Spironolactone

Brand names

• Alatone
• Aldactazide [CD]
• Aldactone
• Apo-Spirozide
• Novo-Spiroton
• Sincomen
• Spironazide

Usage

As adjunctive (supplementary) treatment with other diuretics to increase excretion of sodium and water in the urine while conserving potassium. Spironolactone may be used on its own in patients with liver disease or primary hyperaldosteronism, a life threatening disorder that occurs when the adrenal glands secrete too much of the hormone aldosterone. Also used in the treatment of high blood pressure, and to treat edema and sodium retention in congestive heart failure.

How it works

Spironolactone blocks the effect of aldosterone in the kidneys to increase excretion of sodium and water in the urine while conserving potassium. In conjunction with thiazide or loop diuretics, it reduces the overall fluid volume in the body, which helps to control symptoms of liver disease, heart disease, and kidney disease.

Side effects

Serious

Skin rash or itching. shortness of breath, cough or hoarseness, fever or chills, pain in lower back or side, painful or difficult urination.

Common

Dizziness, headache, sweating, decreased sexual ability, breast tenderness, breast enlargement in men, increased hair growth in females, irregular menstrual periods.

Less common

Possible interactions

Other medicaments:

Spironolactone may increase the effects of:

• digoxin (Lanoxin). Cautious and increased checks of digoxin levels are prudent.

Spironolactone may decrease the effects of:

• anticoagulants (Coumadin, etc.). Increased frequency of INR (prothrombin time or protime) testing is needed.

Spironolactone taken concurrently with:

• arginine (various) may lead to excessive potassium levels.
• captopril (Capoten) or other ACE inhibitors may cause further increases in blood potassium levels. More frequent laboratory tests are prudent.
• cortisone-like medicaments (fludrocortisone, others) may lead to excessive potassium loss.
• cyclosporine (Sandimmune) may result in very elevated potassium levels.
• digitoxin (Crystodigin) may cause either increased or decreased digitoxin effects (unpredictable).
• lithium (Lithobid, others) may cause accumulation of lithium to toxic levels.
• norepinephrine (various) may blunt norepinephrine effects.
• potassium preparations may cause excessively high blood potassium levels.
• tacrolimus (Prograf) may lead to excessive potassium levels.
• valsartan (Diovan) may lead to increased potassium levels. More frequent potassium checks are prudent.
• warfarin (Coumadin) may blunt effectiveness of warfarin. More frequent INR checks are prudent. Dose adjustments may be needed.

The following medicaments may decrease the effects of spironolactone:

• aspirin or other NSAIDs-may reduce its diuretic effectiveness.

Foods:

Talk to your doctor about possible need to avoid high-potassium foods. Avoid excessive restriction of salt.

Herbal medicines or minerals:

Hawthorn (Crataegus variety) and co-enzyme Q10 can affect the way the heart works. Be certain to tell your doctor that you are taking or are considering taking these herbs if you are taking spironolactone. Co-enzyme Q10 may also interact badly with aspirin. Soy products (milk, tofu, etc.) contain phytoestrogens that have led to an FDA-approved health claim for reducing risk of heart disease (if they have at least 6.25 grams of soy protein per serving). It is important that potassium and magnesium levels be kept in the normal range while you are taking spironolactone.
Couch grass or nettle should not be taken by patients who have increased fluid (edema) caused by heart weakness. Ginseng may increase blood pressure, blunting some of the benefits of this medicine. Eleuthero root, hawthorn, saw palmetto, ma huang, goldenseal and licorice may also cause increased blood pressure. Couch grass may worsen edema due to heart or kidney problems. Indian snakeroot, calcium and garlic may help lower blood pressure.

Alcohol:

Alcohol may enhance the drowsiness and the blood-pressure-lowering effect of this medicament.

Discontinuation:

With high dosage or prolonged use, it is advisable to withdraw this medicament gradually. Ask your physician for guidance.

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