Spironolactone

Spironolactone is a potassium-sparing diuretic in the physiological sense of "opposing" the hormone of the adrenal cortex to aldosterone, which also has an antihypertensive effect.

Has a long diuretic effect of moderate severity and a weak antihypertensive effect. With regular administration of the drug, the monogone effect can be fully felt on the 2nd-5th day of treatment. After stopping the course of pharmacotherapy, he keeps for another 2-3 days.

The maximum benefit from the use of spironolactone can be recovered in the presence of edema caused by hypersecretion of aldosterone; in particular, in cases where the loss of potassium is strongly undesirable.

Clinical and pharmacological group

Potassium, magnesium-saving diuretic.

Terms of sale from pharmacies

Can buyby prescription.

Price

How much does Spironolactone cost in pharmacies? The average price is at the level of60 rubles.

Composition and form of release

Produced in the form of tablets of 25 or 100 milligrams of active substance, the package contains 20 or 30 tablets.

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One tablet contains 25 or 100 milligrams of spironolactone.

As auxiliary components are present povidone, calcium stearate, lactose, monohydrate and potato starch.

pharmachologic effect

The drug Spironolactone belongs to the group of potassium-sparing diuretics.

It is a competitive antagonist of aldosterone (the main mineralocorticosteroid hormone of the adrenal cortex). It is able to increase the excretion of Cl-, water and Na +, is able to reduce excretion of urea and K +, affects the amount of titrated acidity of urine reducing it. When the drug is used, a non-permanent hypotensive effect is caused (a decrease in blood pressure against a background of diuresis), the effect does not depend on the level of renin in the blood plasma and does not appear at normal blood pressure levels.

After application of the drug, the action occurs on the 2nd-5th day, manifested by a diuretic effect. Absorption is 90%, well absorbed from the gastrointestinal tract after oral administration. Metabolites of the drug are excreted mainly in the urine, a small part is excreted with the feces. The drug Spironolactone is able to penetrate the placental barrier and into breast milk during breastfeeding.

The effect of the drug on the kidney in a single dose reaches a peak after seven hours and the effect lasts about 24 hours.

Indications for use

What helps? Spironolactone is used to treat the following diseases:

hyperaldosteronism;
primary hyperaldosteronism;
Essential hypertension (Spironolactone is used as part of combination therapy);
secondary hyperaldosteronism caused by cirrhosis of the liver, in which edema, ascites and nephrotic syndrome develop;
hypomagnesemia and hypokalemia (the drug is used as an aid in diuretic therapy);
edematous syndrome, the cause of which is chronic heart failure (in this case, the drug is used as a monotherapy or in combination with other drugs).

Contraindications

Diabetes;
Metabolic acidosis;
Increased mammary glands;
Violations of the menstrual cycle;
I trimester of pregnancy;
Lactation period;
Addison's disease;
Hypercalcemia;
Hyperkalemia;
Hyponatremia;
Anuria;
Chronic renal failure;
Liver failure;
Diabetic nephropathy;
Hypersensitivity to the drug.

Special control of the condition during treatment is necessary for patients with impaired liver function.

Intended use for pregnancy and lactation

Studies in animals have found a negative effect of spironolactone on the fetus. Clinical trials involving pregnant women have not been conducted. Spironolactone should not be taken in the first trimester of pregnancy. In the 2nd and 3rd trimesters - only for serious illnesses, as prescribed by the doctor, who assesses the possible benefits and risks.

The active metabolite spironolactone - kaneron - penetrates into breast milk. Therefore spironolactone and breastfeeding are not compatible.

Dosage and route of administration

As indicated in the instructions for use of the tablet, spironolactone should be taken orally.

Recommended dosing regimens for adults:

idiopathic hyperaldosteronism: 100-400 mg per day;
Essential hypertension: 50-100 mg once a day, if necessary, gradually increase the dose (1 every 2 weeks) to 200 mg. An adequate response to therapy is usually noted after 2 weeks;
edematous syndrome due to chronic heart failure: 100-200 mg per day for 2-3 doses for 5 days in combination with thiazide or loop diuretics. The maintenance daily dose is selected individually: the minimum is 25 mg, the maximum is 200 mg;
edema due to nephrotic syndrome (in case of ineffectiveness of other therapies): 100-200 mg each;
edema due to cirrhosis of the liver: if the ratio of sodium and potassium ions in urine exceeds 1 - 100 mg per day, if less than 1 - 200-400 mg. The maintenance dose is selected individually;
hypokalemia and hypomagnesemia caused by the use of diuretics: 25-100 mg per day in one or more doses. If oral potassium preparations or other methods of replenishing its deficiency are ineffective, the daily dose may be increased to the maximum allowable - 400 mg;
pronounced hyperaldosteronism and hypokalemia: 300-400 mg per day for 2-3 doses. After improving the condition, the daily dose is gradually reduced to a maintenance dose of 25 mg.

Children with swelling appoint 1-3.3 mg / kg body weight (30-90 mg / m2) per day for 1-4 admission. After 5 days, dose adjustment is performed. If necessary, it can be increased 3 times compared to the initial one.

The use of Spironolactone for the diagnosis of hyperaldosteronism:

long-term diagnostic test: 400 mg per day (for several doses) for 3-4 weeks. If during this period it is possible to correct hypokalemia and arterial hypertension, we can assume the presence of primary hyperaldosteronism.
short diagnostic test: 400 mg per day (for several doses) for 4 days. If the concentration of potassium during the administration of the drug has increased, and then after its withdrawal has decreased, we can assume the presence of primary hyperaldosteronism.

