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Spironolactone

Sounds like 'spir-ON-oh-LAK-tone'

Key points about spironolactone

Spironolactone is used to treat a number of different conditions such as heart failure, high blood pressure, polycystic ovary syndrome (PCOS) and gender affirming hormone therapy.
Spironolactone is commonly called Spiractin® or Spirotone®.
Find out how to take it safely and possible side effects.

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Spironolactone is used to treat a number of different conditions and related symptoms, including the following.

To reduce extra fluid in your body (called oedema) caused by conditions such as heart failure, liver disease or problems with your kidneys. It can reduce swelling in your ankles or feet, and shortness of breath.
High blood pressure (hypertension), when other blood pressure medicines don’t work as well.
Primary hyperaldosteronism – in hyperaldosteronism, your adrenal glands produce too much of a hormone called aldosterone. Spironolactone works by stopping the effects of aldosterone.
Facial hair growth and acne in women, as in polycystic ovary syndrome (PCOS).
As gender affirming hormone therapy, in combination with oestrogen.

In Aotearoa New Zealand spironolactone is available as tablets (25 mg and 100 mg).

The dose of spironolactone will be different for different people depending on what it is being used for and your response to treatment.
Always take your spironolactone exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it and any special instructions.
Treatment with spironolactone is usually long-term, so keep taking it regularly.

Timing: Spironolactone is usually taken once a day, in the morning. Some people taking higher doses may need to take a second dose later in the day. You can take spironolactone with or without food.
Limit or avoid alcohol while taking spironolactone: Alcohol may increase your chance of side effects such as dizziness.
Missed dose: If you forget to take your dose, take it as soon as you remember that day. If it is nearly time for your next dose, skip the missed dose and take your next dose at the usual time. Do not take 2 doses at the same time.

Avoid foods with a high potassium content

Spironolactone can increase the potassium levels in your blood (also called hyperkalaemia). This is more common in older adults, if you have heart or kidney problems and in if you are taking other medicines that affect potassium levels.

You should avoid things with a high potassium content, such as 'salt substitutes' or low-sodium salt. You are at increased risk of hyperkalaemia if you:

have problems with your kidneys or liver
are an older adult
are dehydrated (not getting enough fluid)
are taking other medicines that can increase potassium, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and non-steroidal anti-inflammatory drugs (NSAIDs).

Blood tests

Your doctor may recommend a blood test to check your potassium level before starting treatment and occasionally during treatment. These checks may be needed more frequently if you have heart or kidney problems or if you take other medicines that affects potassium levels.

Tell your healthcare team if you are taking any other medicines

Spironolactone may interact with some medicines and herbal supplements, so check with your prescriber or pharmacist before starting spironolactone and before starting any new medicines or herbal supplements.

Be careful when taking pain relief medicines

Pain relief medicines called non-steroidal anti-inflammatory pain relief medication (NSAIDs) must be avoided if you have heart failure, as these medicines can make your condition worse. Taking spironolactone with NSAIDs can be very harmful to your kidneys and can cause acute kidney injury. Ask your doctor or pharmacist for a safer pain relief option. Examples of NSAIDs are:

ibuprofen (Brufen, I-Profen, Nurofen, Maxigesic, Nurofen Cold and Flu, Nuromol)
diclofenac (Voltaren, Diclohexal)
naproxen (Noflam, Naprosyn SR)
mefenamic acid (Ponstan)
celecoxib (Celebrex).

Have a sick day plan

If you have diarrhoea (runny poo) or you're vomiting (being sick) from a stomach bug, or you're at risk of dehydration for another reason, it’s important to let your doctor know. They may advise you to stop taking spironolactone for a few days and restart it when you feel better. Spironolactone can increase potassium in your blood, which is worse if you are dehydrated.

Pregnant or planning a pregnancy

You should avoid becoming pregnant while you are taking spironolactone. If you are a woman of childbearing age, you should use an effective method of birth control (contraception) during treatment with spironolactone. It is usually safe to conceive a month after stopping the spironolactone treatment. Discuss with your healthcare provider which types of contraception are suitable for you and tell your doctor straight away if you become pregnant while taking spironolactone.

Like all medicines, spironolactone can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects	What should I do?
Feeling sick (nausea) Stomach upset	These are quite common when you first start taking spironolactone and usually go away after the first few days. Try taking your spironolactone dose with or after food. Tell your doctor if troublesome.
Dizziness Feeling light headed Feeling faint when you stand up	Be careful when getting up from either lying down or sitting to avoid falls. These effects puts you at risk of falls and injuries, especially if you are elderly. Be careful when driving or using tools until you know how this medicine affects you.
Signs of too much potassium in your blood such as irregular heart beat (heart beat feels fluttery), tingling feelings, paralysis (difficulty moving) or difficulty breathing	Spironolactone may cause increased potassium in your blood. Tell your doctor immediately or phone Healthline 0800 611 116.
Signs of dehydration (losing too much salt and water) such as muscle cramps, weakness, dry mouth, thirst or passing unusually reduced amounts of pee	Tell your doctor immediately or phone Healthline 0800 611 116.
Signs of hormone changes such as breast development (in men), changes in menstrual cycle (periods) in women or sexual function problems	Tell your doctor.
Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product(external link)