From the Guidelines
Spironolactone is primarily used to treat heart failure (HF) and reduce hospitalizations due to worsening HF.
Key Uses of Spironolactone
- Heart Failure with Reduced Ejection Fraction (HFrEF): Spironolactone has been shown to reduce mortality and hospitalizations in patients with severe HF, as demonstrated in the RALES trial 1.
- Heart Failure with Preserved Ejection Fraction (HFpEF): The use of spironolactone in HFpEF is more nuanced, with some studies suggesting a potential benefit in reducing hospitalizations, particularly in patients with elevated BNP levels and certain clinical characteristics 1.
Important Considerations
- Hyperkalemia Risk: Spironolactone can cause hyperkalemia, especially in patients with renal dysfunction or those taking other medications that increase potassium levels 1.
- Monitoring: Close monitoring of potassium levels and renal function is essential when initiating spironolactone therapy, with recommendations for regular checks and adjustments as needed 1.
- Dosing: The typical starting dose of spironolactone is 12.5 to 25 mg daily, with adjustments based on patient response and tolerance 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Heart Failure Spironolactone tablets are indicated for treatment of NYHA Class III-IV heart failure and reduced ejection fraction to increase survival, manage edema, and reduce the need for hospitalization for heart failure. 1.2 Hypertension Spironolactone tablets are indicated as add-on therapy for the treatment of hypertension, to lower blood pressure in patients who are not adequately controlled on other agents. 1.3 Edema Associated with Hepatic Cirrhosis or Nephrotic Syndrome Spironolactone tablets are indicated for the management of edema in the following settings: Cirrhosis of the liver when edema is not responsive to fluid and sodium restriction Nephrotic syndrome when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics produce an inadequate response. 1.4 Primary Hyperaldosteronism Spironolactone tablets are indicated in the following settings: Short-term preoperative treatment of patients with primary hyperaldosteronism. Long-term maintenance therapy for patients with discrete aldosterone-producing adrenal adenomas who are not candidates for surgery
Spironolactone is used for the treatment of:
- Heart Failure: NYHA Class III-IV heart failure and reduced ejection fraction
- Hypertension: as add-on therapy to lower blood pressure
- Edema: associated with hepatic cirrhosis or nephrotic syndrome
- Primary Hyperaldosteronism: short-term preoperative treatment and long-term maintenance therapy 2 2
From the Research
Uses of Spironolactone
- Spironolactone is used as a primary medical treatment for hirsutism and female pattern hair loss 3, 4
- It is an effective alternative treatment for acne in women 3, 5
- Spironolactone is used to treat conditions such as hidradenitis suppurativa 5
- It has antiandrogenic properties, making it suitable for diseases in which excess androgen production results in unwanted manifestations in susceptible females 5
- Spironolactone has been used for over 20 years as an antiandrogen in the treatment of acne and hirsutism 6
- It is also used in the treatment of polycystic ovary syndrome (PCOS) 7, 4
Safety and Side Effects
- The long-term use of spironolactone in the treatment of acne in women appears to be safe 6
- Side effects are common, but not usually a cause for stopping the drug 6
- Diuretic effect and menstrual irregularities are the most common adverse effects 6
- Spironolactone should not be used in pregnancy due to its teratogenic effects and is not used in men due to the risk of feminization 3, 4