Spironolactone and Hydrochlorothiazide (Oral)

Spironolactone and hydrochlorothiazide is used in the treatment of a variety of conditions, including hypertension, water retention in patients

Overview

In the United States, spironolactone and hydrochlorothiazide is sold under the brand name, Aldactazide.

Spironolactone and hydrochlorothiazide is a combination medication that is widely used in the treatment of a number of conditions, including hypertension, water retention in patients with congestive heart failure, nephrotic syndrome, liver cirrhosis, and hypokalemia.

The medication works very effectively by preventing your body from absorbing too much salt. It also helps to keep your potassium levels from falling too far, a condition called hypokalemia. Both spironolactone and hydrochlorothiazide are diuretic medicines. They work to reduce the amount of water in the body through increasing the flow of urine, helping to bring down the blood pressure. Consequently, these 'water tablets' are inclined to make the patient urinate more frequently than usual, which can interfere with sleep patterns if the medication is taken too close to the patient's bedtime.

Spironolactone and hydrochlorothiazide is only available on prescription from your doctor or treating physician and comes in tablet form.

Conditions treated

  • hypertension
  • water retention
  • nephrotic syndrome
  • liver cirrhosis
  • hypokalemia

Type of medicine

  • diuretic
  • tablet

Side-effects

Although spironolactone and hydrochlorothiazide will be beneficial to your well-being, it is possible that you may experience a few unpleasant side-effects when you first begin taking it. Tell your doctor immediately if you have ever had an allergic reaction to any other prescription medication or if you have any allergies to certain foods, preservatives, animal derivatives, or dyes.

The following are all side-effects that have been reported by people taking spironolactone and hydrochlorothiazide. If you experience any of these effects, you should be sure to mention them to your doctor immediately.

  • unusual tiredness or weakness
  • unusual bleeding or bruising
  • troubled breathing
  • trembling
  • tightness in the chest
  • swollen, painful, or tender lymph glands in the neck, armpit, or groin
  • swelling of the face, hands, fingers, feet, or lower legs
  • sores, ulcers, or white spots on the lips or in the mouth
  • sore on the skin of the breast that does not heal
  • seizures
  • redness, soreness, or itching skin
  • redness or swelling of the breast
  • red, irritated eyes
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • pinpoint red or purple spots on the skin
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • painful or difficult urination
  • numbness, tingling, pain, or weakness in the hands, feet, or lips
  • nausea and vomiting
  • muscle cramps or pain
  • lump in the breast or under the arm
  • lower back or side pain
  • joint pain, stiffness, or swelling
  • jaundice
  • inverted nipple
  • increased thirst
  • increased hunger
  • hives or welts, skin rash
  • greatly decreased frequency of urination or amount of urine
  • general body swelling
  • fruit-like breath odor
  • flushed, dry skin
  • fever, with or without chills
  • feeling of discomfort or illness
  • feeling dizzy, faint, or lightheaded when getting up suddenly from a lying or sitting position
  • fast or irregular heartbeat
  • difficulty with swallowing
  • difficult, fast, or noisy breathing
  • diarrhea
  • decreased appetite
  • dark urine
  • crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • cough or hoarseness
  • confusion
  • clear or bloody discharge from the nipple
  • clay-colored stools
  • chest pain
  • blurred vision
  • blue lips and fingernails
  • bloody or cloudy urine
  • bloody or black, tarry stools
  • blistering, peeling, or loosening of the skin
  • back or leg pains
  • abdominal or stomach cramping tenderness

Take care not to overdose on this medication. The following are symptoms of overdose with spironolactone and hydrochlorothiazide. If you notice any of the following symptoms, call 911.

  • rash with flat lesions or small raised lesions on the skin
  • mood or other mental changes
  • lethargy
  • hallucination
  • feeling lightheaded
  • drowsiness to profound coma
  • disorientation
  • difficulty with sleeping

Some of the following side-effects that can be caused by spironolactone and hydrochlorothiazide may resolve themselves without the need for medical intervention, as your body gets used to the new drug. Ask your doctor's advice on how to manage or prevent these effects if they are persistent or particularly bothersome.

