Spironolactone

An oral medication for the treatment of fluid build-up as a consequence of liver cirrhosis, heart failure and kidney disease, spironolactone is also known by the brand name Aldactone.

Overview

Spironolactone is a potassium-sparing diuretic used to treat a number of ailments, primarily the build-up of fluid in the body as a result of liver scarring, kidney disease, and heart failure. It has also proven effective for treating hypertension (or, high blood pressure) and low levels of potassium in the blood that have failed to improve following use of potassium supplements. Spironolactone is also used for a number of hormonal treatments, such as excessive hair growth and acne amongst female patients and early-onset puberty, as well as in courses of hormone therapy treatment for the use of transgender women.

Spironolactone is a steroid-based medication whose impact is caused by blocking the effects of testosterone and aldosterone hormones, and which exhibits some effects that are similar to estrogen. As an effective aldosterone blocker, spironolactone is often employed to treat and diagnose hyperaldosteronism, which is a medical condition where too much aldosterone is produced by the patient’s adrenal gland.

Spironolactone is often used as a combination treatment with other drugs to combat the effects of heart failure and hypertension by helping to lower blood pressure. This reduction in blood pressure has been proven to lower the chance of suffering from heart attacks and strokes.

Spironolactone effectiveness in the treatment of fluid retention comes about by its properties as a water pill. It successfully prevents excessive levels of salt from being absorbed by the body and aids the body in keeping its levels of potassium at a sufficiently high level. As such, it is also a recommended treatment for patients suffering from hypokalemia, of which low levels of potassium in the patient’s blood are symptomatic.

Spironolactone is only available with a prescription from your health care professional.

Spironolactone is available in the following dosage form:

  • Tablet

Conditions Treated

  • hypertension (high blood pressure)
  • strokes
  • heart attacks
  • heart failure
  • hyperaldosteronism
  • edema (fluid retention) – for patients with certain medical conditions
  • hypokalemia (low levels of potassium in a patient’s blood)
  • early-onset puberty
  • excessive hair growth and acne in women
  • hormone therapy (specifically in the case of transgender women)

Type of Medicine

  • potassium-sparing diuretic
  • steroid

Side Effects

In addition to its desired and expected impact on the body, spironolactone may also induce several less desirable effects. While there is no guarantee that all, or even some, of these side effects will occur, should any of them do so, they might require the attention of a medical professional.

Should any of these listed side effects occur during your course of treatment with spironolactone, you should immediately consult your doctor.

  • yellow skin or eyes
  • weight gain
  • vomiting of material resembling coffee grounds
  • vomiting of blood
  • unusual weakness or tiredness
  • unusual bruising or bleeding
  • trembling, unsteadiness, or other difficulties with coordination or muscle control
  • unpleasant breath odor
  • troubled breathing
  • trembling
  • tightness to the chest
  • painful, tender, or swollen lymph glands on the neck, in the groin, or armpit
  • swelling of the lower legs, ankles, feet, fingers, and face
  • white spots, ulcers, or sores in the mouth, or on the lips
  • sore throat
  • sores appearing on the skin around the breast that will not heal
  • unsteady walk, or shakiness
  • severe pain to the stomach
  • swelling or redness of the breast
  • swelling or puffiness around the eyes, or on the eyelids, or around the tongue, lips, or face
  • red pinpoint spots upon the skin
  • persistent scaling or crusting of the nipple
  • difficult or painful urination
  • vomiting and nausea
  • muscle twitching, or spasms
  • muscle cramps, or pain
  • lump under the arm, or in the breast
  • side or lower back pain
  • loss of appetite
  • inverted nipple
  • indigestion
  • increased thirst
  • skin rash, itching, or hives
  • heartburn
  • headache
  • overall feeling of weakness or tiredness
  • fever, occurring with chills, or without
  • irregular or fast heartbeat
  • drowsiness
  • dizziness
  • dimpling of the skin around the breast
  • difficulty when swallowing
  • diarrhea
  • noticeable decrease in output of urine, or noticeable decrease in ability of urine-concentrating
  • dark urine
  • hoarseness or coughing
  • convulsions
  • constipation
  • confusion
  • coma
  • cloudy urine
  • bloody or clear discharge from the nipples
  • clay-colored stools
  • chills
  • chest pain
  • breast pain
  • bloody urine
  • black and tarry, or bloody stools
  • bleeding gums
  • stomach or abdominal cramps, tenderness, or burning

It is possible to overdose on spironolactone. Should any symptoms of overdose, such as those listed below, occur during your course of treatment, it’s essential that you get immediate emergency assistance.

