May 29, 2023


Hello everybody my name is yvonne and i am a 2022 pharmd candidate i will be talking about spironolactone also known as aldactone or kerospur for the treatment of hypertension to start off i will be going over some main patient counseling points for spironolactone spironolactone is used for the management of hypertension unresponsive to other therapies all

Spironolactone products may be taken with or without food but they should be taken the same way in respect to food every time the spironolactone suspension must be shaken before taking some of the more common side effects include nausea vomiting diarrhea dizziness drowsiness gynecomastia or enlargement of the breast tissue menstruation disorders and erectile

Dysfunction now these side effects are more serious they include itching hives swelling of the face hands mouth or throat chest tightness trouble breathing blistering peeling red skin rash blood in the stools or urine vomiting blood mood changes or confusion muscle pain or weakness an uneven heartbeat unusual weight loss and any unexplained bruising or bleeding

If you notice any of these side effects be sure to contact your doctor right away now we will be going a little more in depth on the medication spironolactone spironolactone is an aldosterone receptor antagonist or as some may refer an anti-mineralocorticoid mcra or mra it is also classified as a potassium sparing diuretic now spironolactone has many labeled

Indications which include edema heart failure hepatic cirrhosis hypertension that is resistant or unresponsive primary hyperaldosteronism and also as well as some off-labeled indications which include acne vulgaris hirsutism polycystic ovary syndrome and premenstrual syndrome for this video we will be mainly focusing on spironolactone for the treatment of

Hypertension spironolactone as mentioned before is used for the management of hypertension that is unresponsive to other therapies which is also known as resistant hypertension this is defined as blood pressure that remains above gold despite concurrent use of three anti-hypertensive agents of different classes taken at maximally tolerated doses one of which

Should have been a diuretic spironolactone works by inhibiting the effects of aldosterone by competing for the aldosterone dependent sodium potassium exchange site in the distal renal tubules as you can see circled in red in the figure on the right this inhibition leads to an increase in sodium chloride and water excretion while conserving the potassium and

Hydrogen ions the dosage formulations come in tablets and a suspension there are three tablet strengths of 25 50 and 100 milligrams as for the suspension it comes as a 25 milligram per 5 milliliter bottle the initial dose recommendation for tablets is 25 milligrams once daily this can be titrated as needed based on response and tolerability up to a hundred

Milligrams once daily the initial dose recommendation for the suspension is 20 to 75 milligrams per day in one or two divided doses and this one may be titrated at two week intervals as needed based on response intolerability when it comes to dose adjustments for renal impairment be sure to get their estimated glomerular filtration rate or egfr to see if the dose

May need to be altered for tablets an egfr level that is greater than 10 no dose adjustment is needed but be sure to monitor the renal function closely as hyperkalemia is more likely to occur in patients with renal impairment with an egfr less than 10 avoid use an egfr between 30 to 50 in patients with heart failure consider 25 milligrams every other day for an

Egfr greater than 50 in heart failure consider 12.5 milligrams to 25 milligrams per day as for the suspension an egfr that is greater than 50 no dosage adjustment is needed but for an egfr between 30 to 50 consider an initial dosage of 10 milligrams once daily again due to the risk of hyperkalemia for hepatic impairment there are no specific dose adjustments

However do use it with caution as minor alterations of fluid and electrolyte balance may precipitate hepatic coma here are some warnings and precautions when taking spironolactone spironolactone may cause a fluid or electrolyte imbalance it is possibly tomorrow genic in chronic toxicity animal studies it was shown to be a tomorrow gen but in recent studies it

Didn’t suggest an increased risk of prostate or breast cancer spironolactone should be discontinued prior to an adrenal vein catheterization and it should be avoided in triple therapy which is the combined use of an ace inhibitor angiotensin ii receptor blocker and spironolactone combined in elderly patients you want to avoid the use of tablets greater than

25 milligram per day in patients with heart failure or with reduced renal function the suspension is not therapeutically equivalent to tablets so in patients requiring greater than 100 milligrams per dose use tablets instead there are a few contraindications when it comes to taking spironolactone which include hyperkalemia addison’s disease or chronic adrenal

Insufficiency can concomitant use with aplerenone aneuria severe renal impairment and acute renal failure as for monitoring parameters be sure to get blood pressure readings serum electrolyte levels uric acid glucose levels renal function and volume status here are my references and thank you for listening to my presentation

Transcribed from video
Spironolactone for Hypertension By Riverside Rx Services