From the Guidelines
The maximum dose of spironolactone for high blood pressure is 100 mg daily. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, the usual dose range for spironolactone is 25-100 mg daily, taken as a single dose. This guideline suggests that spironolactone is a preferred agent in primary aldosteronism and resistant hypertension, but it is associated with a greater risk of gynecomastia and impotence compared to eplerenone.
Some key points to consider when prescribing spironolactone for high blood pressure include:
- Starting with a lower dose of 25 mg daily and gradually increasing as needed and tolerated
- Monitoring potassium levels and kidney function regularly to avoid hyperkalemia
- Avoiding use with potassium supplements, other potassium-sparing diuretics, or significant renal dysfunction
- Being aware of potential side effects such as gynecomastia, menstrual irregularities, and increased urination
It is essential to weigh the benefits and risks of spironolactone in individual patients, particularly considering its potential side effects and interactions with other medications. As stated in the guideline 1, eplerenone is often preferred over spironolactone due to its more favorable side effect profile, but spironolactone remains a valuable option for certain patients with high blood pressure.
From the FDA Drug Label
2.3 Treatment of Essential Hypertension The recommended initial daily dose is 25 mg to 100 mg of spironolactone tablets administered in either single or divided doses is recommended. Dosage can be titrated at two-week intervals. Doses greater than 100 mg/day generally do not provide additional reductions in blood pressure.
14.2 Hypertension The dose response of spironolactone for hypertension has not been well characterized. In patients with hypertension, decreases in systolic blood pressure have been observed at doses ranging from 25 mg/day to 100 mg/day. Doses greater than 100 mg/day generally do not provide additional reductions in blood pressure [see Dosage and Administration (2.3)] .
The maximum dose of spironolactone for high blood pressure is 100 mg/day. Doses greater than 100 mg/day generally do not provide additional reductions in blood pressure 2 2.
From the Research
Maximum Dose of Spironolactone for High Blood Pressure
The maximum dose of spironolactone for high blood pressure is not strictly defined, but several studies provide guidance on safe and effective dosing.
- The study 3 suggests that a daily spironolactone dose of 25 mg should not be exceeded, especially in patients with renal insufficiency, diabetes, older age, worsening heart failure, or those at risk for dehydration.
- Another study 4 used a dose of 25 to 50 mg of spironolactone once daily and found it to be effective in reducing blood pressure in patients with resistant hypertension.
- The study 5 reviews the pharmacology and efficacy of spironolactone in treating resistant hypertension and notes that the average blood pressure lowering achieved with spironolactone was 22/10 mm Hg, but does not specify a maximum dose.
- The study 6 found that spironolactone was associated with a significant fall in blood pressure among patients with chronic kidney disease and difficult-to-control blood pressure, but also notes that the incidence of hyperkalemia was higher in this group.
- The study 7 used a dose of 25 mg once daily and found that adding spironolactone to conventional antihypertensive treatment safely reduced albuminuria and blood pressure in type 2 diabetic patients with nephropathy.
Key Considerations
- Patients with renal insufficiency, diabetes, or older age may require closer monitoring and lower doses of spironolactone due to the risk of hyperkalemia 3, 6.
- The dose of spironolactone should be individualized based on the patient's response and tolerance, with regular monitoring of blood pressure, serum potassium, and renal function 4, 5.