getting the maximum benefit from the medication
• Allows for discussion of any lifestyle changes that may complement your treatment

Don’t hesitate to reach out to your healthcare provider if you have questions or concerns about your spironolactone treatment. They are there to support you and ensure your health and well-being.

Lifestyle Considerations While Taking Spironolactone

Certain lifestyle factors can impact the effectiveness of spironolactone and your overall health while taking this medication. What lifestyle considerations should you keep in mind?

Dietary Considerations

Spironolactone affects potassium levels in the body. How should this influence your diet?

• Be cautious with high-potassium foods (e.g., bananas, oranges, leafy greens)
• Avoid salt substitutes that contain potassium
• Maintain a balanced diet as recommended by your healthcare provider
• Stay well-hydrated, but follow any fluid intake guidelines provided by your doctor

Alcohol Consumption

Can you drink alcohol while taking spironolactone? While moderate alcohol consumption may be permissible for some patients, it’s essential to discuss this with your healthcare provider. Alcohol can increase the risk of dehydration and may interact with spironolactone’s effects on blood pressure.

Sun Protection

Spironolactone may increase skin sensitivity to sunlight. How can you protect yourself?

• Use broad-spectrum sunscreen with a high SPF
• Wear protective clothing when outdoors
• Avoid prolonged sun exposure, especially during peak hours

Exercise and Physical Activity

Regular physical activity is generally beneficial, but how might spironolactone affect your exercise routine?

• Start slowly and gradually increase intensity
• Stay hydrated during workouts
• Be aware of any dizziness or fatigue during exercise
• Consult your healthcare provider about any necessary adjustments to your fitness routine

Long-term Use of Spironolactone: What to Expect

For many conditions, spironolactone may be prescribed for long-term use. What should patients know about taking this medication over an extended period?

Effectiveness Over Time

Does spironolactone remain effective with long-term use? In many cases, yes. However, the effectiveness can vary depending on the condition being treated and individual factors. Regular follow-ups with your healthcare provider will help ensure the medication continues to meet your needs.

Potential Long-term Side Effects

While many side effects of spironolactone improve over time, some may persist or develop with long-term use. What should you be aware of?

• Changes in menstrual cycles in women
• Gynecomastia (breast enlargement) in men
• Potential impacts on bone density
• Rare cases of certain types of tumors (in animal studies)

Regular monitoring and open communication with your healthcare provider can help identify and address any long-term concerns.

Discontinuation and Withdrawal

If you need to stop taking spironolactone, it’s crucial to do so under medical supervision. Why is this important? Abrupt discontinuation can lead to a rapid increase in blood pressure or worsening of the condition being treated. Your healthcare provider can guide you through a safe tapering process if necessary.

Alternative Treatments and Complementary Therapies

While spironolactone is effective for many patients, it may not be suitable for everyone. What alternatives might be considered?

Other Medications

Depending on the condition being treated, alternative medications may include:

• Other types of diuretics
• ACE inhibitors or ARBs for blood pressure control
• Eplerenone, another aldosterone antagonist
• Topical or oral treatments for acne

Lifestyle Modifications

In some cases, lifestyle changes can complement or potentially replace medication. What modifications might be beneficial?

• Dietary changes (e.g., reducing sodium intake)
• Regular exercise
• Stress management techniques
• Weight management

Complementary Therapies

Some patients may explore complementary therapies alongside conventional treatment. What options might be considered?

• Acupuncture
• Herbal supplements (with caution and medical supervision)
• Mindfulness and meditation practices
• Yoga or tai chi for stress reduction and blood pressure management

It’s crucial to discuss any alternative or complementary treatments with your healthcare provider to ensure they are safe and appropriate for your specific situation.

Side effects of spironolactone – NHS

Like all medicines, spironolactone can cause side effects, although not everyone gets them.

Side effects often happen when you first start taking spironolactone and get better as your body gets used to the medicine.

Common side effects

These common side effects of spironolactone happen in more than 1 in 100 people. There are things you can do to help cope with them:

Feeling dizzy

If spironolactone makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better. Do not drive, cycle or use tools or machines while you’re feeling dizzy.

This side effect usually wears off after a few days. Talk to your doctor if it carries on for longer.

Feeling or being sick

Take spironolactone with or just after a meal. It may help if you stick to simple meals and do not eat rich or spicy food. If you’re being sick, take small, frequent sips of water so you do not get dehydrated (ask your doctor how much fluid you can drink).

If you take contraceptive pills and you’re being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

This side effect usually wears off after a few days. Talk to your doctor about taking an anti-sickness medicine if it carries on for longer.

Muscle or leg cramps

If you get unusual muscle cramps that are not from exercise or physical work, talk to your doctor. You may need a blood test to check what is causing it.

Feeling tired or low in energy

Do not drive, cycle or use tools or machinery while you’re feeling tired.

Some ways to increase your energy levels include exercise, eating a healthy diet and making sure you have a regular sleep pattern. There are self-help tips you can try to improve your energy levels.

If you are still feeling tired and low in energy, and this bothers you, or if it’s getting worse, talk to your doctor.

Breast pain and breast enlargement, including in men

If this bothers you, talk to your doctor.

Serious side effects

Some people have serious side effects after taking spironolactone.

