What is the recommended dose of Aldactone (spironolactone) for treating hypertension?

From the Guidelines

The recommended dose of Aldactone (spironolactone) for treating hypertension is 25 mg once daily, as a fourth-line agent, in patients whose serum potassium is <4.5 mmol/L and whose eGFR is >45 ml/min/1.73m2, as stated in the 2020 international society of hypertension global hypertension practice guidelines 1.

Key Considerations

• The dosage may be considered in patients with resistant hypertension, after excluding causes of pseudoresistance and optimizing the current treatment regimen, including health behavior change and diuretic-based treatment.
• Patients should have their potassium levels and kidney function monitored regularly, especially when starting treatment or adjusting doses, due to the risk of hyperkalaemia.
• The addition of spironolactone should be considered after assessing adherence and referring the patient to an expert centre for appropriate work-up, if BP is still uncontrolled under maximally tolerated triple-combination therapy.

Monitoring and Adjustments

• Serum sodium and potassium concentrations and renal function should be checked within 1 month of increasing diuretic dose, and repeated as required thereafter.
• Blood pressure response typically occurs within 2 weeks, but full effects may take several weeks to develop.
• Patients should be aware that spironolactone may increase potassium levels, so they should avoid potassium supplements and high-potassium foods unless directed by their healthcare provider.

Alternative Options

• If spironolactone is contraindicated or not tolerated, alternative options such as eplerenone, amiloride, beta-blockers, or other potassium-sparing diuretics may be considered, as recommended in the 2024 esc guidelines for the management of elevated blood pressure and hypertension 1.

From the FDA Drug Label

Essential hypertension For adults, an initial daily dosage of 50 to 100 mg of spironolactone tablets administered in either single or divided doses is recommended. The recommended dose of Aldactone (spironolactone) for treating hypertension is an initial daily dosage of 50 to 100 mg administered in either single or divided doses 2.

• The dosage should be adjusted according to the response of the patient after at least two weeks of treatment.
• Spironolactone tablets may also be given with diuretics that act more proximally in the renal tubule or with other antihypertensive agents.

From the Research

Recommended Dose of Aldactone for Hypertension

The recommended dose of Aldactone (spironolactone) for treating hypertension varies depending on the patient's condition and response to the medication.

• The dose of spironolactone can range from 25 mg to 100 mg per day, with some studies suggesting that doses above 50 mg per day may not provide additional blood pressure reduction 3.
• A study found that low-dose spironolactone (25 mg) added to combination therapy with calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin AT1-receptor blockers resulted in significant blood pressure reduction in patients with uncontrolled hypertension 4.
• Another study demonstrated that low-dose spironolactone (25-50 mg/day) provided significant additive blood pressure reduction in patients with chronic kidney disease and resistant hypertension 5.
• The addition of low-dose spironolactone to previous antihypertensive therapy in patients with resistant hypertension resulted in significant blood pressure reduction, with a mean decrease in systolic and diastolic blood pressure of 16.6/7.0 mmHg at 1 month and 26.0/10.7 mmHg at 6 months 6.
• An observational study found that low-dose spironolactone (25-50 mg) was effective in managing resistant hypertension, with a mean fall in systolic blood pressure of 21.7 mmHg and diastolic blood pressure of 8.5 mmHg 7.

Key Considerations

• The dose of spironolactone should be individualized based on the patient's response to the medication and their underlying medical conditions.
• Patients should be monitored for potential adverse effects, such as hyperkalemia, and the dose of spironolactone should be adjusted accordingly.
• The use of low-dose spironolactone in combination with other antihypertensive medications may be effective in managing resistant hypertension.