From the Guidelines
Spironolactone can be used with caution in patients with gout, but it is essential to monitor uric acid levels and adjust gout medication as needed, as it can potentially worsen this condition. Spironolactone is a potassium-sparing diuretic that can increase uric acid levels in the blood, which is the primary cause of gout flares, as noted in the management of gout [ 1 ]. The medication works by blocking aldosterone receptors, which not only affects potassium retention but also can reduce uric acid excretion by the kidneys.
Key Considerations
- If you have gout and need to take spironolactone for conditions like heart failure, edema, or hypertension, your healthcare provider should monitor your uric acid levels regularly [ 1 ].
- They may need to adjust your gout medication (such as allopurinol or febuxostat) to compensate for the effects of spironolactone, as recommended in the 2016 updated EULAR evidence-based recommendations for the management of gout [ 1 ].
- In some cases, your doctor might consider alternative medications that don't affect uric acid levels if your gout is severe or poorly controlled.
- Always inform your healthcare provider about your gout history before starting spironolactone, and report any increase in gout symptoms while taking this medication.
Lifestyle Modifications
- Weight loss, if appropriate, and avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals, and excessive intake of meat and seafood can help reduce uric acid levels [ 1 ].
- Low-fat dairy products should be encouraged, and regular exercise should be advised to help manage gout symptoms [ 1 ].
From the FDA Drug Label
Asymptomatic hyperuricemia can occur and rarely gout is precipitated. The use of spironolactone may worsen or precipitate gout in some patients.
- Caution is advised when using spironolactone in patients with a history of gout.
- Patients with gout should be monitored for signs of worsening gout when taking spironolactone 2
From the Research
Spironolactone and Gout
- There are no direct studies that investigate the use of spironolactone in patients with gout.
- However, spironolactone can increase the risk of hyperkalemia, which may be a concern in patients with gout who may already be at risk for kidney stones or other kidney problems 3, 4, 5, 6.
- Patients with chronic kidney disease (CKD) who take spironolactone may be at higher risk for hyperkalemia-associated hospitalization 6.
- The use of spironolactone in patients with heart failure and CKD may be safe, but requires careful monitoring of serum potassium levels and renal function 4.
- The effects of spironolactone on kidney function and hyperkalemia-associated hospitalization in patients with CKD are complex and require further study 6, 7.
Key Considerations
- Patients with gout who are considering taking spironolactone should discuss the potential risks and benefits with their healthcare provider.
- Careful monitoring of serum potassium levels and renal function is necessary for patients taking spironolactone, especially those with CKD or other kidney problems 4, 6.
- The use of spironolactone in patients with gout requires careful consideration of the potential risks and benefits, and alternative treatments may be necessary in some cases.