Tell your doctor or call 111 straight away if:

• the whites of your eyes turn yellow, or your skin turns yellow, although this may be less obvious on brown or black skin – these can be signs of liver problems
• you get a slow or irregular heartbeat, tingling feeling, muscle weakness or shortness of breath – these can be signs of potassium levels being too high
• you’re peeing less that usual or have dark, strong smelling pee, feel thirsty or feel dizzy or light-headed – these can be signs of dehydration
• you have diarrhoea, are peeing less than usual, are feeling or being sick, and feel drowsy or confused – these can be signs of loss of kidney function

Serious allergic reaction

It’s possible to have a serious allergic reaction (anaphylaxis) to spironolactone.

Immediate action required: Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Other side effects

These are not all the side effects of spironolactone. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 6 July 2022

Next review due: 6 July 2025

Side Effects, Dosage, Uses, and More

1. Spironolactone oral tablet is available as a brand-name drug and a generic drug. Brand name: Aldactone.
2. Spironolactone comes as an oral tablet and an oral suspension.
3. Spironolactone is used to reduce swelling from liver disease and nephrotic syndrome. It’s also used to treat high blood pressure, heart failure, and excessive aldosterone secretion.

• Potassium intake: This drug can cause hyperkalemia (high potassium levels). While taking this drug, you should watch your potassium intake. You should not take potassium supplements, eat a diet rich in potassium, or consume salt substitutes containing potassium. Having too much potassium in your body can lead to severe problems. This can even be fatal. Talk with your doctor or a nutritionist if you’re concerned about your potassium intake.
• Enlarged breasts: This drug may cause gynecomastia (increased breast size in males*†). If this happens, your doctor may stop your treatment with this drug. This symptom usually goes away once you stop taking this drug.
• Low blood pressure and worsening kidney function: This drug may result in low blood pressure and worsening kidney function. Your doctor will monitor your blood pressure and kidney function while you take this drug.

  * In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
  † This side effect could also affect someone who was assigned female at birth but has a certain level of testosterone in their body.

  Spironolactone is a prescription drug. It comes as an oral tablet and an oral suspension (a kind of liquid mixture).

  Spironolactone oral tablet is available as the brand-name drug Aldactone and as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

  This drug may be taken as part of a combination therapy with other medications.

  Why it’s used

  This drug is used to reduce swelling from liver disease and nephrotic syndrome (a kidney problem). It’s also used to treat high blood pressure, heart failure, and hyperaldosteronism (excessive secretion of the hormone aldosterone).

  How it works

  This drug belongs to a group of drugs called aldosterone antagonists (blockers), or potassium-sparing diuretics. These drugs are often used to treat similar conditions.

  Spironolactone works by blocking aldosterone activity. Aldosterone is a chemical made by the body that can cause water retention. This makes certain heart, kidney, and liver conditions worse. By blocking aldosterone, your body won’t retain fluid. This process also stops your body from ridding itself of potassium.

  This drug may lower your blood pressure by blocking aldosterone’s effect on your blood vessels.

  How long it lasts

  After you take a dose of spironolactone, it takes about 1.5 hours for half of the dose to leave your body. This is known as the drug’s half-life. The drug will have its greatest effect in your body during this time.

  How often you take spironolactone depends on the condition you’re taking the drug to treat. Studies have determined the dosages that help keep an effective level of the drug in the body for the different conditions spironolactone treats. Your doctor will recommend the right dosage of spironolactone for your condition.

  After you stop taking spironolactone, the drug should be removed from your body in about a day.

  If you have questions about how long spironolactone lasts in your body, ask your doctor or pharmacist.

  Spironolactone oral tablet may be used off-label for certain conditions. With off-label use, doctors prescribe a drug for a purpose other than what it’s approved for. Examples of possible off-label uses of spironolactone are discussed below.

  For acne

  Spironolactone is often used off-label to treat acne. For this purpose, 2016 guidelines from the American Academy of Dermatology recommend the drug specifically for certain females.* The drug is not recommended for treating acne in males.*

  Research into the effectiveness of spironolactone for treating acne is ongoing.

  To find out more about taking spironolactone to treat acne, talk with your doctor or pharmacist.

  * In this article, we use the terms “male” and female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

  For hair loss

  Spironolactone may be used off-label to treat a certain kind of hair loss called female* pattern baldness. A small study suggests the drug may be effective for treating this condition, but more research is needed to confirm this.

  Spironolactone is usually not prescribed for male* pattern baldness. This is because it also has the potential to cause gynecomastia (increased breast size in males†). In certain situations, a doctor may consider using spironolactone off-label for male pattern baldness.

  To learn more about taking spironolactone to treat hair loss, talk with your doctor or pharmacist.

  * In this article, we use the terms “male” and female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
  † This side effect could also affect someone who was assigned female at birth but has a certain level of testosterone in their body.

  Spironolactone oral tablet may cause drowsiness. You should not drive, use machinery, or do similar tasks that require alertness until you know how this drug affects you.

  This drug can also cause other side effects.