  • heaviness or weakness of the legs
  • reddened skin
  • rash with small raised lesions, or flat lesions upon your skin
  • tingling or numbness in the lips, hands, or feet
  • nervousness

While the above effects most likely will require the attention of a medical professional, some effects might occur that will not need a consultation with a doctor. Such effects will often disappear during the course of your treatment with spironolactone as you find your body adjusting to the medication. Additionally, your prescribing doctor might offer you some ways in which you can reduce or prevent the impact of some of these effects. You should check with your doctor or other health care profession should you exhibit any of the effects listed below and they continue throughout your treatment, or become bothersome to you.

  • feeling of general sluggishness, or an unusual dullness
  • soreness or swelling of the breasts (this might occur in both males and females)
  • upset stomach
  • blisters, welts, or sores
  • leg cramps
  • thinning or loss of hair

These are the most common side effects associated with spironolactone, but there might be other unlisted effects which can occur among some patients. Should you notice any unexpected effects during your course of treatment, consult your prescribing doctor.

Dosage

The dosage prescribed for spironolactone differs between patients. You should always follow the orders of your doctor or the instructions printed on the drug’s label. The information listed below only includes the average dosage for this medication. Should your doctor prescribe a different dosage you should not alter it unless told to do so by your prescribing doctor.

The amount of spironolactone you will be prescribed is determined by the strength of the medication. Additionally, the duration of your course of treatment, the number of times you are expected to take it, and the time permitted between dosages will all depend upon the specific medical condition for which it is prescribed.

For oral dosage form tablets:

For edema:

Adults: initially 100 milligrams (mg) each day, either taken as a single dosage or divided across the day. Your prescribing doctor might choose to adjust the dosage if required.

Children: the specific dosage and usage will be determined by your prescribing doctor.

For heart failure:

Adults: initially 25 milligrams (mg) each day. Your prescribing doctor might choose to adjust the dosage if required and if you can tolerate it.

Children: the specific dosage and usage will be determined by your prescribing doctor.

For high blood pressure:

Adults: initially 50 milligrams (mg) to 100 mg each day, either taken as a single dosage or divided across the day. Your prescribing doctor might choose to adjust the dosage if required.

Children: the specific dosage and usage will be determined by your prescribing doctor.

For low level of blood potassium:

Adults: 25 milligrams (mg) to 100 mg each day.

Children: the specific dosage and usage will be determined by your prescribing doctor.

For excess levels of aldosterone in the body:

Adults: 400 milligrams (mg) per day, for 4 days, or 400 mg per day over the course of three to four weeks in order to diagnose the condition, followed by 100 mg to 400 mg each day once the diagnosis has been confirmed.

Children: the specific dosage and usage will be determined by your prescribing doctor.

If you fail to take a dosage of spironolactone, you should ensure that you take it again as soon as you can. However, should it be close to the timing of your next due dosage, you should skip the dose that you missed and return to your regular schedule. Under no circumstances should you double your doses.

Major Drug Interactions

Whilst some drugs ought not to be used together under any circumstances, under certain conditions two separate medications might be prescribed at the same time, even if it is expected that an unwanted interaction might take place. In such cases, it is likely that your prescribing doctor might choose to alter the dosage or recommend other precautions as they deem necessary. When taking spironolactone, it is essential that you inform your healthcare professional if you are also taking any of the following medications. The interactions listed below have been chosen based on their likely significance. This list might not necessarily be exhaustive.

Using spironolactone alongside the following drugs is not advisable. Your prescribing doctor may choose not to prescribe this medication or might decide to alter some of your other prescriptions.

  • Triamterene
  • Eplerenone

Using spironolactone alongside any of the drugs listed below is not normally advisable, but it might be necessary in certain cases. Should both medications be prescribed at once, your prescribing might choose to amend the dosage, or the frequency of doses for either of the drugs prescribed, or both of them.

