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
  • Angiotensin-converting enzyme inhibitors
  • Apomorphine
  • Apraclonidine
  • Ardeparin
  • Aripiprazole
  • Arsenic Trioxide
  • Asenapine
  • Aspirin, ASA
  • 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
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Azelastine; Fluticasone
  • Azilsartan
  • Azilsartan; Chlorthalidone
  • Baclofen
  • Beclomethasone
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Benazepril
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzphetamine
  • Betamethasone
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bortezomib
  • Bosentan
  • Brexpiprazole
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Budesonide
  • Budesonide; Formoterol
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Butabarbital
  • Cabergoline
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Phosphate, Supersaturated
  • Canagliflozin
  • Canagliflozin; Metformin
  • Candesartan
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Captopril
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Carbonic anhydrase inhibitors
  • Cardiac glycosides
  • Cariprazine
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chloroprocaine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Cholestyramine
  • Choline Salicylate; Magnesium Salicylate
  • Ciclesonide
  • Cidofovir
  • Citalopram
  • Clozapine
  • Co-Enzyme Q10, Ubiquinone
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Conivaptan
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Cosyntropin
  • Cyclosporine
  • Dalteparin
  • Darifenacin
  • Deflazacort
  • Desloratadine; Pseudoephedrine
  • Desvenlafaxine
  • Dexamethasone
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmethylphenidate
  • Dextroamphetamine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Quinidine
  • Diazoxide
  • Dichlorphenamide
  • Digitoxin
  • Digoxin
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Phenylephrine
  • Drospirenone
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Duloxetine
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Enflurane
  • Enoxaparin
  • Ephedrine
  • Eplerenone
  • Epoprostenol
  • Eprosartan
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Escitalopram
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Ethanol
  • Etomidate
  • Fentanyl
  • Fexofenadine; Pseudoephedrine
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Fludrocortisone
  • Flunisolide
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluticasone
  • Fluticasone; Salmeterol
  • 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
  • Levodopa
  • Levomilnacipran
  • Levorphanol
  • Lisdexamfetamine
  • Lisinopril
  • Lithium
  • Loratadine; Pseudoephedrine
  • Losartan
  • Lovastatin; Niacin
  • Low Molecular Weight Heparins
  • Lurasidone
  • Magnesium Citrate
  • Magnesium Hydroxide
  • Magnesium Salicylate
  • Magnesium Salts
  • Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate
  • Mannitol
  • Meperidine
  • Meperidine; Promethazine
  • Mephobarbital
  • Mestranol; Norethindrone
  • Methadone
  • Methamphetamine
  • Methazolamide
  • Methohexital
  • Methylphenidate
  • Methylprednisolone
  • Milnacipran
  • 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
  • Risperidone
  • 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
  • Streptozocin
  • Sufentanil
  • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
  • Tacrolimus
  • Tapentadol
  • Telmisartan
  • Tetrabenazine
  • Tetracaine
  • Thiopental
  • Thiothixene
  • Tinzaparin
  • Tizanidine
  • Tolterodine
  • Tolvaptan
  • Tramadol
  • Trandolapril
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trazodone
  • Triamcinolone
  • Trimethoprim
  • Tubocurarine
  • Valsartan
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Warfarin
  • Yohimbine
  • Ziconotide
  • Ziprasidone
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