  More common side effects

  The more common side effects that can occur with spironolactone include:

  • diarrhea and belly cramps
  • nausea and vomiting
  • hyperkalemia (high potassium level)
  • leg cramps
  • headache
  • dizziness
  • drowsiness
  • itching
  • irregular menstrual cycles or bleeding after menopause

  If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

  Serious side effects

  Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Allergic reaction. Symptoms can include:
    • skin rash
    • hives
    • fever
    • trouble breathing
    • swelling of your lips, mouth, tongue, or throat
  • Fluid and electrolyte problems. Symptoms can include:
    • mouth dryness
    • extreme thirst
    • extreme weakness and tiredness
    • fast heart rate and dizziness
    • not being able to urinate
  • Dangerously high potassium levels. Symptoms can include:
    • muscle weakness
    • not being able to move your legs and arms
    • extreme tiredness
    • tingling or numb feeling in your hands or feet
    • slow heart rate
  • Gynecomastia (increased breast size in males*†).
  • Severe skin reactions. Symptoms can include:
    • skin discoloration, blistering, peeling, or loosening of your skin, including inside of your mouth

  * In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
  † This side effect could also affect someone who was assigned female at birth but has a certain level of testosterone in their body.

  Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.

  Spironolactone oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

  To help avoid interactions, be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. They’ll let you know if any interact with propranolol and adjust your treatment if needed. To find out how this drug might interact with something else you’re taking, talk with your doctor or pharmacist.

  Examples of drugs that can cause interactions with spironolactone are listed below.

  Drugs and supplements that increase potassium blood levels

  Taking certain medications with spironolactone can increase the amount of potassium in your body to unsafe levels. Examples of these drugs include:

  • angiotensin-converting enzyme (ACE) inhibitors, such as:
    • benazepril (Lotensin)
    • captopril
    • enalapril (Vasotec)
    • fosinopril
    • moexipril
    • perindopril
    • quinapril
    • ramipril (Altace)
    • trandolapril
  • angiotensin II receptor blockers (ARBs), such as:
    • irbesartan (Avapro)
    • losartan (Cozaar)
    • olmesartan (Benicar)
    • telmisartan (Micardis)
    • valsartan (Diovan)
  • direct renin inhibitors, such as:
    • aliskiren (Tekturna)
  • heparin and low molecular weight heparin (LMWH)
  • potassium supplements
  • potassium-sparing diuretics, such as:
    • triamterene (Dyrenium)
    • eplerenone (Inspra) (This drug should not be used with spironolactone. )

  Pain drugs

  Taking certain pain drugs with spironolactone can result in kidney damage and increased blood pressure. Examples of these pain drugs include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
    • diclofenac (Zipsor)
    • ibuprofen (Advil)
    • indomethacin (Indocin)
    • ketoprofen
    • ketorolac (Sprix)
    • meloxicam (Mobic)
    • nabumetone
    • naproxen (Aleve)
    • piroxicam (Feldene)

  Cholesterol drugs

  Taking certain cholesterol drugs with spironolactone can increase the amount of potassium and acid in your body to unsafe levels. Examples of these drugs include:

  • cholestyramine (Prevalite)

  Lithium

  Taking lithium (Lithobid) with spironolactone can increase the effects of lithium. Your doctor may lower your dosage of lithium if you take these drugs together.

  Digoxin

  Taking digoxin (Lanoxin) with spironolactone may increase the effects of digoxin. Your doctor may monitor you closely if you take these drugs together.

  Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare professional about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

  This drug comes with several warnings.

  Allergy warning

  This drug can cause a severe allergic reaction. Symptoms include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

  Call 911 or go to the nearest emergency room if you develop these symptoms.

  Do not take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

  Warnings for people with certain health conditions

  For people with liver disease: Taking this drug when you have liver disease may lead to a coma. Tell your doctor right away if you have the following symptoms, which may be signs of hepatic coma:

  • confusion
  • poor judgment
  • foggy memory
  • abnormal body movements and shaking
  • trouble concentrating

  For people with hyperkalemia: You should not take this drug if you have hyperkalemia (high potassium levels). It can worsen the condition.

  For people with kidney disease: You’re at increased risk of side effects from this drug. You’re also at increased risk of high potassium levels. If you take this drug, you should monitor your potassium levels closely. Your doctor can check your potassium levels using a blood test.

  For people with Addison’s disease: You should not take this drug if you have Addison’s disease. It can make your illness worse.

  For people with heart disease: Don’t take potassium supplements, eat a diet high in potassium, or take drugs that increase potassium levels if you have heart failure and you’re taking this drug. Dangerously high potassium levels are more likely if you have heart failure. This can be fatal.

  Warnings for other groups

  For pregnant people: There haven’t been enough studies done to be certain how the drug might affect a fetus.

  Despite this lack of research, this drug should be used during pregnancy only if the potential benefit justifies the potential risk. Tell your doctor if you’re pregnant or plan to become pregnant. If you become pregnant while taking this drug, contact your doctor right away.

  For people who are breastfeeding: A metabolite (substance that results from the breakdown of a drug) from spironolactone passes into breast milk. This may cause side effects in a child who is breastfed. Talk with your doctor if you breastfeed your child. They may recommend that you stop breastfeeding or suggest a different medication for your condition.

  For older adults: Older adults may process drugs more slowly. A usual adult dose may cause levels of spironolactone to be higher than usual. If you’re an older adult, you may need a lower dose or a different dosage schedule.

  For children: This medication should not be used in children younger than 18 years.

