Drug reference

Spironolactone

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 228, 229

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Oedema | Ascites in cirrhosis of the liver ▶BY MOUTH ▶Adult: 100–400 mg daily, adjusted according to response Malignant ascites ▶BY MOUTH ▶Adult: Initially 100–200 mg daily, then increased if necessary to 400 mg daily, maintenance dose adjusted according to response Nephrotic syndrome ▶BY MOUTH ▶Adult: 100–200 mg daily Oedema in congestive heart failure ▶BY MOUTH ▶Adult: Initially 100 mg daily, alternatively initially 25–200 mg daily, dose may be taken as a single dose or divided doses, maintenance dose adjusted according to response Moderate to severe heart failure (adjunct) ▶BY MOUTH ▶Adult: Initially 25 mg once daily, then adjusted according to response to 50 mg once daily Resistant hypertension (adjunct) ▶BY MOUTH ▶Adult: 25 mg once daily Primary hyperaldosteronism in patients awaiting surgery ▶BY MOUTH ▶Adult: 100–400 mg daily, may be used for long-term maintenance if surgery inappropriate, use lowest effective dose l UNLICENSED USE Resistant hypertension (adjunct) unlicensed indication.

PDF page 228

Contra Indications

Addison’s disease. anuria. hyperkalaemia

PDF page 228

Cautions

Acute porphyrias p. 1120. elderly. potential metabolic products carcinogenic in rodents CAUTIONS, FURTHER INFORMATION ▶Elderly For aldosterone antagonists, prescription potentially inappropriate (STOPP criteria) with concurrent potassium-conserving drugs without monitoring of serum potassium (risk of dangerous hyperkalaemia). See also Prescribing in the elderly p. 33.

PDF page 228

Safety

Interactions

→Appendix 1: aldosterone antagonists

PDF page 228

Side Effects

Acidosis hyperchloraemic. acute kidney injury. agranulocytosis. alopecia. breast neoplasm benign . breast pain. confusion. dizziness. electrolyte imbalance. gastrointestinal disorder. gynaecomastia. hepatic function abnormal. hyperkalaemia (discontinue). hypertrichosis. leg cramps. leucopenia. libido disorder. malaise. menstrual disorder. nausea. severe cutaneous adverse reactions (SCARs). skin reactions. thrombocytopenia

PDF page 228

Pregnancy

Use only if potential beneﬁt outweighs risk— feminisation of male fetus in animal studies.

PDF page 228

Breast Feeding

Metabolites present in milk, but amount probably too small to be harmful.

PDF page 228

Renal Impairment

Avoid in acute renal insufﬁciency or severe impairment. Monitoring Monitor plasma-potassium concentration (high risk of hyperkalaemia in renal impairment).

PDF page 228

Monitoring Requirements

Monitor electrolytes— discontinue if hyperkalaemia occurs (in severe heart failure monitor potassium and creatinine 1 week after initiation and after any dose increase, monthly for ﬁrst 3 months, then every 3 months for 1 year, and then every 6 months).

PDF page 228

Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet CAUTIONARY AND ADVISORY LABELS 21 ▶Spironolactone (Non-proprietary) Spironolactone 25 mg Spironolactone 25mg tablets | 28 tablet P £1.95 DT = £1.24 | 500 tablet P £26.79 Spironolactone 50 mg Spironolactone 50mg tablets | 28 tablet P £9.99 DT = £4.68 | 250 tablet P £46.88 Spironolactone 100 mg Spironolactone 100mg tablets | 28 tablet P £2.96 DT = £2.22 | 250 tablet P £19.29 ▶Aldactone (Pfizer Ltd) Spironolactone 25 mg Aldactone 25mg tablets | 100 tablet P £8.89 Spironolactone 50 mg Aldactone 50mg tablets | 100 tablet P £17.78 Spironolactone 100 mg Aldactone 100mg tablets | 28 tablet P £9.96 DT = £2.22 | 100 tablet P £35.56 DRUGS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ANGIOTENSIN II RECEPTOR ANTAGONISTS

PDF pages 228, 229

Dose text by age group

Adult

100–400 mg daily, adjusted according to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

Initially 100–200 mg daily, then increased if

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

100–200 mg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

Initially 100 mg daily, alternatively initially

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

Initially 25 mg once daily, then adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

25 mg once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

100–400 mg daily, may be used for long-term

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Spironolactone

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 228, 229

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 228

Contra Indications

Addison’s disease. anuria. hyperkalaemia

PDF page 228

Cautions

PDF page 228

Safety

Interactions

→Appendix 1: aldosterone antagonists

PDF page 228

Side Effects

PDF page 228

Pregnancy

Use only if potential beneﬁt outweighs risk— feminisation of male fetus in animal studies.

PDF page 228

Breast Feeding

Metabolites present in milk, but amount probably too small to be harmful.

PDF page 228

Renal Impairment

Avoid in acute renal insufﬁciency or severe impairment. Monitoring Monitor plasma-potassium concentration (high risk of hyperkalaemia in renal impairment).

PDF page 228

Monitoring Requirements

PDF page 228

Dose and formulations

Medicinal Forms

PDF pages 228, 229

Dose text by age group

Adult

100–400 mg daily, adjusted according to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

Initially 100–200 mg daily, then increased if

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

100–200 mg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

Initially 100 mg daily, alternatively initially

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

Initially 25 mg once daily, then adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

25 mg once daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Adult

100–400 mg daily, may be used for long-term

First-line fragment. Read the complete Indications and Dose section above.

PDF page 228

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.