Spironolactone
HFrEF (GDMT component), Cirrhotic ascites, Resistant hypertension, Primary aldosteronism
Indications
- HFrEF (GDMT component)
- Cirrhotic ascites
- Resistant hypertension
- Primary aldosteronism
Adult dosing
- hf: dose: 25; unit: mg; route: PO daily; interval: May increase to 50mg daily; fixed: true; cirrhosis: dose: 100; unit: mg; route: PO daily; interval: Max 400mg/day; ratio 100:40 with furosemide; fixed: true
Contraindications
- Hyperkalemia (K >5.0)
- Severe renal impairment (GFR <30)
- Addison disease
Clinical pearls
- RALES trial: 30% mortality reduction in HFrEF
- Cirrhosis: start 100mg, pair with furosemide 40mg (100:40 ratio)
- Monitor K within 1 week of starting — hyperkalemia is the main risk
- Gynecomastia side effect — use eplerenone if intolerable
Source and review
- RALES Trial, NEJM 1999; AASLD Ascites Guidelines. Last reviewed: 2024-11-01