  • swelling of the breasts or breast soreness in both females and males
  • stopping of menstrual bleeding
  • stomach upset
  • severe sunburn
  • sensation of spinning
  • restlessness
  • muscle spasm
  • increased sensitivity of the skin to sunlight
  • inability to have or keep an erection
  • feeling of constant movement of self or surroundings
  • discoloration of the skin
  • burning feeling in the chest or stomach
  • bleeding after menopause
  • absent, missed, or irregular menstrual periods

This list of recognized side-effects that have been experienced by patients taking spironolactone and hydrochlorothiazide is not necessarily exhaustive. If you do not feel that your condition is showing an improvement or you think that your symptoms are actually getting worse since beginning your course of treatment, you should ask your doctor for advice.

Dosage

Spironolactone and hydrochlorothiazide is only available on prescription from your doctor or specialist. The medication comes in tablet form.

The dose of spironolactone and hydrochlorothiazide that you are prescribed will vary from that given to other patients, depending on the condition that you are being treated for. Follow your doctor's orders or the directions on the dispensed product label. The dose outlined below is only the average recommended dose for this medicine. Do not change the dose that you have been prescribed, unless you are told to do so by your doctor.

Take your prescription of spironolactone and hydrochlorothiazide exactly as per your doctor's directions. Do not take more than you have been prescribed, take it more often, or for a longer period than you have been told to. This could increase the risk of you experiencing serious side-effects.

Your prescription will be dispensed with patient guidelines. Be sure to read the guidelines thoroughly and ask your doctor or specialist if you have any queries.

Do not share your medicine with anyone else.

For the treatment of edema

  • Adults: 100mg each of spironolactone and hydrochlorothiazide each day, either in one dose or divided doses. Your treating physician may adjust your dose as necessary.
  • Children: use and dose as instructed by your doctor.

For the treatment of hypertension

  • Adults: 50g to 100mg each of spironolactone and hydrochlorothiazide each day, either in one dose or divided doses. Your treating physician may adjust your dose as necessary.
  • Children: use and dose as instructed by your doctor.

Your doctor may also include a weight control program in your treatment regimen, including changes in the kinds of foods you eat, especially those that are high in potassium and salt. Before changing your diet, you should consult your doctor.

Take your medication exactly as you are directed to by your doctor, and keep any check-up appointments. Remember that, even though you may feel completely normal, you may still have high blood pressure.

Treatment with spironolactone and hydrochlorothiazide will not cure your condition, but it may help to control it. You must continue to take the medication as directed; this may be for the rest of your life. If you do not have treatment to control your hypertension, you could develop serious complications including, blood vessel disease, kidney disease, stroke, or heart failure.

If you omit a dose of your medication, try to take it as soon as possible. If the time of your next dose is almost due, skip the dose that you have missed and go back to your usual schedule. Do not take a double dose. Taking the medication at the same time/s each day can help to ensure that you do not forget to take a dose. As this drug causes the body to produce more urine, you may want to take your last dose at least two hours before bedtime to avoid the need to get up during the night.

You can take this medication with or without food.

You must swallow the tablet whole. Do not chew, suck, crush, or split the tablet; to do so will affect the rate at which the drug is absorbed by your body and can affect the way that it works.

Major drug interactions

Some drugs should not be taken at the same time. However, in other cases, different medicines and treatments can be used in tandem, even if an interaction does occur. Under these circumstances, your doctor may alter the dose of one or more of your prescriptions or may advise you to take other measures to avoid unwanted that interactions may cause.

If you are prescribed spironolactone and hydrochlorothiazide, it is extremely important that you tell your doctor if you are already taking any of the drugs that are listed below. These drugs are known to have interactions with spironolactone and hydrochlorothiazide and their use is NOT recommended.