  When to call the doctor

  1. Call your doctor if you have trouble breathing or swelling in your legs. This means that your heart disease may be getting worse.

  Was this helpful?

  All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

  Drug forms and strengths

  Generic: Spironolactone

  • Form: oral tablet
  • Strengths: 25 milligrams (mg), 50 mg, 100 mg

  Brand: Aldactone

  • Form: oral tablet
  • Strengths: 25 mg, 50 mg, 100 mg

  Dosage for high blood pressure (hypertension)

  Adult dosage (ages 18 to 64 years)

  The typical starting dosage is 25 mg to 100 mg taken by mouth each day. It’s given as a single dose or split into two doses.

  Child dosage (ages 0 to 17 years)

  This medication isn’t approved for use in children younger than 18 years.

  Older adult dosage (ages 65 years and older)

  There are no specific recommendations for older adult dosing. Older adults may process drugs more slowly. A usual adult dose may cause levels of this drug to be higher than typical in your body. If you’re an older adult, you may need a lower dose or a different dosage schedule.

  Dosage for swelling (edema) from nephrotic syndrome and liver disease

  Adult dosage (ages 18 to 64 years)

  The typical starting dosage is 100 mg taken by mouth each day. It’s given as a single dose or split into two doses. Some people may take as little as 25 mg per day or as much as 200 mg per day.

  Child dosage (ages 0 to 17 years)

  This medication isn’t approved for use in children younger than 18 years.

  Older adult dosage (ages 65 years and older)

  There are no specific recommendations for older adult dosing. Older adults may process drugs more slowly. A usual adult dose may cause the level of this drug to be higher than typical in your body. If you’re an older adult, you may need a lower dose or a different dosage schedule.

  Dosage for heart failure

  Adult dosage (ages 18 to 64 years)

  The typical starting dosage is 25 mg taken by mouth once per day. Your doctor may increase or decrease your dosage based on how you respond to the drug. Some people may take 50 mg once per day, and others may take 25 mg once every other day.

  Child dosage (ages 0 to 17 years)

  This medication isn’t approved for use in children younger than 18 years.

  Older adult dosage (ages 65 years and older)

  There are no specific recommendations for older adult dosing. Older adults may process drugs more slowly. A usual adult dose may cause the level of this drug to be higher than typical in your body. If you’re an older adult, you may need a lower dose or a different dosage schedule.

  Dosage for excessive aldosterone secretion

  Adult dosage (ages 18 to 64 years)

  The typical dosage is 100 mg to 400 mg daily in preparation for surgery. If you cannot have surgery, your doctor may give you the lowest effective dose of this drug long term.

  Child dosage (ages 0 to 17 years)

  This medication isn’t approved for use in children younger than 18 years.

  Older adult dosage (ages 65 years and older)

  There are no specific recommendations for older adult dosing. Older adults may process drugs more slowly. A usual adult dose may cause the level of this drug to be higher than typical in your body. If you’re an older adult, you may need a lower dose or a different dosage schedule.

  Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

  Spironolactone is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

  If you do not take it at all: If you do not take this drug, your blood pressure will stay high. This can lead to a heart attack or stroke. Fluid may also build up in your body. This can cause serious worsening of kidney and liver disease.

  If you stop taking it suddenly: If you stop taking this drug, you may start retaining water. You may also have a sudden increase in your blood pressure. This can lead to a heart attack or stroke.

  If you do not take it on schedule: If you don’t take this drug on schedule, your blood pressure might not be managed. This can lead to a heart attack or stroke.

  What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember. If it’s just a few hours before the time for your next dose, then wait and only take one dose at that time. Never try to catch up by taking two doses at once. This could cause dangerous side effects.

  If you take too much: If you take too much of this drug, you may have the following symptoms:

  • drowsiness
  • confusion
  • skin rash
  • nausea
  • vomiting
  • dizziness
  • diarrhea
  • changes in your body’s electrolytes, which can cause irregular heart rate or muscle pain and cramping

  If you think you’ve taken too much of this drug, contact your doctor right away. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

  How to tell the drug is working: You may not be able to tell whether this drug is working or not. It’s important that you take your medication every day as directed by your doctor. Your doctor will monitor your condition and be able to tell if this drug is working. You may need to buy your own blood pressure monitor to check your blood pressure at home.

  Keep these considerations in mind if your doctor prescribes spironolactone for you.

  General

  • This drug can be taken with or without food.

  Storage

  • Store spironolactone at room temperature between 68°F and 77°F (20°C and 25°C).
  • Don’t freeze this drug.
  • Keep it away from light.
  • Keep it away from high temperature.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

  Refills

  A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

  Travel

  When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

  Self-management

  You may need to check your blood pressure at home using a blood pressure monitor. You should keep a log with the date, time of day, and your blood pressure readings. Bring this diary with you to your doctor appointments.

  Clinical monitoring

  While you’re taking this drug, your doctor will check the following:

  • heart function
  • kidney function
  • liver function
  • electrolytes
  • blood pressure

  Hidden costs

  You may need to purchase a home blood pressure monitor to check your blood pressure at home. These are available for purchase at most pharmacies.

