I. Definition

  1. Potassium-Sparing Diuretic via aldosterone blockade

III. Contraindications

  1. Anuria
  2. Renal insufficiency with Serum Creatinine over 2.4
  3. Hyperkalemia

IV. Drug Interactions

  1. Increased Serum Potassium (Hyperkalemia risk)
    1. Potassium Supplementation
    2. NSAIDs
    3. ACE Inhibitor
  2. Increases Digoxin half-life
  3. Salicylates decreases Spironolactone effect

V. Dosing

  1. Congestive Heart Failure: 25 to 50 mg PO qd
  2. Diuretic: 50-100 mg PO per day divided qd to bid
  3. Hyperandrogenism: 50 mg PO bid
  4. Hypertension: 12.5 to 50 mg PO qd

VII. Pharmacokinetics

  1. Primarily renal excretion
  2. Half-life: 14 to 16 hours

VIII. Mechanism

  1. General
    1. Spironolactone is a aldosterone competitive inhibitor
    2. Acts at distal convoluted renal tubule
  2. Congestive Heart Failure
    1. Works synergistically with ACE Inhibitors in CHF
    2. ACE Inhibitors block Angiotensin II production
      1. Renal response is to increase Aldosterone
      2. Spironolactone blocks aldosterone escape

Images: Related links to external sites (from Google)

Cost: Medications

SPIRONOLACTONE (on 2/10/2012 at Target.com)
SPIRONOLACTONE 25 MG* Tablet #30 for $4.00 ($0.13/unit)
Spironolactone (on 2/9/2012 at DrugStore.com)
Spironolactone 100mg Tablets #30 for $34.99 ($1.17/unit)
Spironolactone 25mg Tablets #30 for $15.99 ($0.53/unit)
Spironolactone 50mg Tablets #30 for $21.99 ($0.73/unit)
Spironolactone-HCTZ (on 2/9/2012 at DrugStore.com)
Spironolactone-HCTZ 25-25mg Tablets #30 for $16.99 ($0.57/unit)
Aldactone (on 2/9/2012 at DrugStore.com)
Aldactone 25mg Tablets #30 for $39.99 ($1.33/unit)
Aldactone 100mg Tablets #30 for $94.49 ($3.15/unit)
Aldactone 50mg Tablets #30 for $65.99 ($2.20/unit)

Ontology: Spironolactone (C0037982)

Definition (MSH) A potassium sparing diuretic that acts by antagonism of aldosterone in the distal renal tubules. It is used mainly in the treatment of refractory edema in patients with congestive heart failure, nephrotic syndrome, or hepatic cirrhosis. Its effects on the endocrine system are utilized in the treatments of hirsutism and acne but they can lead to adverse effects. (From Martindale, The Extra Pharmacopoeia, 30th ed, p827)
Definition (NCI) A synthetic 17-spironolactone corticosteroid with potassium-sparing diuretic, antihypertensive, and antiandrogen activities. Spironolactone competitively inhibits adrenocortical hormone aldosterone activity in the distal renal tubules, myocardium, and vasculature. This agent may inhibit the pathophysiologic effects of aldosterone produced in excess by various types of malignant and benign tumors. (NCI04)
Definition (CSP) potassium sparing diuretic that acts by antagonism of aldosterone in the distal renal tubules; used mainly in the treatment of refractory edema in patients with congestive heart failure, nephrotic syndrome, or hepatic cirrhosis; its effects on the endocrine system are utilized in the treatments of hirsutism and acne but they can lead to adverse effects.
Definition (PDQ) A synthetic 17-spironolactone corticosteroid with potassium-sparing diuretic, antihypertensive, and antiandrogen activities. Spironolactone competitively inhibits adrenocortical hormone aldosterone activity in the distal renal tubules, myocardium, and vasculature. This agent may inhibit the pathophysiologic effects of aldosterone produced in excess by various types of malignant and benign tumors. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39444&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39444&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C840" NCI Thesaurus)
Concepts Steroid (T110) , Pharmacologic Substance(T121)
MSH D013148
SnomedCT 13929005, 387078006
English Spirolactone, Veroshpiron, Verospirone, Pregn-4-ene-21-carboxylic acid, 7-(acetylthio)-17-hydroxy-3-oxo-, gamma-lactone, (7alpha,17alpha)-, 17-Hydroxy-7alpha-mercapto-3-oxo-17alpha-pregn-4-ene-21-carboxylic Acid, gamma Lactone, Acetate, spironolactone, Spironolactone, SPL, spironolactone (medication), SPIRONOLACTONE, Spironolactone [Chemical/Ingredient], spirolactones, spirolactone, Spironolactone (product), Spironolactone (substance)
Swedish Spironolakton
Czech spironolakton
Finnish Spironolaktoni
Russian SPIROLAKTON, VEROSHPIRON, SPIRONOLAKTON, ВЕРОШПИРОН, СПИРОЛАКТОН, СПИРОНОЛАКТОН
Japanese アポラスノン, ダイロパール, アルパメド, アルダクトンA, ラッカルミン, メラルコン, アルダクトン, アルマトール, アレキサン, ホクラトン, ピロラクトン, スピロラクトン, オジロール, スピロノール, スピロノラクトン, アポタクッス
Italian Spirolattone, Spironolattone
Croatian SPIRONOLAKTON
Polish Spironolakton, Aldakton
Spanish espironolactona (producto), espironolactona (sustancia), espironolactona, Espirolactona, Espironolactona
French Spironolactone
German Spirolacton, Spironolacton
Portuguese Espirolactona, Espironolactona

Ontology: Aldactone (C0591054)

Concepts Steroid (T110) , Pharmacologic Substance(T121)
MSH D013148
English Pfizer Brand of Spironolactone, aldactone, Aldactone, Roche Brand of Spironolactone, Searle Brand of Spironolactone