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.
- 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.
Edema Management: Spironolactone is indicated for the management of edema in certain settings, including:
- Heart failure (NYHA Class III-IV) to manage edema and reduce hospitalization for heart failure 1
- Edema associated with hepatic cirrhosis or nephrotic syndrome, when other treatments are inadequate 1
From the Research
Edema should be evaluated and managed based on its underlying cause, with treatment options including lifestyle modifications, medications such as diuretics, and addressing the underlying condition, as recommended by the most recent study 2. The evaluation of edema should begin with obtaining a basic metabolic panel, liver function tests, thyroid function testing, brain natriuretic peptide levels, and a urine protein/creatinine ratio, as suggested by the study 2. Some key points to consider in the management of edema include:
- Validated decision rules, such as the Wells and STOP-Bang criteria, can guide decision-making regarding the possibility of venous thromboembolic disease and obstructive sleep apnea, respectively 2.
- Acute unilateral lower-extremity edema warrants immediate evaluation for deep venous thrombosis with a d-dimer test or compression ultrasonography 2.
- For patients with chronic bilateral lower-extremity edema, duplex ultrasonography with reflux can help diagnose chronic venous insufficiency 2.
- Patients with pulmonary edema or elevated brain natriuretic peptide levels should undergo echocardiography to assess for heart failure 2.
- Lymphedema is often a clinical diagnosis; lymphoscintigraphy can be performed if the diagnosis is unclear 2.
- Treatment of edema is specific to the etiology, and diuretics are effective but should be used only for systemic causes of edema 2.
- Ruscus extract and horse chestnut seed demonstrate moderate-quality evidence to improve edema from chronic venous insufficiency 2.
- Compression therapy is effective for most causes of edema 2.