  Prior authorization

  Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

  Other drugs are available to treat your condition. Some may be better suited for you than others. Examples of alternatives for the conditions spironolactone treats are listed below. Not all of the alternatives available for treating the same conditions as spironolactone are included. Talk with your doctor about other options that may work for you.

  For high blood pressure

  Below are a couple of examples of alternatives to spironolactone that are used to treat high blood pressure:

  • hydrochlorothiazide
  • eplerenone (Inspra)

  For swelling from liver disease and nephrotic syndrome

  The following are some examples of medications other than spironolactone that may be used to treat swelling from liver disease and nephrotic syndrome (a kidney problem).

  • amiloride (Midamor)
  • eplerenone (Inspra)

  For heart failure

  Below are a couple of examples of alternatives to spironolactone that are used to treat heart failure:

  • torsemide (Soaanz)
  • bumetanide (Bumex)

  For excessive aldosterone secretion

  The following is an example of a medication other than spironolactone that may be used to treat hyperaldosteronism (excessive aldosterone secretion):

  • eplerenone (Inspra)

  Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

  From what tablets, mechanism, side effects, dosage

  Publication date: 03/14/2023

  THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS NECESSARY.High blood pressureFor the heart and blood vesselsEdemaPills

  Author of the article

  Ripatti Yuliya Igorevna,

  Diploma of pharmaceutical education: 105924 3510926, reg. number 32018

  All authors

  Article content

  • Spironolactone: mechanism of action
  • Spironolactone: what pills are for
  • Spironolactone: dosage
  • Spironolactone: contraindications
  • Spironolactone: side effects
  • Spironolactone or Veroshpiron: which is better
  • Spironolactone or Indapami e: which is better
  • Summary
  • Ask an expert on the topic of the article

  In 2021, the first comprehensive analysis of global trends in the prevalence of hypertension was carried out. The statistics turned out to be disappointing: over the past 30 years, the number of hypertensive patients among adults aged 30 to 79years has increased from 650 million to 1.28 million people. Nearly half of the patients examined were unaware of the disease. Arterial hypertension or high blood pressure syndrome is a pathological condition that significantly increases the risk of developing other cardiovascular diseases, as well as diseases of the brain and kidneys.

  The pharmacist will tell you about the drug Spironolactone: introduce you to its mechanism of action, indications for use, contraindications and side effects, and compare it with analogues.

  Spironolactone: mechanism of action

  Spironolactone belongs to the group of long-acting potassium-sparing diuretics. The international non-proprietary name of the medicinal product (INN) is Spironolactone, which is identical to the trade name. In addition, the substance is available as: Veroshpiron and Veroshpilakton.

  The mechanism of action of Spironolactone is associated with the suppression of the effects of aldosterone, a hormone of the adrenal cortex responsible for the retention of sodium and water ions by the kidneys, as well as the excretion of potassium and magnesium. We can say that aldosterone is one of the main regulators of the balance of minerals and water in the human body. However, with stable high blood pressure, chronic heart failure, some kidney diseases and other conditions, the activity of the hormone increases many times over. This results in:

  • Excessive accumulation of sodium and water, as a result of which the volume of circulating blood increases and the load on the heart increases;
  • Excessive excretion of potassium, which disturbs the heart rhythm and increases blood pressure.

  As an aldosterone antagonist, Spironolactone counteracts its pathological effects by increasing the excretion of water and sodium and conserving potassium. Due to the prolonged action, the drug retains its effects for 24 hours.

  All products Spironolactone

  20 reviews

  Spironolactone: from what tablets

  A common request from patients for capsules and tablets Spironolactone: from what they are taken. The drug is prescribed in the complex therapy of cardiovascular diseases and other diseases, a symptom of which is fluid retention. The indications of Spironolactone include the treatment of adults and children from 3 years of age with:

  • Arterial hypertension;
  • Chronic heart failure;
  • Cirrhosis of the liver, accompanied by edema or accumulation of fluid in the peritoneum;
  • Nephrotic syndrome with edema;
  • Increased concentration of aldosterone in Conn’s syndrome;
  • Low potassium content in the body.

  Spironolactone dosage

  Spironolactone is available as 25 mg tablets and 25, 50 and 100 mg capsules. The dosage of the drug is selected individually for each patient based on the indications, purpose of therapy and age. Doses are adjusted as treatment progresses. For example, for arterial hypertension, an average of 25 mg Spironolactone is prescribed, but if the target values ​​​​are not reached within 2-4 weeks, the dose is increased. In some cases, an assessment of the level of potassium and creatinine in the blood serum is required.

  Spironolactone: contraindications

  • Hypersensitivity to drug components;
  • Hereditary galactose intolerance, lactase deficiency and glucose-galactose malabsorption;
  • Addison’s disease – decreased function of the adrenal cortex;
  • High levels of potassium and sodium in the body;
  • Renal insufficiency;
  • Chronic heart failure with decreased glomerular filtration rate of the kidneys or increased creatinine;
  • Co-administration with other potassium-sparing diuretics;
  • Pregnancy and lactation;
  • Children under 3 years of age.

  Spironolactone: side effects

  • Increased potassium concentration;
  • Cardiac arrhythmias;
  • Erectile dysfunction and decreased libido;
  • Nausea and vomiting;
  • Increased fatigue;
  • Confusion;
  • Hypersensitivity reactions;
  • Skin rash and urticaria;
  • Decreased concentration of platelets and certain other blood cells;
  • Inflammation of vessel walls;
  • Inflammation of the liver.