  • Triamterene
  • Eplerenone
  • Dofetilide
  • Dyazide®
  • Dyrenium®
  • Maxzide®
  • Midamor®
  • Moduretic®

Taking this medication with any of the following drugs is not generally recommended, but it may be necessary in some cases. If you are prescribed both medicines, your treating physician may alter the dose and how often you take one or more of the medications.

  • Aceclofenac
  • Zofenopril
  • Valdecoxib
  • Trimethoprim
  • Trandolapril
  • Tolmetin
  • Tolfenamic Acid
  • Tiaprofenic Acid
  • Tenoxicam
  • Temocapril
  • Sulindac
  • Spirapril
  • Sotalol
  • Sodium Salicylate
  • Salsalate
  • Salicylic Acid
  • Rofecoxib
  • Ramipril
  • Quinapril
  • Proscillaridin
  • Proquazone
  • Propyphenazone
  • Proglumetacin
  • Pranoprofen
  • Potassium
  • Piroxicam
  • Piketoprofen
  • Phenylbutazone
  • Perindopril
  • Pentopril
  • Parecoxib
  • Oxyphenbutazone
  • Oxaprozin
  • Ouabain
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Niflumic Acid
  • Nepafenac
  • Naproxen
  • Nabumetone
  • Morniflumate
  • Moexipril
  • Metildigoxin
  • Methotrexate
  • Meloxicam
  • Mefenamic Acid
  • Meclofenamate
  • Lumiracoxib
  • Loxoprofen
  • Lornoxicam
  • Lithium
  • Lisinopril
  • Levomethadyl
  • Ketorolac
  • Ketoprofen
  • Ketanserin
  • Indomethacin
  • Imidapril
  • Ibuprofen
  • Fosinopril
  • Flurbiprofen
  • Flufenamic Acid
  • Floctafenine
  • Flecainide
  • Feprazone
  • Fepradinol
  • Fenoprofen
  • Felbinac
  • Etoricoxib
  • Etofenamate
  • Etodolac
  • Enalaprilat
  • Enalapril Maleate
  • Droxicam
  • Droperidol
  • Dipyrone
  • Digoxin
  • Digitoxin
  • Digitalis
  • Diflunisal
  • Diclofenac
  • Dexketoprofen
  • Dexibuprofen
  • Deslanoside
  • Delapril
  • Cyclophosphamide
  • Clonixin
  • Cilazapril
  • Choline Salicylate
  • Celecoxib
  • Captopril
  • Bufexamac
  • Bromfenac
  • Benazepril
  • Aspirin
  • Arsenic Trioxide
  • Arginine
  • Amtolmetin Guacil
  • Amphetamine
  • Alacepril
  • Acetyldigoxin
  • Acemetacin

Using this medication with any of the products listed below could increase the risk of side-effects, although using both together might be the most effective therapy for your condition.

  • Topiramate
  • Licorice
  • Gossypol
  • Ginkgo
  • Digitoxin
  • Cholestyramine
  • Carbamazepine
  • Bepridil

Some medicines should not be taken with certain foodstuffs, when eating, smoking or drinking alcohol. If any of these applies to you, ask your doctor for advice.

This list is not necessarily all-inclusive. If you already taking a medicine that is not included in the above list, tell your doctor before taking spironolactone and hydrochlorothiazide.

Warnings

If you have a history of some medical problems, it can affect the use of spironolactone and hydrochlorothiazide. Be sure to tell your doctor if you suffer from any other medical problems, in particular:

  • severe liver disease
  • severe kidney disease
  • hyperkalemia
  • hypercalcemia
  • anuria
  • Addison's disease

This drug should NOT be used in patients who are known to have a sulfa drug allergy.

Asthma sufferers should not take this drug as it can increase the chances of a severe allergic reaction.

Using spironolactone and hydrochlorothiazide in patients with the following medical problems can risk making the conditions worse:

  • Diabetes
  • low chloride
  • low magnesium
  • low potassium
  • low sodium
  • dehydration
  • glaucoma, secondary angle-closure
  • gout
  • high cholesterol or fats in the blood
  • kidney disease
  • liver disease
  • myopia
  • systemic lupus erythematosus
  • sympathectomy

If you experience blurred vision, problems reading, eye pain or any other visual disturbances, check with your doctor straight away, as this could indicate a serious eye problem. Your doctor may refer you to an ophthalmologist for further tests.

