- Potassium-sparing diuretic, antagonist of aldosterone
- Oedema associated with heart failure, hepatic cirrhosis and nephrotic syndrome
Forms and strengths
- 25 mg tablet
Adjunctive therapy in heart failure
- Adult: 25 mg once daily
Ascites in hepatic cirrhosis
- Adult: 100 to 400 mg daily.
When weight is stable, administer the lowest possible maintenance dose, in order to prevent adverse effects.
Oedema in nephrotic syndrome
- Adult: 100 to 200 mg daily
The daily dose can be administered in 2 to 3 divided doses or once daily.
- According to clinical response; avoid prolonged use.
Contra-indications, adverse effects, precautions
- Do not administer to patients with severe renal impairment, anuria, hyperkalaemia > 5 mmol/litre, hyponatraemia.
- Do not combine with potassium salts, potassium-sparing diuretics; lithium (risk of lithium toxicity).
- Avoid or closely monitor combination with angiotensin-converting enzyme inhibitors (risk of severe, potentially fatal hyperkalaemia), digoxin (risk of digoxin toxicity) and reduce dosages.
- May cause:
- hyperkalaemia (especially in elderly or diabetics patients, patients with renal impairment or patients taking NSAIDs), hyponatraemia; metabolic acidosis (in patients with decompensated cirrhosis);
- gynecomastia, metrorrhagia, impotence, amenorrhoea, gastrointestinal disturbances, headache, skin rash, drowsiness.
- Administer with caution in patients with hepatic or renal impairment or diabetes.
- Monitor regularly plasma-potassium levels.
- Pregnancy: avoid, use only if clearly needed (risk of feminisation of foetus); spironolactone is not indicated in the treatment of pregnancy-related oedema.
- Breast-feeding: no contra-indication
- In children with oedema, the daily dose is 1 to 3 mg/kg once daily or 0.5 to 1.5 mg/kg 2 times daily.
- Spironolactone is also used for the diagnosis and treatment of primary hyperaldosteronism.