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

Using spironolactone alongside the medicines listed below might result in a higher chance of some side effects, but utilising both medications at once might be the ideal course of treatment for your condition. Should both drugs be prescribed at the same time, your prescribing doctor might choose to alter the dosage or frequency of either of the medications or both of them.

  • Licorice
  • Gossypol
  • Digitoxin

Warnings

When choosing to use any medication, you must always weigh the risks of taking it against the positive impact it might have. You and your prescribing doctor should come to this decision following your consultation. When taking spironolactone, you should have consideration of the following items:

Be sure to inform your prescribing doctor should you ever have suffered an allergic or otherwise unusual reaction to spironolactone, or any other form of medication. Also make your doctor aware if you suffer from any other kind of allergy, including an allergic reaction to animals, preservatives, dyes, or foods.

Appropriate studies have yet to be performed regarding the relationship between age and the impact of spironolactone among the pediatric population.

There is no information currently available regarding the relationship between age and the impact of spironolactone among geriatric patients.

No adequate studies have been undertaken among pregnant women to determine the effect of spironolactone on the fetus in the womb.

Studies among women indicate that spironolactone poses a minimal risk to nursing infants when taken by the mother during breastfeeding.

Certain additional medical conditions can affect your usage of spironolactone. Be sure to inform your doctor should you suffer from any other medical concerns, particularly any of the following:

  • adrenal problems, such as Addison's disease
  • anuria (an inability or difficulty in passing urine)
  • hyperkalemia (high levels of potassium in the patient’s blood)
  • severe kidney disease

ironolactone should not be taken by patients suffering from the above conditions.

  • imbalance of electrolytes, including low sodium, magnesium, or chloride levels in the patient’s body
  • imbalances of fluids, such as may be caused through diarrhea, vomiting, or dehydration
  • severe liver disease, including cirrhosis

Spironolactone should be used with extreme caution by patients suffering from the above conditions, as it has been shown to make them worse.

Your doctor may recommend a change in diet (particularly the consumption of certain high-sodium and high-potassium foodstuffs), and a weight control regimen, alongside spironolactone, when being treated for high blood pressure. You should always consult with your prescribing doctor before making changes to your diet.

Often, patients suffering from hypertension are unaware of any symptoms, and may well feel quite normal. It is essential that you complete your course of spironolactone precisely as your doctor prescribes, and that you attend any follow-up appointments, even though you might feel quite well.

Spironolactone is not a cure for hypertension, only a method of controlling it.

Do not use spironolactone alongside eplerenone, as the combination of these drugs may result in serious unwanted side effects.

Unless previously discussed with your prescribing doctor, do not take any potassium supplements, and do not take any salt substances that contain potassium. Certain diuretics, including amiloride and triamterene, should also be avoided, as should other medical products that contain spironolactone.

Spironolactone is known to cause light-headedness, drowsiness and dizziness among certain patients. Be sure that you are aware of your reaction to spironolactone before using machinery, driving, or doing anything else that requires a clear head.

Should you become ill during your course of spironolactone, be sure to consult your prescribing doctor immediately. This is particularly important should you develop severe or continuous diarrhea, vomiting, or nausea that does not appear to stop. Such symptoms might result in you losing too much salt or water, resulting in hypotension, or low blood pressure.

Spironolactone might cause gynecomastia (an unusual swelling of the breasts in both males and females), or painful breasts among certain patients. Should you have any concerns in this matter, you should consult your prescribing doctor.

Storage

Spironolactone should always be stored away from direct light, moisture, and heat. It should be kept from freezing at room temperature and in a closed container.

Spironolactone should always be kept beyond the reach of children.

If you no longer require your spironolactone tablets, or if they should become outdated, you should not keep them.

Be sure to consult your medical professional before disposing of any unwanted or outdated spironolactone.

Summary

Spironolactone is an effective treatment for a variety of conditions, particularly the build-up of fluid in the body as a consequence of liver scarring, kidney disease, and heart failure. It also has its uses in the treatment of hypertension and low blood-potassium, as well as in hormonal treatments such as early-onset puberty, excessive hair growth and acne in women, and hormone therapy courses for transgender women.

Its primary impacts are as a diuretic for reducing built-up fluids, a hormone blocker for its various uses as a hormonal treatment, and lowering blood pressure to treat heart failure and hypertension.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017