spironolactone

Active mechanism:

• Competitive inhibition of aldosterone on mineralocorticoid receptor
• Aldosterone can no longer trigger sodium resorption and potassium secretion
• Sodium and water are separated
• Potassium is saved (calcium-saving diuretic)

For heart failure:

• Prevents the harmful effect of aldosterone on the heart
• Reduced cardiac fibrosis (snoring)
• Improves endothelial function
• Reduces mortality by 30% (RALES study)

Antiandrogen effect:

• Blocks androgen receptors
• inhibits testosterone production
• Can improve acne and milletutism in women
• Can cause gynecomastia and potency disorders in men

• Chronic heart failure (NYHA III-IV, as additional therapy)
• Treatment-resistant high blood pressure (as a 4th drug)
• Primary Hyperaldosteronism (Conn Syndrome)
• Liver cirrhosis with ascites and edema
• Hypokaliemia by other diuretics

Especially recommended at:

• Serious heart failure (life saving!)
• High blood pressure that does not appeal to 3 drugs
• Conn Syndrome (Aldosterone-producing adenoma)
• Liver cirrhosis with ascites

Not suitable:

• Heavy kidney failure (GFR below 30 ml/min)
• Heavy hyperkaliemia
• Morbus Addison
• Anurie
• At the same time with Eplerenon

Sufficiency:

• 25-50 mg once a day
• For potassium under 5.0 mmol/l: 25 mg
• For potassium over 5.5 mmol/l: reduce or pause dose

Therapy-resistant high blood pressure:

• 25-50 mg once a day

Leberzirrhose mit Aszites:

• start dose: 100 mg daily
• Up to 400 mg daily possible
• In combination with furosemide (ratio 100:40)

Primary hyperaldosteroneism:

• 100-400 mg daily

Available starches:

• 25 mg, 50 mg, 100 mg tablets

Intake:

• Once a day, preferably morning or midday
• At or after meals (improved reception)
• With sufficient water

Important notes:

• Engmaschige Potassium Controls (Calium can increase dangerously!)
• No potassium supplements without medical instructions
• No calcium-containing salt substitutes
• Control kidney values regularly
• For potassium over 5.5 mmol/l: contact doctor immediately

Monitoring:

• Potassium and creatine: after 1 week, 4 weeks, then every 3 months
• In case of heart failure: tighter controls

**Spironolactone must not be taken at:* *

• Heavy hyperkalemia (over 5.5 mmol/l)
• Heavy kidney failure (GFR below 30 ml/min)
• Morbus Addison
• Anurie
• At the same time with Eplerenon
• hypersensitivity to Spironolacton

Preview at:

• Moderate renal insufficiency
• Simultaneous intake of ACE inhibitors/sartans (hyperkaliemia risk!)
• Diabetes mellitus (hyperkalemia risk increased)
• Simultaneous NSAR intake
• Older patients

Acid (1-10%):

• Hyperkaliemia (most important side effect!)
• Gynecomastia in men (dose dependent, up to 10%)
• Breast tensions and sensitivity
• Gastrointestinal complaints
• tiredness, sleepiness
• Headaches

** Occasionally (0,1-1%):* *

• Menstrual disorders in women
• Changes in mood in women
• Potency disorders in men
• Skin rash
• nausea, vomiting
• Muscle cramps

Selten:

• Heavy hyperkalemia (life threatening!)
• Hyponatriemia
• Metabolic aziosis
• liver value increases
• Blood-image changes

**Dangerous combinations (hyperkaliemia risk!):* *

• ACE inhibitors and sartans → narrow-meshed potassium controls!
• Potassium supplements → contraindicated
• Other potassium-saving diuretics (triamteren, Amilorid) → contraindicated
• Eplerenon → contraindicated
• Trimethoprim → enhanced hyperkalemia

Preview at:

• NSAR → reduced diuresis, hyperkalemia
• Lithium → increased lithium mirror
• Digoxin → increased digoxin level (but hyperkalemia protects against digitalis toxicity)
• Antihypertensive → increased blood pressure reduction