Spironolactone

💊 What is Spironolactone used for?

• •Heart failure with reduced ejection fraction (NYHA Class III-IV), to help increase survival, manage edema, and reduce the need for hospital stays for heart failure. The label says it is usually given with other heart failure medicines.
• •High blood pressure, as an add-on medicine for people not adequately controlled on other medicines. The label notes that lowering blood pressure reduces the risk of strokes and heart attacks.
• •Edema in adults who have cirrhosis when fluid and sodium restriction has not helped, or in nephrotic syndrome when other treatments have given an inadequate response.
• •Primary hyperaldosteronism: short-term treatment before surgery, or long-term maintenance for people who cannot have surgery, such as those with aldosterone-producing adrenal adenomas or bilateral adrenal hyperplasia.

How it works

How it is usually taken

• •The label says spironolactone can be taken with or without food, but it should be taken consistently with respect to food. The dose and schedule vary by condition and are set by your prescriber. Follow the instructions from your prescriber or pharmacist.

Comes as

• •25 mg tablets: white, round, unscored, debossed MP 35
• •50 mg tablets: white, round, film coated, scored, debossed MP 542
• •100 mg tablets: white, oval, film coated, scored, debossed MP 303

⚠️ Spironolactone side effects

🛑 Who should not take Spironolactone, and who should be careful

The label says not to take it if

• 🚨You have high potassium (hyperkalemia).
• 🚨You have Addison's disease.
• 🚨You are taking eplerenone.

Tell your doctor before taking it if

• •The label says high potassium (hyperkalemia) is a key risk. Your prescriber should monitor potassium levels within one week of starting and regularly after that.
• •Avoid potassium supplements, foods high in potassium, and salt substitutes, as the label advises.
• •Tell your prescriber about kidney problems, liver problems, or dehydration, because the label describes higher risks in these situations.
• •Your prescriber may also check electrolytes, uric acid, blood glucose, and kidney function from time to time.
• •The label says lithium levels should be checked periodically if you take lithium.

🔀 Spironolactone with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Potassium supplements, salt substitutes, or drugs that raise potassium, such as ACE inhibitors, angiotensin receptor blockers, NSAIDs, heparin, and trimethoprim. Combining these can lead to severe high potassium.
• •Lithium: spironolactone can increase the risk of lithium toxicity.
• •NSAIDs (such as ibuprofen): may reduce the diuretic and blood-pressure-lowering effect of spironolactone.
• •Digoxin: spironolactone can interfere with some lab tests for digoxin levels. The label says to use an assay that does not interact with spironolactone.
• •Cholestyramine: high potassium with acid buildup (hyperkalemic metabolic acidosis) has been reported.
• •Acetylsalicylic acid (aspirin): may reduce how well spironolactone works.
• •Abiraterone: may increase prostate-specific antigen (PSA) levels.
• •Mitotane: the label says to avoid using it with spironolactone.
• •Drugs that harm the kidneys, such as aminoglycosides, cisplatin, and NSAIDs, can worsen kidney function.

Alcohol and food

The label says spironolactone can be taken with or without food, but it should be taken consistently with respect to food. The label does not give specific alcohol guidance in the text provided.

🤰 Spironolactone in pregnancy and breastfeeding

Pregnancy

The label says that because of the potential risk to a male fetus, spironolactone should be avoided in pregnant women, or a pregnant woman should be told about the potential risk to a male fetus. The label also notes that heart failure, cirrhosis, and poorly controlled high blood pressure carry their own risks during pregnancy. Talk with your prescriber about any pregnancy.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store at 20° to 25°C (68° to 77°F), in a tight, light-resistant container.

If a dose is missed

The label does not say.

If too much is taken

The label says acute overdose may cause drowsiness, mental confusion, a rash, nausea, vomiting, dizziness, or diarrhea. Hyperkalemia may also occur, especially in people with impaired kidney function. The label says there is no specific antidote, and treatment is supportive, focusing on hydration, electrolyte balance, and vital functions. Get emergency medical help right away if an overdose is suspected.

🗒️ Questions to ask about Spironolactone

• Why am I taking spironolactone, and what condition is it treating for me?
• How often will I need blood tests to check my potassium and kidney function?
• Which foods, salt substitutes, or supplements should I avoid while taking this medicine?
• What should I do if I think I have taken too much or missed a dose?
• Are any of my other medicines, including ibuprofen or lithium, a concern with spironolactone?
• What signs should make me call you or seek urgent care while I am on this medicine?

❓ Spironolactone: frequently asked questions