spironolactone Nursing Considerations & Management

Drug Name

Generic Name : spironolactone

Brand Name: Aldactone, Novospiroton (CAN)

Classification: Potassium-sparing diuretic, Aldosterone antagonist

Pregnancy Category D

Available forms : Tablets—25, 50, 100 mg

Edema: Initially, 100 mg/day (range 25–200 mg/day) when given as the sole agent; continue > 5 days, then adjust dose or add another diuretic or both.
Diagnosis of hyperaldosteronism: 400 mg/day PO for 3–4 wk (long test). Correction of hypokalemia and hypertension are presumptive evidence of primary hyperaldosteronism. 400 mg/day PO for 4 days (short test). If serum K+ increases but decreases when drug is stopped, presumptive diagnosis can be made.
Maintenance therapy for hyperaldosteronism: 100–400 mg/day PO.
Essential hypertension: 50–100 mg/day PO. May be combined with other diuretics.
Hypokalemia: 25–100 mg/day PO.

Edema: 1–3.3 mg/kg/day PO adjusted to patient’s response, administered as single or divided dose.

Spironolactone acts on the distal renal tubules as a competitive antagonist of aldosterone. It increases the excretion of sodium chloride and water while conserving potassium and hydrogen ions.

Diagnosis and maintenance of primary hyperaldosteronism
Adjunctive therapy in edema associated with CHF, nephrotic syndrome, hepatic cirrhosis when other therapies are inadequate or inappropriate
Treatment of hypokalemia or prevention of hypokalemia in patients who would be at high risk if hypokalemia occurred: Digitalized patients, patients with cardiac arrhythmias
Essential hypertension, usually in combination with other drugs
Unlabeled uses: Treatment of hirsutism due to its antiandrogenic properties, palliation of symptoms of PMS, treatment of familial male precocious puberty, short-term treatment of acne vulgaris

Fluid or electrolyte imbalance, gynecomastia, GI upset, drowsiness, headache, hyponatremia; tachycardia, hypotension, oliguria, hyperkalemia; confusion, weakness, paresthesia, hirsutism, mental disturbances, menstrual irregularities, loss of libido and impotence.
Potentially Fatal: Fatal hyperkalemia in combination with ACE inhibitors and previous renal impairment; agranulocytosis.

Anuria, hyperkalemia, acute or progressive renal insufficiency. Addison’s disease.

History: Allergy to spironolactone; hyperkalemia; renal disease; pregnancy, lactation
Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength; P, baseline ECG, BP; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns, menstrual cycle; CBC, serum electrolytes, renal function tests, urinalysis

Mark calendars of edema outpatients as reminders of alternate day or 3- to 5-day/wk therapy.
Give daily doses early so that increased urination does not interfere with sleep.
Make suspension as follows: Tablets may be pulverized and given in cherry syrup for young children. This suspension is stable for 1 mo if refrigerated.
Measure and record regular weight to monitor mobilization of edema fluid.
Avoid giving food rich in potassium.
Arrange for regular evaluation of serum electrolytes and BUN.

Record alternate-day therapy on a calendar, or prepare dated envelopes. Take the drug early because of increased urination.
Weigh yourself on a regular basis, at the same time and in the same clothing, and record the weight on your calendar.
Avoid foods that are rich in potassium (fruits, Sanka); avoid licorice.
You may experience these side effects: Increased volume and frequency of urination; dizziness, confusion, feeling faint on arising, drowsiness (avoid rapid position changes, hazardous activities: such as driving, using alcohol); increased thirst (suck on sugarless lozenges; use frequent mouth care); changes in menstrual cycle, deepening of the voice, impotence, enlargement of the breasts can occur (reversible).
Report weight change of more than 3 pounds in 1 day, swelling in your ankles or fingers, dizziness, trembling, numbness, fatigue, enlargement of breasts, deepening of voice, impotence, muscle weakness, or cramps.