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.