After establishing the diagnosis of "primary hyperaldosteronism" with more accurate diagnostic methods, spironolactone is prescribed for a short course of preoperative therapy - 100-400 mg per day (1-4 sessions) during the entire preparatory period. If the operation is not indicated, the drug is used for long-term maintenance therapy at the lowest effective dose that the doctor selects individually for each patient.

Side effect

When using the drug, the following symptoms may develop:

thrombocytopenia, agranulocytosis, megaloblastosis;
alkalosis, hyperuricemia, hypercreatininaemia, increased urea concentration;
ataxia, retardation, headache, lethargy, drowsiness, dizziness;
decreased potency and muscle spasms;
itching, drug fever, erythematous and maculopapular rashes, urticaria;
breast carcinoma, pain in the mammary glands, coarsening of the voice, hirsutism, metrorrhagia in the climacteric, amenorrhea,
dysmenorrhea, erectile dysfunction in men and gynecomastia;
constipation or diarrhea, intestinal colic, bleeding and ulceration in the gastrointestinal tract, gastritis, pain in the abdomen, nausea and vomiting.

Overdose

Spironolactone is a drug that must be taken in the amount indicated. Exceeding the norm leads to serious deviations in vital activity, biological processes. Overdose is fraught with increased urea concentration, dehydration, headache, nausea, vomiting.

There is hyponatremia in the form of thirst, dry mouth. Hyperkalemia in extreme cases can lead to cardiac arrest. In people with hypertension, there is a sharp decrease in blood pressure, convulsions, arrhythmia.

special instructions

During the treatment period, the content of electrolytes and urea in the blood should be periodically determined.

Against the background of the use of spironolactone should not prescribe drugs containing potassium, as well as other diuretics that cause a delay in potassium in the body. Avoid the use of spironolactone with carbenoxolone, which causes sodium retention.

C use with caution in AV blockade (the possibility of amplification due to the development of hyperkalemia), decompensated liver cirrhosis, surgical interventions, admission of drugs that cause gynecomastia, with the administration of local and general anesthetics, in elderly patients.

When using spironolactone in combination with other diuretic or antihypertensive agents, the dose of the latter is recommended to be reduced. When using spironolactone simultaneously with digoxin, it may be necessary to reduce both the saturating and maintenance dose of the latter.

Interaction with other drugs

When using the drug, it is necessary to take into account the interaction with other drugs:

With simultaneous use of spironolactone inhibits the excretion of digoxin by the kidneys and, probably, reduces its volume of distribution. This can cause an increase in the concentration of digoxin in the blood plasma.
With simultaneous use with candesartan, losartan, eprosartan, there is a risk of hyperkalemia.
With simultaneous application with colestyramine cases of hypochloremic alkalosis are described.
With simultaneous application of lithium carbonate, an increase in the concentration of lithium in the blood plasma is possible.
With the simultaneous use of norepinephrine, a decrease in the sensitivity of the vessels to norepinephrine may be possible.
With simultaneous use, the action of tryptorelin, buserelin, gonadorelin is enhanced.
With simultaneous use with antihypertensive drugs, the hypotensive effect of spironolactone is potentiated.
With simultaneous use with ACE inhibitors, it is possible to develop hyperkalemia (especially in patients with impaired renal function) because ACE inhibitors reduce the content of aldosterone, which leads to a delay in potassium in the body against the background of the limitation of potassium excretion.
With simultaneous use with potassium preparations, other potassium-sparing diuretics, substitutes for table salt and dietary supplements for food containing potassium, it is possible to develop hyperkalemia.
With simultaneous application with salicylates, the diuretic effect of spironolactone is reduced due to blockade of canrenon excretion by the kidneys.
Indomethacin and mefenamic acid inhibit canrenone excretion by the kidneys.
With simultaneous use, the hypoprothrombinemic effect of oral anticoagulants is reduced.
With simultaneous use with digitoxin, both amplification and reduction in the effects of digitoxin are possible.

Reviews

We offer you to read reviews of people who used the drug Spironolactone:

Tatyana. I suffer from heart failure, the drug periodically drink courses. He does his work, but many unpleasant accompanying effects, the head always hurts, the pressure starts to decrease, because of this, it tends to sleep, it is difficult to concentrate on any day-to-day affairs. Negative manifestations intensify over time.
Leonid. I was prescribed this drug before the surgery for a tumor of the adrenal glands. The course was short, but it was remembered as heavy, constantly nauseated, my stomach hurted, several times I vomited. The diuretic effect is also pronounced and unpleasant, a constant feeling of having to go to the toilet. I noticed an increased thirst on the background of taking this medicine.

Analogues

The drug has analogues, the mechanism of action of which largely coincides with the drug Spirolactone. Some of them differ only in price, being generics generics. Others have composition peculiarities, they can be prescribed in cases when the original is contraindicated.

When choosing an analog that is supposed to be replaced, specialist consultation is necessary. The basic preparations:

Veroshpilakton - is a potassium-sparing diuretic, produced in a dosage of 25 mg, is not suitable for self-administration, it is used exclusively as part of a combination therapy.
Veroshpiron - Hungarian analogue of the original drug, has an excellent, softer action. In the patients' reviews, there were a small number of side effects, easy tolerability.
Espiro - is designed specifically for people with severe heart failure, prevents deaths on the background of the disease, is a more powerful analogue.

Before buying an analogue, consult your doctor.