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Spironolactone

Spironolactone is a potassium-sparing diuretic and aldosterone antagonist used to treat heart failure, liver cirrhosis, high blood pressure, hypokalemia, and primary hyperaldosteronism. It works by blocking the effects of aldosterone in the kidneys, causing the loss of sodium and water while retaining potassium. Common side effects include increased urination, dizziness, and diarrhea. It can also cause hyperkalemia in some patients and interacts with several other drugs to increase potassium levels, so monitoring of electrolytes is important when using this medication.

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3K views

Spironolactone

Spironolactone is a potassium-sparing diuretic and aldosterone antagonist used to treat heart failure, liver cirrhosis, high blood pressure, hypokalemia, and primary hyperaldosteronism. It works by blocking the effects of aldosterone in the kidneys, causing the loss of sodium and water while retaining potassium. Common side effects include increased urination, dizziness, and diarrhea. It can also cause hyperkalemia in some patients and interacts with several other drugs to increase potassium levels, so monitoring of electrolytes is important when using this medication.

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spironolactone

(speer on oh lak' tone)


Aldactone, Novospiroton (CAN)

Pregnancy Category D

Drug classes
Potassium-sparing diuretic
Aldosterone antagonist

Therapeutic actions
Competitively blocks the effects of aldosterone in the renal tubule, causing loss of
sodium and water and retention of potassium.

Indications
• Diagnosis and maintenance of primary hyperaldosteronism
• Adjunctive therapy in edema associated with CHF, nephrotic syndrome, hepatic
cirrhosis when other therapies are inadequate or inappropriate
• Treatment of hypokalemia or prevention of hypokalemia in patients who would be
at high risk if hypokalemia occurred: Digitalized patients, patients with cardiac
arrhythmias
• Essential hypertension, usually in combination with other drugs
• Unlabeled uses: Treatment of hirsutism due to its antiandrogenic properties,
palliation of symptoms of PMS, treatment of familial male precocious puberty,
short-term treatment of acne vulgaris

Contraindications and cautions


• Contraindicated with allergy to spironolactone, hyperkalemia, renal disease,
anuria, amiloride or triamterene use.
• Use cautiously with pregnancy, lactation.

Available forms
Tablets—25, 50, 100 mg

Dosages
ADULTS
• Edema: Initially, 100 mg/day (range 25–200 mg/day) when given as the sole
agent; continue > 5 days, then adjust dose or add another diuretic or both.
• Diagnosis of hyperaldosteronism: 400 mg/day PO for 3–4 wk (long test).
Correction of hypokalemia and hypertension are presumptive evidence of primary
hyperaldosteronism. 400 mg/day PO for 4 days (short test). If serum K+ increases
but decreases when drug is stopped, presumptive diagnosis can be made.
• Maintenance therapy for hyperaldosteronism: 100–400 mg/day PO.
• Essential hypertension: 50–100 mg/day PO. May be combined with other
diuretics.
• Hypokalemia: 25–100 mg/day PO.
PEDIATRIC PATIENTS
• Edema: 1–3.3 mg/kg/day PO adjusted to patient's response, administered as single
or divided dose.

Pharmacokinetics
Route Onset Peak Duration
Oral 24–48 hr 48–72 hr 48–72 hr

Metabolism: Hepatic; T1/2: 20 hr


Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Dizziness, headache, drowsiness, fatigue, ataxia, confusion
• Dermatologic: Rash, urticaria
• GI: Cramping, diarrhea, dry mouth, thirst, vomiting.
• GU: Impotence, irregular menses, amenorrhea, postmenopausal bleeding
• Hematologic: Hyperkalemia, hyponatremia, agranulocytosis
• Other: Carcinogenic in animals, deepening of the voice, hirsutism, gynecomastia

Interactions
Drug-drug
• Increased hyperkalemia with potassium supplements, ACE inhibitors, diets rich in
potassium
• Decreased diuretic effect with salicylates
• Decreased hypoprothrombinemic effect of anticoagulants
Drug-food
• Increased absorption when taken with food
Drug-lab test
• Interference with radioimmunoassay for digoxin; false increase in serum digoxin
levels
Drug-alternative therapy
• Decreased effectiveness if combined with licorice therapy

Nursing considerations
Assessment
• History: Allergy to spironolactone; hyperkalemia; renal disease; pregnancy,
lactation
• Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength; P,
baseline ECG, BP; R, pattern, adventitious sounds; liver evaluation, bowel
sounds; urinary output patterns, menstrual cycle; CBC, serum electrolytes, renal
function tests, urinalysis

Interventions
• Mark calendars of edema outpatients as reminders of alternate day or 3- to 5-
day/wk therapy.
• Give daily doses early so that increased urination does not interfere with sleep.
• Make suspension as follows: Tablets may be pulverized and given in cherry syrup
for young children. This suspension is stable for 1 mo if refrigerated.
• Measure and record regular weight to monitor mobilization of edema fluid.
• Avoid giving food rich in potassium.
• Arrange for regular evaluation of serum electrolytes, BUN.

Teaching points
• Record alternate-day therapy on a calendar, or prepare dated envelopes. Take the
drug early because of increased urination.
• Weigh yourself on a regular basis, at the same time and in the same clothing, and
record the weight on your calendar.
• Avoid foods that are rich in potassium (fruits, Sanka).
• These side effects may occur: Increased volume and frequency of urination;
dizziness, confusion, feeling faint on arising, drowsiness (avoid rapid position
changes, hazardous activities: driving, using alcohol); increased thirst (suck on
sugarless lozenges; use frequent mouth care); changes in menstrual cycle,
deepening of the voice, impotence, enlargement of the breasts can occur
(reversible).
• Report weight change of more than 3 lb in one day, swelling in your ankles or
fingers, dizziness, trembling, numbness, fatigue, enlargement of breasts,
deepening of voice, impotence, muscle weakness or cramps.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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