Spironolactone

Spironolactone/ Aldactone, Spiractin             preg risk B

Classifications: diuretic for oedema, hypertension, nephrotic syndrome, diuretic induced hypokalaemia, detection of primary hyper aldosteronism

Action: a potassium sparing diuretic that antagonises aldosterone in the distal tubules, increasing sodium and water excretion. Potassium is retained. Both a diuretic and antihypertensive, can be used alone or in combo with other diuretic agents which act more proximally in the renal tubules.

Adverse reactions:

  CNS: headache, drowsiness, lethargy, confusion, ataxia

     GI: abnormal hepatic function, diarrhoea, gastric bleeding, ulceration, cramping, gastritis

     GU: inability to maintain erection, menstrual disturbances

    Haematologic: agranulocytosis, leucopenia, thrombocytopenia

     Metabolic: hyperkalaemia, dehydration, hyponatraemia, transient elevation in urea level, mild acidosis

     Skin: urticaria

     Other: gynaecomastia in males, breast soreness in women, drug fever,anaphylaxis

Drug-drug: Ace inhibitors, indomethacin, other potassium-sparing diuretics, potassium supplements. Increased risk of hyperkalaemia, HF,renal failure if used together.

Ammonium chloride and cholestyramine, aspirin,indomethacin, mefoenamic acid and other NSAIDs, Digoxin, anaesthetic agents.

Herbs: licorice, high potassium diet(bananas, dates,citrus, tomatoes)  

Contraindications: hypersensitivity, Addison’s disease, anuria, acute or progressive renal disease, hyperkalaemia

Care considerations: Use cautiously in individuals with fluid or electrolyte imbalance, hepatic or kidney dysfunction.

Give drug with meals, protect drug from light, monitor seurm electrolytes, fluid balance, weight and bp.

Monitor elderly closely. Drug is less potent thn thazide and loop diuretics but is useful as and adjunct to other diuretics. Effect is delayed 2-3 days when used alone. Max antihypertensive response is delayed for up to 2 weeks.

Not recommended to take with: ache inhibitors, ARBs, aldosterone blockers, potassium supplements, high potassium diets

Dose   25 -100 mg PO daily

Teaching Avoid high potassium diets, licorice, give drug with meals, advise men about gynecomastia, avoid hazardous activities in presence of adverse CNs symptoms.