Spironolactone contraindications

In patients without contraindications, spironolactone is initiated at a dose of 12.5 to 25 mg daily, or occasionally on alternate days for patients with baseline renal insufficiency. Eplerenone is used at a dose of 25 mg daily, with the option to titrate up to 50 mg daily. Doses should be halved or switched to alternate-day dosing if creatinine clearance falls below 50 mL/minute. Potassium supplementation is often decreased or stopped after aldosterone antagonists are initiated, and patients should be counseled to avoid high-potassium foods. At anytime after initiation of therapy, if potassium concentrations exceed... 

The answer is e. (Hardman, p 708.) Spironolactone is a competitive antagonist of aldosterone that blocks the reabsorption of Na and water from the collecting duct in exchange for K and hydrogen ion retention. Therefore, in the presence of hyperkalemia, spironolactone is contraindicated The administration of each of the other diuretic agents listed results in increased excretion of K. 

Potassium-sparing diuretics may cause hyperkalemia, especially in patients with chronic kidney disease or diabetes, and in patients receiving concurrent treatment with an ACE inhibitor, ARB, NSAID, or potassium supplement. Eplerenone has an increased risk for hyperkalemia and is contraindicated in patients with impaired renal function or type 2 diabetes with proteinuria. Spironolactone may cause gynecomastia in up to 10% of patients, but this effect occurs rarely with eplerenone. 

Also contraindicated for the treatment of hypertension in patients with the following conditions Type 2 diabetes with microalbuminuria serum creatinine greater than 2 mg/dL in males or greater than 1.8 mg/dL in females Ccr less than 50 mL/min concomitant use of potassium supplements or potassium-sparing diuretics (amiloride, spironolactone, or triamterene). 

Symptomatic or prior-symptomatic fluid retention responds well to treatment with diuretics and salt restriction if LVEF is reduced. This will usually improve current HF symptoms. Especially, an aldosterone antagonist like spironolactone should be added in selected patients with advanced HF symptoms and reduced LVEF with preserved renal function. Potassium has to be normal and should be carefully monitored. Patients with renal dysfunction and with serum creatinine levels >2.5 mg/dl in men and >2.0 mg/dl in women are contraindicated for aldosterone antagonists. 

Contraindications Concurrent use of potassium supplements or potassium-sparing diuretics (such as amiloride, spironolactone, and triamterene), or strong inhibitors of the cytochrome P450 3A4 enzyme system (including ketoconazole and itraconazole), creatinine clearance less than 50 ml/min, serum creatinine level greater than 2 mg/dl in males or 1.8 mg/dl in females, serum potassium level greater than 5.5 mEq/L, type 2 diabetes mellitus with microalbuminuria... 

A 69-year-old man with hypertension and heart failure took losartan 25 mg/day, increasing to 50 mg/day after 2 weeks. He also took spironolactone 50 mg/day, furo-semide 40 mg/day, digoxin 0.25 mg/day, acenocou-marol, and allopurinol. Two weeks later he developed acute renal insufficiency with a plasma creatinine concentration of 725 pmol/l (previously 115 pmol/l). Within 24 hours after losartan withdrawal (it was not stated whether spironolactone was also stopped) and hemodialysis, he recovered renal function (plasma creatinine 124 mg/1). He was later found to have bilateral renal artery stenosis, which is a contraindication to angiotensin II receptor antagonists. 

Antagonists Spironolactone 25-50 1 or 2 diuresis epierenone contraindicated in patients with... 

APA-Dependent Hyperaldosteronism. The treatment of choice for APA-dependent aldosteronism remains laparoscopic resection of the adenoma. If no primary lesion is found, resection of one and a half of the adrenal glands may be attempted, followed by supplemental spironolactone therapy. However, a recent retrospective analysis of patients with aldosterone-producing adenomas who chose medical management instead of surgical resection, revealed medical management to be efficacious in this population and should be considered as an alternative in patients in whom surgery is contraindicated. ... 

Mitotane (lysodren) is administered in initial daily oral doses of 2-6 g, usually given in 3 or 4 divided portions, but the maximal tolerated dose may vary from 2 to 16 g/day. Treatment should be continued for at least 3 months if beneficial effects are observed, therapy should be maintained indefinitely. Spironolactone should not be administered concomitantly, since it interferes with the adrenal suppression produced by mitotane. Treatment with mitotane is indicated for the palliation of inoperable adrenocortical carcinoma, producing symptomatic benefit in 30—50% of such patients. Although the administration of mitotane produces anorexia and nausea in 80% of patients, somnolence and lethargy in 34%, and dermatitis in 15—20%, these effects do not contraindicate the use of the drug at lower doses. Since this drug damages the adrenal cortex, administration of corticosteroids is indicated, particularly in patients with evidence of adrenal insufficiency, shock, or severe trauma. 

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