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 elevating the affected area, reducing salt intake, wearing compression stockings, and using diuretics or other medications as needed, as recommended by the most recent and highest quality study 2.
Causes and Evaluation of Edema
Edema is a common clinical sign that may indicate numerous pathologies, and its chronicity and laterality guide evaluation. Medications, such as antihypertensives, anti-inflammatory drugs, and hormones, can contribute to edema. Evaluation 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 2.
Treatment Options for Edema
Treatment of edema is specific to the etiology, and diuretics are effective but should be used only for systemic causes of edema. Ruscus extract and horse chestnut seed demonstrate moderate-quality evidence to improve edema from chronic venous insufficiency, as noted in 2. Compression therapy is effective for most causes of edema.
Key Considerations in Edema Management
- Elevating the affected area to reduce swelling
- Reducing salt intake to 1,500-2,000 mg daily to minimize fluid retention
- Wearing compression stockings (15-30 mmHg pressure) to improve circulation and reduce swelling
- Using diuretics, such as furosemide (20-80 mg daily) or hydrochlorothiazide (12.5-50 mg daily), for moderate to severe cases
- Regular exercise, maintaining a healthy weight, and avoiding prolonged sitting or standing to prevent fluid buildup
- Considering ACE inhibitors, like lisinopril (5-40 mg daily), for edema caused by heart failure, as recommended by 2.