What is it for and how to take spironolactone (aldactone)

Spironolactone, known commercially as Aldactone, acts as a diuretic, increasing the elimination of water through the urine, and as an antihypertensive, and can be used to treat high blood pressure, swelling related to problems in the functioning of the heart or diseases in the liver and kidneys, hypokalemia or in the treatment of hyperaldosteronism, for example.

In some cases, this remedy can be prescribed for the treatment of acne and to prevent hair loss, however these applications are not part of the main indications for spironolactone, nor are they mentioned in the package insert.

Spironolactone can be purchased in pharmacies, for a price of about 14 to 45 reais, depending on whether the person chooses the brand or the generic, requiring a prescription.

What is it for

Spironolactone is indicated for:

• Essential hypertension; Edema caused by heart, kidney or liver problems; Idiopathic edema; Auxiliary therapy in malignant hypertension; Hypokalemia when other measures are considered inappropriate or inadequate; Prevention of hypokalemia and hypomagnesaemia in people taking diuretics; Diagnosis and treatment of hyperaldosteronism.

Learn about other types of diuretics and learn how they work.

How to take

The dosage depends on the problem to be treated:

1. Essential hypertension

The usual dose is 50 mg / day to 100 mg / day, which in resistant or severe cases can be gradually increased, in intervals of two weeks, up to 200 mg / day. Treatment should be continued for at least two weeks to ensure an adequate response to treatment. The dose should be adjusted as needed.

2. Congestive Heart Failure

The recommended starting daily dose is 100 mg in a single or divided dose, which can vary between 25 mg and 200 mg daily. The usual maintenance dose should be determined for each person.

3. Liver cirrhosis

If the urinary sodium / urinary potassium ratio is greater than 1, the usual dose is 100 mg / day. If this ratio is less than 1, the recommended dose is 200 mg / day to 400 mg / day. The usual maintenance dose should be determined for each person.

4. Nephrotic Syndrome

The usual dose in adults is 100 mg / day to 200 mg / day.

5. Edema

The usual dose is 100 mg per day for adults and approximately 3.3 mg per kg of weight administered in a fractional dose. The dosage should be adjusted based on the response and tolerability of each person.

6. Hypokalemia / hypomagnesaemia

A dosage of 25 mg / day to 100 mg / day is recommended in the treatment of hypopotassemia and / or hypomagnesemia induced by diuretics, when oral potassium and / or magnesium supplements are not adequate.

7. Preoperative treatment of Primary Hyperaldosteronism

When the diagnosis of hyperaldosteronism is well established by more definitive tests, spironolactone can be administered in daily doses of 100 mg to 400 mg in preparation for surgery.

8. Malignant hypertension

It should only be used as auxiliary therapy and when there is excessive secretion of aldosterone, hypokalemia and metabolic alkalosis. The starting dose is 100 mg / day, which can be increased, when necessary, at intervals of two weeks, up to 400 mg / day.

Mechanism of action

Spironolactone is a specific aldosterone antagonist, acting mainly on the aldosterone-dependent sodium and potassium ion exchange site, located in the distal outlined tubule of the kidney, leading to increased sodium and water elimination and increased potassium retention.

Possible side effects

Some of the side effects of spironolactone may include benign breast cancer, leukopenia, thrombocytopenia, electrolyte disturbances, changes in libido, confusion, dizziness, gastrointestinal disturbances and nausea, abnormal liver function, Steve-Johnson syndrome, toxic epidermal necrolysis, drug rash, hair loss, hypertrichosis, itching, hives, leg cramps, acute kidney failure, breast pain, menstrual disorders, gynecomastia and malaise.

Contraindications

Spironolactone should not be used by people who are hypersensitive to the components of the formula, people with acute renal failure, significant impairment of kidney function, anuria, Addison's disease, hyperkalaemia or who are using a medicine called eplerenone.