Spironolactone: Difference between revisions
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==Administration==
==Administration==
*Type: Antihypertensive; Potassium Sparing Diuretic; Aldosterone Receptor Antagonist
*Type: [[Antihypertensive]]; [[potassium sparing diuretic]]; aldosterone receptor antagonist
*Dosage Forms: 25,50,100
*Dosage Forms: 25,50,100
*Routes of Administration: Oral
*Routes of Administration: Oral
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==Adult Dosing==
==Adult Dosing==
*Edema: 25-200 mg/day PO divided qd-bid
===Edema===
**For edema assoc. with CHF, cirrhosis, or nephrotic syndrome
*25-200mg/day PO divided QD-bid
**For edema associated with [[CHF]], [[cirrhosis]], or [[nephrotic syndrome]]


*HTN: 25-50 mg/day PO divided qd-bid
===[[Hypertension]]===
**Start: 12.5 mg PO qd
*25-50mg/day PO divided QD-bid
**Start: 12.5mg PO QD


*Hyperaldosteronism, primary: 100-400 mg PO qd
===Hyperaldosteronism, primary===
*100-400mg PO QD


*Hypokalemia, diuretic-induced: 25-100 mg/day PO divided qd-qid
===[[Hypokalemia]], diuretic-induced===
*25-100mg/day PO divided QD-QID


*CHF, NYHA Class III/IV: 25 mg PO qd
===[[CHF]], NYHA Class III/IV===
**Use with standard tx; may incr. to 50 mg/day after 8wk for worsening CHF if K stable
*25mg PO QD
**May decr. to 25 mg qod if hyperkalemia; hold if K >5 mEq/L or Cr >4 mg/dL
**Use with standard treatment; may increase to 50mg/day after 8wk for worsening CHF if K stable
**May decrease to 25mg qod if hyperkalemia; hold if K >5 mEq/L or creatinine >4mg/dL


*Hirsutism, idiopathic: 50-200 mg PO qd
===Hirsutism, idiopathic===
*50-200mg PO QD
**Off label use
**Off label use


*Acne vulgaris: 50-200 mg PO qd
===Acne vulgaris===
**Start: 25 mg PO qd
*50-200mg PO QD
**Start: 25mg PO QD
**Off label use
**Off label use


==Pediatric Dosing==
==Pediatric Dosing==
*Edema: 1-3.3 mg/kg/day PO divided qd-qid
===Edema===
**Max: 3.3 mg/kg/day up to 200 mg/day
*1-3.3mg/kg/day PO divided QD-QID
**Max: 3.3mg/kg/day up to 200mg/day
**Off label use
**Off label use


*Hyperaldosteronism test: 125-375 mg/m^2/day PO divided bid-qid
===Hyperaldosteronism test===
**Max: 375 mg/m^2/day
*125-375mg/m^2/day PO divided bid-QID
**Max: 375mg/m^2/day
**Off label use
**Off label use


==Special Populations==
==Special Populations==
*Pregnancy Risk Factor: C
*[[Drug ratings in pregnancy|Pregnancy Risk Factor]]: C


===Renal Dosing===
===Renal Dosing===
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*anuria
*anuria
*renal impairment, acute
*renal impairment, acute
*hyperkalemia
*[[hyperkalemia]]
*Addison disease
*Addison disease


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==See Also==
==See Also==
*[[CHF]]
*[[Cirrhosis]], [[Ascites]]


==References==
==References==
<Epocrates, UpToDate>
<Epocrates, UpToDate>
[[Category:Pharmacology]]
[[Category:Pharmacology]]

Latest revision as of 12:41, 7 July 2017

Administration

Adult Dosing

Edema

Hypertension

  • 25-50mg/day PO divided QD-bid
    • Start: 12.5mg PO QD

Hyperaldosteronism, primary

  • 100-400mg PO QD

Hypokalemia, diuretic-induced

  • 25-100mg/day PO divided QD-QID

CHF, NYHA Class III/IV

  • 25mg PO QD
    • Use with standard treatment; may increase to 50mg/day after 8wk for worsening CHF if K stable
    • May decrease to 25mg qod if hyperkalemia; hold if K >5 mEq/L or creatinine >4mg/dL

Hirsutism, idiopathic

  • 50-200mg PO QD
    • Off label use

Acne vulgaris

  • 50-200mg PO QD
    • Start: 25mg PO QD
    • Off label use

Pediatric Dosing

Edema

  • 1-3.3mg/kg/day PO divided QD-QID
    • Max: 3.3mg/kg/day up to 200mg/day
    • Off label use

Hyperaldosteronism test

  • 125-375mg/m^2/day PO divided bid-QID
    • Max: 375mg/m^2/day
    • Off label use

Special Populations

Renal Dosing

  • CrCl <10, anuria, or acute renal impairment: contraindicated

Hepatic Dosing

  • Caution advised with hepatic impairment

Contraindications

  • Allergy to class/drug
  • CrCl <10
  • anuria
  • renal impairment, acute
  • hyperkalemia
  • Addison disease

Adverse Reactions

Serious

  • anaphylaxis
  • Stevens-Johnson syndrome
  • toxic epidermal necrolysis
  • drug reaction with eosinophilia and systemic sx
  • vasculitis
  • hepatotoxicity
  • renal failure
  • electrolyte imbalance
  • hyperkalemia, severe
  • arrhythmias
  • leukopenia
  • agranulocytosis
  • thrombocytopenia

Common

  • nausea/vomiting
  • abdominal cramps/pain
  • muscle cramps
  • diarrhea
  • headache
  • confusion
  • dizziness
  • somnolence

Pharmacology

  • Half-life: 1.3-2h (parent drug), 13.8-16.5h (active metabolites)
  • Metabolism: Liver
  • Excretion: Urine

Mechanism of Action

Antagonizes aldosterone receptors in the distal convoluted tubule, decreasing Na and water reabsorption and increasing K retention

Comments

See Also

References

<Epocrates, UpToDate>

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