Can Aldactone (spironolactone) cause shivering?

Shivering as a Side Effect of Aldactone (Spironolactone)

Aldactone (spironolactone) does not commonly cause shivering as a side effect, and shivering is not listed among the known adverse effects in clinical guidelines or drug information.

Common Side Effects of Spironolactone

Spironolactone, a mineralocorticoid receptor antagonist, is associated with several well-documented side effects, but shivering is not among them. The most common adverse effects include:

Electrolyte Disturbances

• Hyperkalemia: The most common and potentially dangerous side effect 1
  • Occurs in up to 36% of patients (serum K+ >5 mmol/L) 2
  • Severe hyperkalemia (>6 mmol/L) occurs in approximately 10% of patients 2
• Hyponatremia: Less common but possible 3

Endocrine Effects

• Gynecomastia: Occurs in 5-10% of male patients 1, 4
• Breast tenderness: Reported in up to 17% of patients 5
• Menstrual irregularities: Occurs in approximately 22% of female patients 5

Renal Effects

• Increased serum creatinine: An increase of >20% occurs in about 55% of patients 2
• Acute kidney injury: Especially in patients with pre-existing renal dysfunction 6

Monitoring Recommendations

When using spironolactone, guidelines recommend monitoring:

1. Serum potassium: Check at baseline (must be <5.0 mEq/L before starting), within 3 days after initiation, at 1 week, monthly for 3 months, and quarterly thereafter 5

2. Renal function: Monitor serum creatinine at the same intervals as potassium 5

3. Body weight: Regular weight checks can help detect fluid retention early 5

Special Considerations

Dosing

• Starting dose is typically 12.5-25 mg daily for heart failure 5
• For ascites in liver disease, the recommended initial dose is 100 mg/day, which can be adjusted up to 400 mg/day 6
• Dose adjustments should occur no sooner than every 72 hours due to the long half-life of spironolactone 6

Risk Factors for Adverse Effects

• Elderly patients: May require lower starting doses and more frequent monitoring 5
• Concomitant use of ACE inhibitors or ARBs: Increases risk of hyperkalemia 3
• Renal dysfunction: Increases risk of hyperkalemia and further renal deterioration 2

Management of Adverse Effects

If adverse effects occur:

• For hyperkalemia >5.5 mmol/L: Reduce dose by half 5
• For hyperkalemia ≥6.0 mmol/L: Stop spironolactone immediately 5
• For significant increase in creatinine: Consider dose reduction or discontinuation 5

Conclusion

While spironolactone has several well-documented side effects that require careful monitoring, shivering is not reported as a known adverse effect in clinical guidelines or research studies. If a patient experiences shivering while taking spironolactone, other causes should be investigated, as this symptom is not typically associated with this medication.