  Spironolactone or Veroshpiron: which is better

  We can say that Spironolactone and Veroshpiron are one and the same. Veroshpiron is a drug in the form of tablets and capsules based on Spironolactone. The difference lies in the manufacturing companies: in the case of Spironolactone, there are several of them, including domestic ones. Due to this, Spironolactone has a lower cost. Veroshpiron is produced by the Hungarian company Gedeon Richter.

  All products Veroshpiron

  20 reviews

  Spironolactone or Indapamide: which is better

  Indapamide is a diuretic with a different mechanism of action. Similar to Spironolactone, the drug is used for cardiovascular diseases, but unlike the drug in question:

  • Indapamide is indicated exclusively for arterial hypertension to further reduce pressure and reduce edema;
  • Indapamide reduces left ventricular hypertrophy caused by increased workload due to high blood pressure;
  • Indapamide has other contraindications and side effects, including not used for the treatment of children under 18 years of age.

  Spironolactone and Indapamide belong to the same group of drugs, but are used for different conditions. Spironolactone is prescribed for potassium deficiency, which increases the progression of heart disease, as well as for fluid accumulation. Indapamide, in turn, with arterial hypertension for an additional hypotensive effect and removal of edema.

  All products Indapamide

  12 reviews

  Summary

  • Spironolactone is a long-acting potassium-sparing diuretic.
  • The drug is prescribed in the complex therapy of cardiovascular diseases, edema, pathological accumulations of fluid and reduced potassium content.
  • Spironolactone is available as 25 mg tablets and 25, 50 and 100 mg capsules.
  • Spironolactone has contraindications and side effects;
  • Veroshpiron is a drug in the form of tablets and capsules based on Spironolactone.
  • Spironolactone and Indapamide belong to the same group of drugs, but are used for different conditions.

  Ask an expert about the topic of the article

  Still have questions? Ask them in the comments below and our experts will answer you. There you can also share your experience with other Megatips readers.

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  The role of aldosterone antagonists in the treatment of cardiovascular diseases | Mareev V.

  Yu.

  Dear Vyacheslav Yurievich! Today we would like to talk with you about the role of aldosterone antagonists in modern cardiology practice and determine the contingent of patients for whom the use of this group of drugs is most important.

  The renin-angiotensin-aldosterone system (RAAS) plays an important role in the development and progression of cardiovascular diseases (CVD), and today its importance is generally recognized. Over time, new tissue and hemodynamic effects of its individual components and the end product of this chain, aldosterone, are determined. Aldosterone is a steroid hormone synthesized mainly in the adrenal cortex under the influence of angiotensin II. It is also present in the vascular wall, heart, brain, and adipose tissue, which is responsible for its effects.

  To understand the role of aldosterone, it is important to know that as a result of the activation of aldosterone receptors in the distal tubules of the kidneys, the reabsorption of sodium and hydrogen ions increases in exchange for potassium ions excreted from the body, which causes antidiuretic effects, manifested by fluid retention in the body and an increase in blood pressure (BP) . Chronic activation of myocardial receptors is accompanied by the development of fibrosis and myocardial remodeling, which underlies the formation of chronic heart failure (CHF), which is the outcome of most CVDs. Also, hyperactivation of endothelial aldosterone receptors leads to remodeling of the vascular wall, medial hypertrophy and endothelial hyperplasia. In addition, aldosterone activates the sympathetic division of the autonomic nervous system, increases free radical oxidation, which leads to the development of inflammation, remodeling, apoptosis and fibrosis.

  Thus, the appointment of aldosterone antagonists in various clinical conditions accompanied by hyperaldosteronism is justified from a pathophysiological point of view; these drugs have long been successfully used in clinical practice.

  As for patients who need to take aldosterone antagonists, these are, first of all, those suffering from CHF, arterial hypertension (AH), especially its resistant form. Also, these drugs are used in the treatment of cirrhosis of the liver with edematous syndrome, nephrotic syndrome, hypokalemia and primary hyperaldosteronism.

  Which aldosterone antagonists are used in modern cardiology?

  The most widely used aldosterone antagonist is spironolactone, a structural analogue of aldosterone. This drug, called the BS-8109 molecule, was developed in the mid-1950s. Spironolactone as a potassium-sparing diuretic was used in patients with edematous syndrome due to CHF and portal cirrhosis of the liver. It is the diuretic properties of high doses of Veroshpiron with simultaneous blockade of the loss of potassium and magnesium that have become the main indication for its use for a quarter of a century. These effects and the method of its use were described in detail in ours with Academician N.M. Mukharlyamov, my teacher, a monograph on the treatment of CHF, published at 1985 year.

  Then, in the 1980s, the presence of aldosterone receptors in the myocardium and vascular endothelium was proven. By the end of the 20th century, aldosterone antagonists or, as they came to be called, mineralocorticoid receptor antagonists (MCR) began to be used as neurohormonal modulators in the long-term treatment of CHF. This was discussed in detail in our meeting with Academician Yu.N. Belenkov monograph on the rational treatment of CHF, published in 2000.