Some patients feel dizzy, sleepy, lightheaded or faint when taking this drug, especially when getting up quickly from a seated or lying position. Be sure that you understand how you will react to this drug before driving or operating machinery. If you do feel dizzy, sit down for a few minutes so that you don't pass out, and then get up again slowly.

You should consult your doctor immediately if you become nauseous or begin vomiting while you are taking this medication. If you have diarrhea, you should also tell your doctor. All these conditions could cause dehydration and low salt levels in your body, potentially leading to low blood pressure. Be sure to drink plenty of water when exercising or during hot weather to combat dehydration.

If you notice a change in your blood or urine sugar test results, mention this to your doctor. Spironolactone and hydrochlorothiazide can affect your blood sugar levels.

This drug can cause gynecomastia (swelling of the breasts) and breast pain in some people. If you find that you are affected in this way, talk to your doctor.

When deciding to use this medication, you should weigh up the risks and benefits of taking it. Your doctor will discuss the pros and cons of using spironolactone and hydrochlorothiazide with you in greater detail.

You must tell your doctor if you have ever suffered any allergic reactions to any form of prescription or non-prescription medication, herbal remedies, or vitamin supplements. You should also mention any allergies that you have to foods, preservatives, dyes, or animal derivatives.

You will need to attend your doctor for regular blood tests to monitor your progress and to check for any side-effects while you are taking this medication. Your doctor will advise you further on this.

There is no evidence to suggest that taking this medication can affect the unborn baby. If you are pregnant or if you are intending to become pregnant while you are being treated with spironolactone and hydrochlorothiazide, you should discuss the potential risks with your doctor, before commending your course of treatment.

It is unclear whether spironolactone and hydrochlorothiazide pass from the mother into her breast milk. However, it may be advisable not to breastfeed your infant while you are being treated with this drug. Ask your midwife or doctor for more advice on some alternatives for feeding your child.

Storage

Always keep your supply of spironolactone and hydrochlorothiazide in a sealed, airtight container and at room temperature. Do not freeze or refrigerate the medication. Do not expose it the medication to direct sunlight or to sources of heat.

Keep the medication in a safe place that is well away from children and pets. In the event that a pet consumes spironolactone and hydrochlorothiazide, you should seek veterinary advice immediately.

Do not keep any leftover or unwanted medication. Do not use any drugs that have become out-of-date.

Do not flush unwanted medication down the toilet or the drain. Do not throw any unused spironolactone and hydrochlorothiazide tablets out with your trash, as this could present a danger to small children and pets. Always ask your doctor or pharmacist for advice on the safe disposal of unwanted or unused medication.

Summary

Spironolactone and hydrochlorothiazide is used in the treatment of a variety of conditions, including hypertension, water retention in patients with congestive heart failure, nephrotic syndrome, liver cirrhosis, and hypokalemia.

Spironolactone and hydrochlorothiazide can cause many side-effects in people taking it. People who suffer from serious kidney or liver disease, diabetes, or conditions that cause an electrolyte imbalance within the body should not take this medication. One of the more serious side-effects of this medication is dehydration. Be sure to drink plenty of water while taking this drug and guard against sickness and diarrhea. Avoid eating foods that contain too much salt and potassium, as this can exacerbate dehydration.

Spironolactone and hydrochlorothiazide is undoubtedly very effective in controlling many of the unpleasant symptoms of a number of medical conditions, including high blood pressure. In order to get the best results from your treatment with spironolactone and hydrochlorothiazide, it is important that you have full and frank discussions with your doctor to determine the appropriate dose and frequency of use for this drug. During your course of treatment, it is essential that you attend your doctor for regular check-ups. These visits will include blood and urine tests, which are necessary to allow your doctor to make sure that the drug is working effectively and that there are no unwanted side-effects.

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Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018