Aldactone: Potassium-Sparing Diuretic for Edema and Hypertension Control
Aldactone
| Product dosage: 100mg | |||
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| 360 |
$0.96
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Aldactone (spironolactone) is a prescription medication classified as a potassium-sparing diuretic and aldosterone antagonist. It is primarily indicated for the management of edema in congestive heart failure, cirrhosis of the liver, and nephrotic syndrome, as well as for the treatment of essential hypertension. Its unique mechanism of action distinguishes it from other diuretics by conserving potassium while promoting sodium and water excretion. This medication requires careful medical supervision due to its specific pharmacokinetic profile and potential interactions.
Features
- Active ingredient: spironolactone
- Therapeutic class: potassium-sparing diuretic/aldosterone antagonist
- Available in 25mg, 50mg, and 100mg oral tablets
- Bioavailability: approximately 90% following oral administration
- Protein binding: 91-98% to plasma proteins
- Metabolism: hepatic via CYP3A4 to active metabolites
- Elimination half-life: 1.3-2 hours for parent drug; 13-24 hours for active metabolites
- Excretion: primarily renal (42-56%) and biliary (14-18%)
Benefits
- Effectively reduces fluid retention without causing hypokalemia
- Provides targeted antagonism of aldosterone receptors
- Demonstrates anti-androgenic properties beneficial for certain dermatological conditions
- Offers long-acting therapeutic effect due to active metabolites
- Serves as an adjunct therapy in resistant hypertension management
- Provides cardioprotective effects in heart failure with reduced ejection fraction
Common use
Aldactone is predominantly prescribed for the treatment of edema associated with congestive heart failure, hepatic cirrhosis, and nephrotic syndrome. It is also indicated for essential hypertension, either as monotherapy or in combination with other antihypertensive agents. Off-label uses include management of primary hyperaldosteronism, hirsutism in polycystic ovary syndrome, and acne vulgaris. In cardiology practice, it is increasingly utilized as part of guideline-directed medical therapy for heart failure with reduced ejection fraction.
Dosage and direction
Dosage must be individualized based on therapeutic response and serum electrolyte levels. For edema: initial dose typically ranges from 25-200mg daily in divided doses. For hypertension: usual starting dose is 25-50mg daily in single or divided doses. Maximum recommended daily dose is 400mg. Administration with meals enhances absorption. Regular monitoring of serum potassium, sodium, and renal function is essential during therapy. Dose adjustments are necessary in renal impairment.
Precautions
Patients should be monitored for hyperkalemia, particularly those with renal impairment, diabetes, or concomitant use of potassium supplements or other potassium-sparing agents. Regular assessment of electrolyte balance, renal function, and fluid status is mandatory. Caution is advised in elderly patients due to increased susceptibility to hyperkalemia and dehydration. Patients should avoid potassium-rich foods and salt substitutes containing potassium. Hepatic function should be monitored in patients with pre-existing liver disease.
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 hepatic impairment, electrolyte imbalances, metabolic acidosis, and pregnancy (category C). Concomitant use with strong CYP3A4 inhibitors requires careful risk-benefit assessment. Hypersensitivity to spironolactone or any component of the formulation prohibits use.
Possible side effect
Common adverse reactions include hyperkalemia (particularly with renal impairment), hyponatremia, dehydration, gynecomastia (dose-dependent), menstrual irregularities, gastrointestinal disturbances, dizziness, and headache. Less frequent effects include Stevens-Johnson syndrome, agranulocytosis, hepatotoxicity, and hypertriglyceridemia. Endocrine effects may include impotence, hirsutism, and deepening of voice. Most side effects are dose-dependent and reversible upon discontinuation.
Drug interaction
Significant interactions occur with ACE inhibitors, ARBs, NSAIDs, potassium supplements, and other potassium-sparing diuretics, increasing hyperkalemia risk. Concurrent use with digoxin may increase digoxin concentration. CYP3A4 inducers (rifampin, carbamazepine) may decrease spironolactone efficacy, while inhibitors (ketoconazole, erythromycin) may increase concentrations. Enhanced hypotensive effects may occur with other antihypertensives. Lithium toxicity risk increases with concomitant use.
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. Patients should never double the dose to make up for a missed administration. Consistent daily administration at the same time(s) is recommended to maintain stable therapeutic levels. Healthcare providers should be consulted if multiple doses are missed to assess potential need for dose adjustment or additional monitoring.
Overdose
Manifestations primarily include electrolyte disturbances, particularly hyperkalemia and hyponatremia, along with dehydration and hypotension. Symptoms may include muscle weakness, cardiac arrhythmias, gastrointestinal distress, and neurological changes. Management involves discontinuation of therapy, gastric lavage if recent ingestion, and supportive care including ECG monitoring. Treatment of hyperkalemia may include calcium gluconate, sodium bicarbonate, glucose with insulin, and potassium-binding resins. Hemodialysis may be considered in severe cases.
Storage
Store at controlled room temperature (20-25°C/68-77°F) in the original container with tight closure. Protect from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations, typically through medication take-back programs rather than flushing or household trash.
Disclaimer
This information is provided 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 therapeutic response and side effect profile may vary. Patients should not initiate, discontinue, or modify dosage without consulting their healthcare provider. Full prescribing information should be reviewed before administration.
Reviews
Clinical studies demonstrate Aldactone’s efficacy in reducing mortality and hospitalization in heart failure patients (RALES trial). Meta-analyses confirm its effectiveness in resistant hypertension management. Dermatological studies show significant improvement in hirsutism and acne outcomes. Most clinical reports emphasize the importance of careful patient selection and monitoring. Patient satisfaction surveys indicate good tolerability when appropriately monitored, though endocrine side effects remain a concern in long-term therapy.