From the Guidelines
Spironolactone is primarily used to treat high blood pressure, heart failure, edema, and conditions related to excess aldosterone hormone production, with a typical dosing range of 25 to 100 mg daily. The medication works as a potassium-sparing diuretic and aldosterone antagonist, blocking the hormone aldosterone to regulate salt and water balance in the body 1. It is also commonly prescribed for women with polycystic ovary syndrome (PCOS) and for treating hormonal acne and unwanted hair growth in women due to its anti-androgenic effects that block male hormone activity 1. Some key points to consider when using spironolactone include:
- Monitoring potassium levels as the medication can cause hyperkalemia (high potassium) 1
- Avoiding potassium supplements and high-potassium foods unless directed otherwise by a healthcare provider 1
- Common side effects such as increased urination, breast tenderness or enlargement in men, irregular menstrual periods in women, and dizziness 1
- The potential for spironolactone to be used in combination with other medications, such as oral contraceptives, for the treatment of acne in women 1. Overall, spironolactone is a valuable medication for the treatment of various conditions, but its use requires careful monitoring and consideration of potential side effects and interactions.
From the FDA Drug Label
1 INDICATIONS AND USAGE
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: to increase survival, manage edema, and reduce hospitalization
- Hypertension: as add-on therapy to lower blood pressure
- Edema: associated with hepatic cirrhosis or nephrotic syndrome
- Primary Hyperaldosteronism: for short-term preoperative treatment and long-term maintenance therapy 2
From the Research
Uses of Spironolactone
- Spironolactone is used in the treatment of heart failure, particularly in patients who remain symptomatic despite combination therapy with a diuretic and an angiotensin-converting-enzyme (ACE) inhibitor 3.
- It is also used in patients with congestive heart failure refractory to high-dose loop diuretic and low-dose angiotensin-converting enzyme inhibitor 4.
- The medication has been shown to reduce morbidity and mortality in patients with heart failure with reduced ejection fraction and decrease hospitalizations in heart failure with preserved ejection fraction 5.
Safety and Tolerability
- The use of spironolactone requires careful monitoring of serum potassium and renal function to minimize the risk of hyperkalemia 5, 6, 7.
- Patients with severe renal failure or hyperkalemia should not be treated with spironolactone 3.
- The combination of spironolactone with an ACE-inhibitor is indicated in patients with cardiac insufficiency NYHA-class II-IV and an ejection fraction of ≤ 35%, but requires close monitoring of serum potassium and renal function 7.