Timing of Spironolactone Administration
Spironolactone should be taken in the morning as a single daily dose, not at bedtime. This recommendation is based on established clinical practice guidelines and maximizes medication compliance while minimizing nocturnal diuresis.
Recommended Dosing Schedule
Single morning dosing is the standard approach across multiple clinical contexts:
For cirrhosis with ascites, the usual regimen consists of single morning doses of oral spironolactone and furosemide, beginning with 100 mg of spironolactone and 40 mg of furosemide 1
For heart failure, spironolactone is administered as 25-50 mg once daily (o.d.) without specific bedtime timing mentioned in guidelines 1
For acne management, the typical starting dose is 100 mg/day in the evening, though this represents an exception to the general morning dosing rule 1
Rationale for Morning Administration
The primary reason for morning dosing is to maximize patient compliance:
Single morning dosing has been explicitly stated to "maximize compliance" in hepatology guidelines 1
Morning administration avoids the inconvenience of nocturnal diuresis (increased nighttime urination), which can disrupt sleep and reduce medication adherence
The long half-life of spironolactone means that precise timing is less critical for maintaining therapeutic effect, but morning dosing provides practical advantages 1
Clinical Context Considerations
Different indications may have slightly different timing preferences:
Cirrhosis/Ascites: Definitively morning dosing 1
Heart failure: Once daily without specific time restriction, though morning is conventional 1
Acne/Dermatologic use: Evening dosing (100 mg/day) is commonly used, likely to minimize daytime diuretic effects in otherwise healthy young women 1
Hypertension: No specific timing mentioned, though standard practice favors morning administration 2
Common Pitfall to Avoid
Do not prescribe spironolactone at bedtime for most patients, as this will cause:
- Nocturia (nighttime urination) that disrupts sleep quality
- Reduced medication adherence due to inconvenience
- No therapeutic advantage, given the drug's long half-life 1
The only exception where evening dosing may be preferred is in young, healthy women taking spironolactone for acne, where the 100 mg evening dose minimizes daytime diuretic inconvenience 1.