Spironolactone dosing

Initial doses should be low (spironolactone 12.5 mg/day eplerenone 25 mg/day), especially in the elderly and those with diabetes or creatinine clearance <50 mL/min. A spironolactone dose of 25 mg/day was used in one major clinical trial. The eplerenone dose should be titrated to the target dose of 50 mg once daily, preferably within 4 weeks as tolerated by the patient. 

Adverse effects Renal function may deteriorate with the decreased circulating fluid volume, especially after the addition of another diuretic drug acting on the RAAS system, and careful monitoring of serum creatinine is essential. Serum potassium should be monitored within one week of initiation and at least every four weeks for the first three months and every three months thereafter. It should also be monitored at any dose change in spironolactone or if there is a change in concomitant medications that affects the potassium balance. The spironolactone dose (standard 25 mg per day) should be reduced if potassium levels are <5.4 mEq/L, and treatment should be discontinued if painful gynecomastia or serious renal dysfunction or hyperkalemia result. 

The elimination half-life of canrenone ranges from approximately 12 to 20 hours, depending upon the spironolactone dose administered [83], Metabolites of spironolactone are primarily eliminated renally, with only minimal biliary excretion. Little to no parent drug is recoverable in the urine, reflecting the complete biotransformation of the compound [72,74,83]. 

Spironolactone is an antiandrogen which blocks androgen-receptors, alters steroidogenesis by adrenals and gonads and inhibits 5-a reductase. In doses of 100-200 mg daily it reduces sebum production and improves inflammatory acne in women. During treatment, birth control measures are required due to the risk of male fetus feminization. 

High-dose diuretics until loss of ascitic fluid o Spironolactone up to 400 enterally daily... 

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... 

Doses should be titrated at intervals no more frequent than every 2 to 3 days. Because spironolactone is used for its antialdosterone effects, much higher doses (up to 400 mg/day) are used than those used when treating hypertension. If intolerable side effects such as gynecomastia occur with spironolactone, other potassium-sparing diuretics may be used, but clinical trials have not shown equivalent efficacy.22... 

Either eplerenone or spironolactone should be considered within the first 2 weeks after MI to reduce mortality in all patients already receiving an ACE inhibitor who have LVEF <40% and either heart failure symptoms or a diagnosis of diabetes mellitus. The drugs are continued indefinitely. Example oral doses include the following ... 

Spironolactone 12.5 mg initially target dose 25 to 50 mg once daily. 

Diuretic therapy should be initiated with single morning doses of spironolactone, 100 mg, and furosemide, 40 mg, with a goal of 0.5-kg maximum daily weight loss. The dose of each can be increased together, maintaining the 100 40 mg ratio, to a maximum daily dose of 400 mg spironolactone and 160 mg furosemide. 

Spironolactone tablets are available in 25 mg strength, but a drug order comes for 150 mg dose. How many tablets should be dispensed ... 

Hyperkalemia Yasmin contains the progestin drospirenone that has antimineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to a 25 mg dose of spironolactone. Yasmin should not be used in patients with conditions that predispose to hyperkalemia. Women receiving daily, long-term treatment for chronic conditions or diseases with medications that may increase serum potassium should have their serum potassium level checked during the first treatment cycle. 

Uses Primary hypothalamic amenorrhea Action Stimulates pituitary release of LH FSH Dose 5 meg IV q90min x 21 d using pump kit Caution [B, M] T Levels w/ androgens, estrogens, progestins, glucocorticoids, spironolactone, levodopa ... 

Hydrochlorothiazide A Spironolactone Aldactazide) [Antihypertensive/Thiazide K Sparing Diuretic] Uses Edema, HTN Action Thiazide K -sparing diuretic Dose 25-200 mg each component/d, doses Caution [D, +] Contra Sulfonamide aUa-gy Disp Tabs (HCTZ/spironolactone) 25 mg/25 mg, 50 mg/50 mg SE Photosens, X BP, t or -1-K% -1- Na% hypoglycemia, hyperlipidemia, hyperuricemia Additional Interactions t Risk of hypokalemia W/ ACEIs, K-sparing diuretics, K supls, salt substitutes -1- effects OF digoxin EMS See Hydrochlorothiazide Amiloride OD See Hydrochlorothiazide Amiloride... 

Ramsay LE, Shelton JR, Tidd MJ. The pharmacodynamics of single doses of prorenoate potasssium and spironolactone in fludrocortisone treated normal subjects. Br J Clin Pharmacol 1976 3(3) 475-82. 

An extremely ill 51-year-old man with Cushing s syndrome, due to an ACTH-secreting pituitary macroadenoma, which had failed to respond to conventional surgical, medical, and radiotherapeutic approaches, responded dramatically in the short-term and long-term to high-dose mifepristone (up to 25 mg/kg/day) for 18 months. However, she developed severe hypokalemia, attributed to excessive cortisol activation of mineralocor-ticoid receptors it responded to spironolactone. 

In 110 patients with cirrhosis, ascites, and hyponatremia in a multicenter, double-blind, randomized, placebo-con-trolled study of three fixed doses of satavaptan (5,12.5, or 25 mg/day) for 14 days plus spironolactone 100 mg/day, satavaptan was associated with improved control of ascites. Thirst was the main adverse effect (4). 

A 63-year-old man reduced his dietary sodium intake to combat fluid retention and was taking furosemide 40 mg/ day, spironolactone 50 mg/day, and enalapril 2.5 mg/day (26). He then took amiodarone 800 mg/day for 7 days and his serum sodium concentration fell to 119 mmol/1 his plasma vasopressin concentration was raised at 2.6 pmol/1. The dose of amiodarone was reduced to 100 mg/day, with fluid restriction his sodium rose to 130 mmol/1 and his vasopressin fell to 1.4 pmol/1. 

A 37-year old man with a dilated cardiomyopathy was given furosemide, spironolactone, and candesartan. After 1 year carvedilol was introduced in a maintenance dose of 10 mg/day. HbAic was 5.1% at the beginning of carvedilol treatment. After 9 months of treatment, he started to feel extremely thirsty and lost 10 kg in 3 months. No viral infections or pancreatitis were detected. The HbAic concentration increased to 17%, the blood glucose concentration was 31 mmol/1 (557 mg/dl). Furosemide was withdrawn and the blood glucose concentration fell within a week to 8.9 mmol/1 (160 mg/dl). Carvedilol was then replaced by metopro-lol and after 2 further weeks the fasting blood glucose concentration fell to 5.9 mmol/1 (106 mg/dl). The patient was stable thereafter. 

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