Aldactone: Effective Potassium-Sparing Diuretic Therapy
Aldactone
| Product dosage: 100mg | |||
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Aldactone (spironolactone) is a prescription medication belonging to the class of potassium-sparing diuretics. It functions as a competitive antagonist of aldosterone, primarily acting on the distal renal tubules to promote sodium and water excretion while conserving potassium. This mechanism makes it uniquely valuable in managing conditions like heart failure, hypertension, and edema where fluid retention and electrolyte balance are critical concerns. Its additional antiandrogenic properties also lend utility in dermatological and endocrine applications.
Features
- Active ingredient: Spironolactone
- Drug class: Potassium-sparing diuretic/aldosterone antagonist
- Available formulations: 25mg, 50mg, and 100mg tablets
- Bioavailability: Approximately 90% following oral administration
- Half-life: 1.3–2 hours for parent compound; active metabolites 15–23 hours
- Metabolism: Hepatic, via CYP3A4 to active metabolites (canrenone)
- Excretion: Primarily renal (40–65%) and biliary (35–55%)
Benefits
- Reduces edema and fluid retention in congestive heart failure, cirrhosis, and nephrotic syndrome
- Lowers blood pressure through diuresis and inhibition of aldosterone-mediated vascular effects
- Preserves potassium levels, reducing risk of hypokalemia compared to thiazide or loop diuretics
- Demonstrates cardioprotective effects in heart failure by counteracting maladaptive aldosterone activation
- Provides antiandrogenic benefits for conditions like hirsutism and acne vulgaris
- May reduce proteinuria and slow progression of chronic kidney disease in selected patients
Common use
Aldactone is primarily indicated for the management of edema associated with congestive heart failure, cirrhosis of the liver accompanied by edema and/or ascites, and nephrotic syndrome. It is also approved for essential hypertension, typically as add-on therapy when other agents prove insufficient. The medication finds significant off-label use in treating hyperaldosteronism, hirsutism in polycystic ovary syndrome, acne vulgaris, and female pattern hair loss. In heart failure with reduced ejection fraction, it is standard care as part of guideline-directed medical therapy to improve outcomes.
Dosage and direction
Dosage must be individualized based on condition being treated and patient response. For edema in adults: initial dose typically 25-200mg daily in single or divided doses. For hypertension: initial dose 25-50mg daily, may increase to 100mg daily. For heart failure: starting dose 25mg once daily, may increase to 50mg once daily. For hirsutism: 50-200mg daily. Tablets should be taken with meals to enhance absorption. Regular monitoring of serum electrolytes, particularly potassium, is essential during therapy. Dosage adjustments may be necessary in renal impairment.
Precautions
Patients should be monitored for electrolyte imbalances, particularly hyperkalemia, which can be life-threatening. Regular assessment of renal function is mandatory. Use with caution in patients with renal impairment, hepatic disease, or diabetes. May cause gynecomastia, impotence, or menstrual irregularities. Can cause drowsiness or dizziness affecting ability to drive or operate machinery. Avoid potassium supplements or salt substitutes containing potassium unless specifically directed. Photosensitivity reactions may occur. Elderly patients may be more susceptible to adverse effects.
Contraindications
Absolute contraindications include anuria, acute renal insufficiency, significant impairment of renal function, hyperkalemia, Addison’s disease, and concomitant use with eplerenone. Relative contraindications include hypersensitivity to spironolactone or components, severe hepatic impairment, electrolyte imbalances, metabolic acidosis, and pregnancy (category C/D depending on trimester). Concomitant use with other potassium-sparing diuretics, potassium supplements, ACE inhibitors, ARBs, or NSAIDs requires extreme caution.
Possible side effect
Common adverse reactions (>10%): hyperkalemia, nausea, vomiting, diarrhea, abdominal cramping, drowsiness, headache, ataxia. Less common (1-10%): gynecomastia, impotence, menstrual irregularities, postmenopausal bleeding, hirsutism, deepening voice, rash, urticaria, photosensitivity. Rare (<1%): Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, hepatitis, hyponatremia, hypocalcemia, hyperglycemia. Endocrine effects are typically dose-dependent and may be reversible upon discontinuation.
Drug interaction
Significant interactions occur with: ACE inhibitors (increased hyperkalemia risk), ARBs (increased hyperkalemia risk), other potassium-sparing diuretics (additive hyperkalemia), digoxin (may alter digoxin levels), NSAIDs (reduced diuretic effect, increased nephrotoxicity risk), lithium (increased lithium toxicity risk), anticoagulants (possible enhanced anticoagulant effect), corticosteroids (additive hypokalemia), ACTH (additive hypokalemia). Moderate CYP3A4 inhibitors may increase spironolactone concentrations. May interfere with digoxin radioimmunoassays.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. If multiple doses are missed, contact healthcare provider for guidance. Maintain regular dosing schedule to ensure consistent therapeutic effect, particularly for hypertension and heart failure management.
Overdose
Symptoms primarily reflect electrolyte disturbances, particularly hyperkalemia (muscle weakness, paralysis, arrhythmias, cardiac arrest) and dehydration (hypotension, tachycardia, dizziness). Hyponatremia may also occur. Gastric lavage may be considered if recent ingestion. Treatment is supportive and symptomatic, focusing on electrolyte correction. Hyperkalemia may require calcium gluconate, glucose with insulin, sodium bicarbonate, or kayexalate. Hemodialysis may be effective for removing active metabolites.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Protect from light and moisture. Keep in original container with tight closure. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Do not transfer tablets to other containers without proper labeling. Discard any medication that appears discolored or shows signs of deterioration.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Aldactone is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to medication may vary. Always consult with your physician for proper diagnosis, treatment recommendations, and monitoring. Do not initiate, adjust, or discontinue medication without professional guidance.
Reviews
Clinical trials demonstrate Aldactone’s efficacy in reducing mortality in severe heart failure (RALES trial: 30% risk reduction) and hospitalizations. In hypertension studies, it shows significant blood pressure reduction, particularly in low-renin hypertension. Dermatological studies report 50-80% improvement in hirsutism scores and significant acne reduction. Most common patient-reported benefits include reduced edema, improved breathing in heart failure, and dermatological improvement. Concerns typically focus on endocrine side effects, particularly in male patients. Overall, it maintains a favorable risk-benefit profile in appropriate patient populations with proper monitoring.