Spironolactone

What is Spironolactone

Spironolactone is a potassium-sparing diuretic.

In patients with severe heart failure (NYHA Class IV), spironolactone has been shown to improve overall survival and NYHA functional class, and to reduce hospitalizations when added to conventional therapy (e.g., ACE inhibitor, loop diuretic, digoxin). 

It is frequently used to treat ascites associated with cirrhosis and also has been used as a diagnostic aid for primary hyperaldosteronism. It is also used to treat hypokalemia.

Compared to thiazide or loop diuretics, it is a relatively weak agent for treating hypertension or generalized edema, although its effects can be additive with thiazide diuretics.

While not FDA-approved indications, acne vulgaris, polycystic ovary syndrome, and female hirsutism have been treated with spironolactone. Spironolactone was approved by the FDA in 1960.

Brand Names

• Aldactone
• CAROSPIR

Indications

• acne vulgaris
• chronic lung disease (CLD)
• edema
• heart failure
• hepatic cirrhosis
• hirsutism
• hyperaldosteronism
• hyperaldosteronism diagnosis
• hypertension
• hypokalemia
• hypokalemia prevention
• nephrotic syndrome
• polycystic ovary syndrome
• premenstrual syndrome (PMS)
• pulmonary edema

Side Effects

1. abdominal pain
2. agranulocytosis
3. alopecia
4. amenorrhea
5. anaphylactoid reactions
6. ataxia
7. bradycardia
8. confusion
9. dehydration
10. diarrhea
11. dizziness
12. drowsiness
13. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
14. erythema
15. fatigue
16. fever
17. gastritis
18. gout
19. gynecomastia
20. headache
21. hepatic failure
22. hirsutism
23. hyperglycemia
24. hyperkalemia
25. hyperuricemia
26. hypocalcemia
27. hypomagnesemia
28. hyponatremia
29. hypotension
30. hypovolemia
31. impotence (erectile dysfunction)
32. infertility
33. lethargy
34. leukopenia
35. libido decrease
36. maculopapular rash
37. mastalgia
38. menstrual irregularity
39. metabolic acidosis
40. metabolic alkalosis
41. muscle cramps
42. nausea
43. new primary malignancy
44. paresthesias
45. polyuria
46. postmenopausal bleeding
47. pruritus
48. renal failure (unspecified)
49. Stevens-Johnson syndrome
50. thrombocytopenia
51. toxic epidermal necrolysis
52. tumorigenicity
53. urticaria
54. vasculitis
55. vomiting
56. weakness

Monitoring Parameters

• blood pressure
• serum creatinine/BUN
• serum electrolytes

Contraindications

• acid/base imbalance
• adrenal insufficiency
• anuria
• ascites
• biliary cirrhosis
• breast-feeding
• diabetes mellitus
• driving or operating machinery
• geriatric
• hepatic disease
• hyperkalemia
• infertility
• menstrual irregularity
• metabolic acidosis
• metabolic alkalosis
• new primary malignancy
• pregnancy
• prostate cancer
• renal disease
• renal failure
• renal impairment
• respiratory acidosis
• tumorigenicity

Interactions

• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetaminophen; Tramadol
• Acetazolamide
• Acrivastine; Pseudoephedrine
• Aldesleukin, IL-2
• Alemtuzumab
• Alfentanil
• Aliskiren
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Aliskiren; Valsartan
• Alprostadil
• Aluminum Hydroxide; Magnesium Hydroxide
• Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
• Alvimopan
• Ambrisentan
• Amifostine
• Aminosalicylate sodium, Aminosalicylic acid
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amobarbital
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamine; Dextroamphetamine Salts
• Amyl Nitrite
• Angiotensin II receptor antagonists
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• Apomorphine
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• Aripiprazole
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• Asenapine
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• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Dipyridamole
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Aspirin, ASA; Pravastatin
• Atorvastatin
• Atorvastatin; Ezetimibe
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
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• Betamethasone
• Bismuth Subsalicylate
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• Bortezomib
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• Brompheniramine; Pseudoephedrine
• Budesonide
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• Butabarbital
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• Calcium Carbonate; Magnesium Hydroxide
• Calcium Phosphate, Supersaturated
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• Captopril
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• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Cholestyramine
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• Clozapine
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• Dextromethorphan; Quinidine
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• Drospirenone
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• Drospirenone; Ethinyl Estradiol
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• Duloxetine
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• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Enalapril, Enalaprilat
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• Enflurane
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• Fluticasone
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• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvoxamine
• food
• Formoterol; Mometasone
• Fosinopril
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fospropofol
• Gallium Ga 68 Dotatate
• General anesthetics
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guaifenesin; Pseudoephedrine
• Haloperidol
• Halothane
• Heparin
• Homatropine; Hydrocodone
• Hydralazine; Isosorbide Dinitrate, ISDN
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydrocortisone
• Hydromorphone
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen lysine
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Iloperidone
• Iloprost
• Inamrinone
• Indapamide
• Inotersen
• Intravenous Lipid Emulsions
• Irbesartan
• Isocarboxazid
• Isoflurane
• Isoproterenol
• Isosorbide Dinitrate, ISDN
• Isosorbide Mononitrate
• Ketamine
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• Levorphanol
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• Lisinopril
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• Losartan
• Lovastatin; Niacin
• Low Molecular Weight Heparins
• Lurasidone
• Magnesium Citrate
• Magnesium Hydroxide
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• Magnesium Salts
• Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
• Mannitol
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• Meperidine; Promethazine
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• Methadone
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• Methohexital
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• Methylprednisolone
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• Milrinone
• Mirtazapine
• Mitotane
• Moexipril
• Mometasone
• Morphine
• Morphine; Naltrexone
• Naproxen; Pseudoephedrine
• Nebivolol; Valsartan
• Nefazodone
• Nesiritide, BNP
• Niacin, Niacinamide
• Niacin; Simvastatin
• Nitrates
• Nitroglycerin
• Nitroprusside
• Nonsteroidal antiinflammatory drugs
• Norepinephrine
• Octreotide
• Olanzapine
• Olmesartan
• Oxybutynin
• Oxycodone
• Oxymetazoline
• Oxymorphone
• Paliperidone
• Paroxetine
• Penicillin G
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Pentoxifylline
• Perindopril
• Perindopril; Amlodipine
• Phenelzine
• Phenobarbital
• Phenylephrine
• Phenylephrine; Promethazine
• Polyethylene Glycol; Electrolytes
• Polyethylene Glycol; Electrolytes; Ascorbic Acid
• Potassium
• Prazosin
• Prednisolone
• Prednisone
• Primidone
• Procainamide
• Procaine
• Propofol
• Propoxyphene
• Pseudoephedrine
• Quinapril
• Quinidine
• Ramipril
• Rasagiline
• Remifentanil
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• Sacubitril; Valsartan
• Salsalate
• Secobarbital
• Selegiline
• Serotonin norepinephrine reuptake inhibitors
• Sertraline
• Sevoflurane
• Silodosin
• Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
• Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
• Solifenacin
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• Sufentanil
• Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
• Tacrolimus
• Tapentadol
• Telmisartan
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• Tetracaine
• Thiopental
• Thiothixene
• Tinzaparin
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• Tolterodine
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• Tramadol
• Trandolapril
• Trandolapril; Verapamil
• Tranylcypromine
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• Trimethoprim
• Tubocurarine
• Valsartan
• Venlafaxine
• Vilazodone
• Vortioxetine
• Warfarin
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• Ziconotide
• Ziprasidone