  Already at 19In the 1960s, spironolactone demonstrated its effectiveness in hypertension, but it became widely used in clinical practice as an antihypertensive agent only in the second decade of the 21st century.

  Also used in cardiology is eplerenone, which is a chemical derivative of mexrenone, a metabolite of spironolactone. Spironolactone and eplerenone are competitive mineralocorticoid receptor antagonists, but have varying degrees of selectivity for them.

  There is another drug – canrenone, which is not registered in the Russian Federation. Finnerenone, the first non-steroidal aldosterone antagonist, is currently undergoing the third phase of clinical trials. As you can see, despite the more than 60-year history of their use, interest in this class of drugs is growing.

  What determines the effectiveness of spironolactone in the treatment of patients with CVD and what pharmacological characteristics does it have?

  Spironolactone is a non-selective, competitive mineralocorticoid receptor antagonist. By blocking aldosterone receptors, it has a diuretic and natriuretic effect, while maintaining potassium and magnesium ions in the body. Since a small amount of sodium is reabsorbed in the distal nephron, the diuretic effect of spironolactone is not very significant, but its diuretic effect is significantly enhanced when used with loop and thiazide diuretics.

  Spironolactone is similar in structure to progesterone, in this regard, it has the properties of a progesterone receptor agonist and a weak antagonist of androgen and corticosteroid receptors, which can lead to such undesirable phenomena as gynecomastia, menstrual irregularities, decreased libido and hirsutism. However, it must be borne in mind that adverse events are dose-dependent. Thus, in a large randomized clinical trial RALES in the treatment of patients with spironolactone at doses of 25–50 mg/day, the incidence of gynecomastia was
  did not exceed 8.5%.

  Spironolactone is a prodrug; its active metabolites, canrenoate and canrenone, are formed in the liver. The half-life of spironolactone is 13-24 hours, which is largely due to active metabolites that continue to act outside the “therapeutic window”. The time to reach maximum plasma concentration after morning administration is 2-6 hours. The drug is excreted mainly by the kidneys.

  What is the evidence base for spironolactone in resistant hypertension and CHF?

  Aldosterone antagonists, in particular spironolactone, can block the negative effects of excessive RAAS activation at all stages of the cardiovascular continuum. At the same time, the benefit of using this drug in resistant hypertension and CHF is maximum.

  In the management of patients with hypertension, spironolactone is an important component of the treatment of resistant hypertension. Let me remind you that hypertension is considered resistant when it is not possible to achieve a decrease in office blood pressure <140/90 mmHg Art. (according to the recommendations of 2018 - below 130/80 mmHg for people under 65 years of age) against the background of the recommended treatment tactics, which should include lifestyle modification measures and taking optimal doses of at least three drugs: a diuretic, an angiotensin-converting enzyme inhibitor ( ACE) or an angiotensin receptor blocker and a calcium channel blocker. If resistant hypertension is suspected, it is necessary to exclude secondary forms of hypertension and pseudoresistance, the causes of which may be low adherence to treatment, the “white coat” phenomenon, violation of the rules for measuring blood pressure, severe calcification of the brachial artery, the use of vasopressors or substances that promote sodium retention, and more.

  According to the PATHWAY-2 study (Prevention And Treatment of Hypertension With Algorithm-based therapy number 2), spironolactone was effective and safe in certain groups of patients with resistant hypertension, such as sleep apnea, obesity, and chronic kidney disease. In this study, spironolactone, compared with bisoprolol and doxazosin, had the maximum hypotensive effect when added to a three-component combination of an ACE inhibitor (or angiotensin receptor blocker), a calcium antagonist and a diuretic at maximum doses.

  Spironolactone has also played an important role in the treatment of CHF for over 40 years. It has been proven that hyperaldosteronemia negatively affects the prognosis and survival of patients with CHF due to the progression of CHF decompensation and an increased risk of sudden death.

  All patients suffering from CHF (in the absence of absolute contraindications) should receive ACE inhibitors in order to block the RAAS. However, it turned out that monotherapy with ACE inhibitors does not completely block the negative effects of RAAS, which is associated with the presence of ACE-independent pathways for the formation of angiotensin II (chymases and other enzymes). It is this effect of reducing the ability of ACE inhibitors to reduce aldosterone secretion, which we described in 1990s, was called “blockade slip phenomenon”. Moreover, this phenomenon develops in patients regardless of the dose of ACE inhibitors and manifests itself by the third month of continuous treatment, which was first shown by our group in 1990. There is also evidence that with long-term use of ACE inhibitors in CHF, alternative pathways for stimulating aldosterone synthesis are activated, not associated with angiotensin II, but mediated by endothelin, antidiuretic hormone, corticotropin and histamine. The identification of these additional activators of aldosterone synthesis served as a rationale for the use of mineralocorticoid receptor inhibitors in combination with an ACE inhibitor (and beta-blockers) for a more complete neurohumoral blockade in the treatment of patients with CHF, which was confirmed by the results of randomized placebo-controlled trials.

