Spironolactone

Pronunciation

Generic Name: spironolactone (spir ON oh LAK tone)
Brand Names: Aldactone

What is spironolactone?

Spironolactone is a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.

Spironolactone is used to diagnose or treat a condition in which you have too much aldosterone in your body. Aldosterone is a hormone produced by your adrenal glands to help regulate the salt and water balance in your body.

Spironolactone also treats fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or a kidney disorder called nephrotic syndrome. This medication is also used to treat or prevent hypokalemia (low potassium levels in the blood).

Spironolactone may also be used for purposes not listed in this medication guide.

Important information

You should not use spironolactone if you have kidney disease, high levels of potassium in your blood, Addison's disease (an adrenal gland disorder), if you are unable to urinate, or if you are also taking eplerenone.

Slideshow: 2014 Update: First Time Brand-to-Generic Switches

In animal studies, spironolactone caused certain types of cancers or tumors. It is not known whether these effects would occur in people using this medicine. Ask your doctor about your risk.

Before taking this medicine

You should not use spironolactone if you are allergic to it, or if you have:

  • kidney disease, or if you are unable to urinate;

  • Addison's disease (an adrenal gland disorder);

  • high levels of potassium in your blood (hyperkalemia); or

  • if you are also taking eplerenone.

To make sure spironolactone is safe for you, tell your doctor if you have:

  • liver disease;

  • heart disease;

  • an electrolyte imbalance (such as low levels of magnesium in your blood); or

  • if you take an NSAID (nonsteroidal anti-inflammatory drug), cholestyramine, heparin, lithium, heart or blood pressure medication, potassium supplements, steroid medicine, or another diuretic.

In animal studies, spironolactone caused certain types of tumors, some of which were cancerous. However, very high doses are used in animal studies. It is not known whether these effects would occur in people using regular doses. Ask your doctor about your risk.

FDA pregnancy category C. It is not known whether spironolactone will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

See also: Pregnancy and breastfeeding warnings (in more detail)

Spironolactone can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

How should I take spironolactone?

Take spironolactone exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

While using spironolactone, you may need frequent blood tests.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using spironolactone.

If you need surgery, tell the surgeon ahead of time that you are using spironolactone. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from heat, light, and moisture.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid?

Drinking alcohol can increase certain side effects of spironolactone.

Do not use salt substitutes or low-sodium milk products that contain potassium. These products could cause your potassium levels to get too high while you are taking spironolactone.

Avoid a high-salt diet. Too much salt will cause your body to retain water, which may reduce the effectiveness of this medicine.

Spironolactone may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Spironolactone side effects

Get emergency medical help if you have any of these signs of an allergic reaction to spironolactone: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using spironolactone and call your doctor at once if you have:

  • signs of stomach bleeding--bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • high potassium--slow heart rate, weak pulse, muscle weakness or limp feeling, tingly feeling;

  • low sodium--confusion, slurred speech, hallucinations, severe weakness, loss of coordination, feeling unsteady, seizure (convulsions), fainting, shallow breathing (breathing may stop); or

  • symptoms of any electrolyte imbalance--dry mouth, increased thirst, drowsiness, lack of energy, restless feeling, confusion, nausea, vomiting, increased urination, muscle cramps or weakness, fast heart rate, little or no urinating, or feeling like you might pass out.

Common spironolactone side effects may include:

  • mild nausea or vomiting, diarrhea;

  • breast swelling or tenderness;

  • dizziness, headache, mild drowsiness;

  • leg cramps; or

  • impotence, difficulty having an erection.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Spironolactone dosing information

Usual Adult Dose for Edema:

25 to 200 mg/day orally in 1 or 2 divided doses.

Usual Adult Dose for Hypertension:

25 to 200 mg/day orally in 1 or 2 divided doses.

Usual Adult Dose for Hypokalemia:

25 to 200 mg/day orally in 1 or 2 divided doses.

Usual Adult Dose for Primary Hyperaldosteronism Diagnosis:

100 to 400 mg/day orally in 1 or 2 divided doses.

Usual Adult Dose for Hirsutism:

50 to 200 mg/day orally in 1 or 2 divided doses.

Usual Adult Dose for Congestive Heart Failure:

25 mg/day orally. Increase or decrease based on response and evidence of hyperkalemia.

Usual Adult Dose for Primary Hyperaldosteronism:

Initial dose: 100 mg orally once a day. This dosage may be divided into two daily doses, and increased as tolerated every two to three days to a maximum recommended total daily dose of 400 mg. It is recommended that the dosage be titrated to decrease sodium retention, hypertension, weakness, hypokalemia, and any other signs or symptoms of primary hyperaldosteronism in this patient.

If this patient has an adrenal adenoma or carcinoma, the lowest possible spironolactone dosage should be given while waiting for surgery. Adrenal hyperplasia, however, usually does not respond to surgery, and chronic spironolactone therapy is recommended.

Patients with adrenal hyperplasia often require other antihypertensive therapy to control their associated hypertension.

Usual Pediatric Dose for Hypertension:

Neonates: 1 to 3 mg/kg/day orally every 12 to 24 hours.
Children: 1.5 to 3.3 mg/kg/day or 60 mg/m2/day orally in divided doses every 6 to 12 hours not to exceed 100 mg/day.

Usual Pediatric Dose for Primary Hyperaldosteronism Diagnosis:

Children: 100 to 400 mg/m2/day orally in 1 to 2 divided doses.

What other drugs will affect spironolactone?

Taking this medicine with other drugs that make you dizzy or lower your blood pressure can worsen these effects. Ask your doctor before taking spironolactone with a narcotic pain medicine, muscle relaxer, or medicine for anxiety or seizures.

Other drugs may interact with spironolactone, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about spironolactone.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use spironolactone only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2014 Cerner Multum, Inc. Version: 9.02. Revision Date: 2014-04-13, 8:28:59 PM.

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