From the Guidelines
Spironolactone is contraindicated in patients with hyperkalemia, those taking other potassium-sparing diuretics, potassium supplements, CYP3A4 inhibitors, and the combined use of an angiotensin receptor blocker and angiotensin-converting enzyme inhibitor due to the increased risk of hyperkaliemia and subsequent cardiac arrhythmia. The use of spironolactone, a potassium-sparing diuretic, requires careful consideration of its potential side effects and contraindications, as highlighted in a recent study published in 2024 1.
Key Contraindications
- Hyperkalemia
- Use of other potassium-sparing diuretics
- Potassium supplements
- CYP3A4 inhibitors
- Combined use of an angiotensin receptor blocker and angiotensin-converting enzyme inhibitor These contraindications are crucial to consider, as spironolactone can increase the risk of hyperkaliemia, particularly in patients with diabetes mellitus, kidney and/or liver disorders, and elderly patients 1.
Special Considerations
- Patients with diabetes mellitus
- Patients with kidney and/or liver disorders
- Elderly patients Regular monitoring of potassium levels and renal function is essential when using spironolactone to minimize the risk of complications, as emphasized in the study 1.
Potential Side Effects
- Headache
- Fatigue
- Gynecomastia
- Decreased libido
- Menstrual disruption These side effects have been reported in more than 10% of patients taking spironolactone, highlighting the need for careful patient selection and monitoring 1.
From the FDA Drug Label
4 CONTRAINDICATIONS Spironolactone is contraindicated in the patients with:
Hyperkalemia Addison’s disease Concomitant use of eplerenone
The contraindications for Spironolactone are:
- Hyperkalemia
- Addison’s disease
- Concomitant use of eplerenone 2
From the Research
Contraindications for Spironolactone
The following are contraindications for spironolactone:
- Hyperkalemia: Spironolactone can increase the risk of hyperkalemia, particularly in patients with renal insufficiency 3.
- Renal insufficiency: Patients with severe renal impairment (eGFR < 30 mL/min/1.73 m2) should not receive spironolactone due to the increased risk of hyperkalemia 4, 5.
- Concurrent use of potassium supplements: The use of potassium supplements with spironolactone can increase the risk of hyperkalemia 3, 6.
- Advanced age: Older patients may be at higher risk of hyperkalemia due to decreased renal function and other comorbidities 3, 6.
- Decompensated congestive heart failure: Patients with decompensated heart failure may be at higher risk of hyperkalemia due to decreased renal function and other comorbidities 3.
Special Considerations
- Patients with chronic kidney disease (CKD) should be carefully monitored for hyperkalemia and renal function when taking spironolactone 4, 5, 7.
- The dose of spironolactone should be carefully titrated in patients with CKD to minimize the risk of hyperkalemia and renal dysfunction 7.
- Patients with stage III, IV, or V chronic renal insufficiency should be carefully monitored for hyperkalemia and renal function when taking spironolactone 6.