Spironolactone: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: Antihypertensive; | *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=== | ||
**For edema associated with CHF, cirrhosis, or nephrotic syndrome | *25-200mg/day PO divided QD-bid | ||
**For edema associated with [[CHF]], [[cirrhosis]], or [[nephrotic syndrome]] | |||
* | ===[[Hypertension]]=== | ||
**Start: 12.5mg PO | *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 | **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 | **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 | **Off label use | ||
===Acne vulgaris=== | |||
**Start: 25mg PO | *50-200mg PO QD | ||
**Start: 25mg PO QD | |||
**Off label use | **Off label use | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
* | ===Edema=== | ||
*1-3.3mg/kg/day PO divided QD-QID | |||
**Max: 3.3mg/kg/day up to 200mg/day | **Max: 3.3mg/kg/day up to 200mg/day | ||
**Off label use | **Off label use | ||
===Hyperaldosteronism test=== | |||
*125-375mg/m^2/day PO divided bid-QID | |||
**Max: 375mg/m^2/day | **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 | ||
Latest revision as of 12:41, 7 July 2017
Administration
- Type: Antihypertensive; potassium sparing diuretic; aldosterone receptor antagonist
- Dosage Forms: 25,50,100
- Routes of Administration: Oral
- Common Trade Names: Aldactone
Adult Dosing
Edema
- 25-200mg/day PO divided QD-bid
- For edema associated with CHF, cirrhosis, or nephrotic syndrome
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>