  The clinical validity of this hypothesis in 1999 was confirmed by the results of a double-blind placebo-controlled study RALES (Randomized ALdactone Evaluation Study). This study included patients with severe CHF (III-IV functional class according to the classification of the New York
  Association of Cardiology (NYHA)), who received spironolactone at a dose of 25–50 mg / day or placebo in addition to the then standard therapy with ACE inhibitors, diuretics and cardiac glycosides (almost without β-blockers). The study was terminated early due to the apparent superiority of spironolactone over placebo. As a result of a three-year follow-up, it was shown that the use of spironolactone can significantly reduce the risk of death by 27%, the total number of hospitalizations by 18%, and the number of hospitalizations as a result of CHF decompensation by 30%. Based on the results of the RALES study, spironolactone was included in European, American and Russian clinical guidelines for the treatment of patients with CHF.

  Thus, aldosterone antagonists have long and widely entered clinical practice and have not lost their positions for many years, however, it is important for practitioners to remember that these drugs often remain “overboard”, despite their extensive evidence base. In the US and Europe, for example, only one third of patients who need them are prescribed these drugs. In Russia, slightly more than half of patients with CHF and LVEF <40% take AMCR during inpatient treatment, but when switching to the outpatient stage of treatment, according to the EPOHA study conducted in 2017, only 14% of patients take spironolactone. At the same time, not only patients do not take or stop taking aldosterone antagonists, but doctors do not prescribe these drugs often enough.

  What place do aldosterone antagonists currently occupy in clinical guidelines?

  In the 2018 European clinical guidelines for the management of patients with hypertension, an important role in the treatment of resistant hypertension is assigned to AMKR as the main “assistant” of the main antihypertensive therapy, including RAAS blockers + slow calcium channel blockers + diuretics. This document notes that fourth-line therapy in the third step should include spironolactone at a dose of 25–50 mg/day. The main studies on the treatment of resistant hypertension were carried out with spironolactone. Also, emphasis is placed on the need to control the level of potassium and the glomerular filtration rate (GFR) of the kidneys. In patients with resistant hypertension, spironolactone is prescribed for GFR ≥45 ml/min/1.73 m ² and plasma potassium concentrations ≤4.5 mmol/L. The recommendations published by the Russian Society of Cardiology and approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in early 2020 also state that all patients with resistant hypertension should be supplemented with spironolactone at doses of 25–50 mg/day to achieve the target level of blood pressure. However, the use of spironolactone is contraindicated in patients with GFR ≤30 ml/min/1.73 m ² and plasma potassium concentration ≥5 mmol/l due to the risk of hyperkalemia. In this case, it is recommended to use loop diuretics.

  With regard to heart failure, the 2016 European guidelines for the diagnosis and treatment of acute and chronic heart failure indicate that spironolactone is recommended for all patients with NYHA functional class II-IV CHF (despite treatment with ACE inhibitors and beta-blockers) with reduced LVEF ≤ 35% to reduce mortality and hospitalizations for heart failure. This drug should be used with caution in patients with impaired renal function (creatinine >221 µmol/l or GFR <30 ml/min/1.73 m ² ), for which regular monitoring should be carried out depending on the clinical status of the patient, and potential drug interactions should also be carefully considered. The starting dose of spironolactone is 25 mg/day, the maintenance dose is 50 mg/day, it is recommended to increase the dose after 4–8 weeks of therapy. The recommendations also specifically mention the need to inform the patient that this treatment is being carried out to improve his well-being, survival and prevent worsening of the course of heart failure and reduce the number of hospitalizations; that symptomatic improvement while taking aldosterone antagonists does not occur immediately – it should take from several weeks to several months from the start of treatment; about the need to avoid non-steroidal anti-inflammatory drugs not prescribed by a doctor and salt substitutes with a high content of K ⁺ .

  From my point of view, an accessible explanation to the patient of the mechanisms of action and the reasons for prescribing these drugs to him is a very important stage of treatment that helps to improve the relationship between the doctor and the patient and increase adherence to treatment.

  In the joint recommendations of the Society of Heart Failure Specialists (OSSN) – the Russian Society of Cardiology (RSC) and the Russian Scientific Medical Society of Therapists (RNMOT) dated 2017, indications for the use of spironolactone (25-50 mg / day) are severe CHF III-IV FC and cases of acute circulatory decompensation when the drug is used in high doses. In CHF (starting with FC II) and in patients with acute myocardial infarction, with left ventricular dysfunction, the use of AMKR (spironolactone or eplerenone) at doses of 25-50 mg / day is indicated. It was also noted that in the presence of an elevated creatinine level >130 μmol/l, a history of renal failure, a decrease in GFR <30 ml/min/1. 73 m ² , hyperkalemia (and even moderate -> 5.2 mmol / l), the combination of aldosterone antagonists with ACE inhibitors requires careful clinical and laboratory monitoring. It is necessary to control the level of potassium and serum creatinine and the calculation of GFR after 2 and 4 weeks, then after 2 and 3 months of treatment, and then once every six months, which minimizes the number of adverse reactions.

  What should a doctor remember when prescribing spironolactone to his patients?

  In the treatment of decompensation, it is impossible to effectively and safely carry out dehydration therapy without the use of high doses of spironolactone as a potassium- and magnesium-sparing diuretic.

  With long-term therapy, only the use of the “triple neurohormonal blockade” tactics really prolongs the life of patients and improves its quality. The doctor should explain to his patients the goals of therapy. This is the only way to influence adherence to therapy and increase the number of patients taking spironolactone.