4 Clinical Pearls About Spironolactone

Spironolactone (Aldactone) is a potassium sparing diuretic.  Based upon my experience, I put together 4 clinical pearls that you have to know!

  1. A commonly known fact with spironolactone is that it is a potassium sparing diuretic and often we use that potential to increase potassium to our advantage.  For patients having a difficult time keeping their potassium levels within normal limits due to thiazides and loops, they may require high doses of potassium supplementation which can be burdensome.  We can use spironolactone augmentation to help raise potassium level and possibly reduce the potassium supplements.  Also keep in mind that ACE Inhibitors and ARBs are frequently used in heart failure as well and can cause potassium elevations as well.
  2. Spironolactone is often used to enhance/augment fluid loss in heart failure, with this, we need to closely monitor kidney function to make sure our patients do not get too dehydrated.
  3. Spironolactone is often used in liver cirrhosis to treat ascites.  Not always, but in ascites, you may see the doses pushed higher than when being used for CHF.  Age or other factors may dictate lower starting doses, but the usual starting doses of spironolactone to furosemide in ascites is 100mg/40mg respectively.
  4. A common side effect that needs to be monitored with spironolactone is “moobs” or “man boobs”.  Gynecomastia is the technical term, which means that men can have the adverse effect of breast enlargement, swelling, and pain.

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Eric Christianson, PharmD, BCPS, CGP

Written By Eric Christianson

September 13, 2015

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