Spironolactone

May be taken with or without food. Take consistently w/ or w/o food.

Hyperkalaemia, Addison's disease, anuria, acute renal insufficiency, significant renal compromise. Concomitant use with other K-sparing diuretics (e.g. eplerenone) and K supplements.

Patient with heart failure. Discontinue use prior to adrenal vein catheterisation. Oral susp is not therapeutically equivalent to the tab; use the tab preparation in patients requiring >100 mg/dose. Renal (eGFR 30-50 mL/min/1.73 m²) and hepatic impairment. Pregnancy and lactation. Monitoring Parameters Monitor blood pressure, uric acid, blood glucose, renal function, and volume status periodically; serum electrolytes (serum K within 1 week of treatment initiation or dose titration and regularly thereafter). In patients with heart failure: Assess serum K and renal function 3 days after initiating therapy, at 1 week after initiation, at least monthly for the 1st 3 months of treatment, and every 3 months thereafter.

Significant: Hypomagnesaemia, hyponatraemia, hypocalcaemia, hyperglycaemia; hyperchloraemic metabolic acidosis (reversible),; hypochloraemic alkalosis, asymptomatic hyperuricaemia, gynaecomastia (reversible); increased blood urea (reversible). Rarely, gout. Blood and lymphatic system disorders: Agranulocytosis, leucopenia, thrombocytopenia. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, stomach cramps, gastritis, gastric ulcer or bleeding. General disorders and administration site conditions: Malaise, ataxia, fever, lethargy. Hepatobiliary disorders: Abnormal hepatic function. Musculoskeletal and connective tissue disorders: Muscle spasms. Nervous system disorders: Dizziness, headache, drowsiness. Psychiatric disorders: Confusional state. Renal and urinary disorders: Acute kidney injury. Reproductive system and breast disorders: Breast pain, libido disorder, menstrual irregularities, postmenopausal bleeding; benign breast neoplasm; impotence (male). Skin and subcutaneous tissue disorders: Pruritus, rash, urticaria, maculopapular or erythematous cutaneous eruptions, toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS), alopecia, hypertrichosis.
Potentially Fatal: Hyperkalaemia.

May increase the risk of hyperkalaemia with ACE inhibitors, ARBs, NSAIDs, heparin and LMWHs, and trimethoprim. Diuretic, natriuretic, and antihypertensive effects may be reduced by NSAIDs (e.g. aspirin, indometacin, mefenamic acid). May increase the serum levels of digoxin. Reduces renal clearance of lithium, which may increase the risk of lithium toxicity. Concomitant use with colestyramine may cause hyperkalaemic metabolic acidosis. May have additive effects with antihypertensive agents and other diuretics. Concomitant use with carbenoxolone may result in reduced efficacy of either agent. May reduce the vascular response to norepinephrine. May increase the PSA levels in prostate cancer patients being treated with abiraterone. Enhances the metabolism of phenazone. Worsening of renal function may occur when used concomitantly with nephrotoxic agents (e.g. aminoglycosides, cisplatin).

Diuretics / Other Antihypertensives

C03DA01 - spironolactone ; Belongs to the class of aldosterone antagonists. Used as potassium-sparing diuretics.