Spironolactone (Aldactone)

Spironolactone, known commercially as Aldactone, acts as a diuretic, increasing the elimination of water through the urine, and as an antihypertensive agent. It can be used to treat high blood pressure, swelling related to heart function or liver and kidney disease. , hypokalemia or treatment of hyperaldosteronism, for example.

In some cases, this medicine may be prescribed for acne treatment and to prevent hair loss, but these applications are not part of the main indications of spironolactone, nor are they mentioned in the package leaflet.

Spironolactone can be bought at drugstores, for a price of about 14 to 45 reais, depending on whether the person chooses the brand or generic, and is required to present a prescription.

What is it for

Spironolactone is indicated for:

  • Essential hypertension;
  • Edema caused by heart, kidney or liver problems;
  • Idiopathic edema;
  • Auxiliary therapy in malignant hypertension;
  • Hypokalemia when other measures are considered improper or inappropriate;
  • Prevention of hypokalemia and hypomagnesemia in people taking diuretics;
  • Diagnosis and treatment of hyperaldosteronism..

How to take

The dosage depends on the problem to be treated:

  1. Essential Hypertension

The usual dose is 50 mg / day to 100 mg / day, which in resistant or severe cases may be gradually increased at two-week intervals to 200 mg / day. Treatment should be continued for at least two weeks to ensure an adequate response to treatment. The dose should be adjusted as needed.

  1. Congestive Heart Failure

The recommended starting daily dose is 100 mg as a single or divided dose and may range from 25 mg to 200 mg daily. The usual maintenance dose should be determined for each person.

  1. Liver Cirrhosis

If the urinary sodium / urinary potassium ratio is greater than 1, the usual dose is 100 mg / day. If this ratio is less than 1, the recommended dose is 200 mg / day to 400 mg / day. The usual maintenance dose should be determined for each person.

  1. Nephrotic Syndrome

The usual dose in adults is from 100 mg / day to 200 mg / day.

  1. Edema

The usual dose is 100 mg per day in adults and approximately 3.3 mg per kg bodyweight given in fractional doses. The dosage should be adjusted based on each person’s response and tolerability.

  1. Hypokalemia / Hypomagnesemia

Dosage of 25 mg / day to 100 mg / day is recommended for the treatment of diuretic-induced hypokalemia and / or hypomagnesemia when oral potassium and / or magnesium supplements are not appropriate.

  1. Preoperative Treatment of Primary Hyperaldosteronism

When the diagnosis of hyperaldosteronism is well established by more definitive tests, spironolactone may be administered in daily doses of 100 mg to 400 mg in preparation for surgery.

  1. Malignant Hypertension

It should only be used as adjunctive therapy and when there is excess secretion of aldosterone, hypokalemia and metabolic alkalosis. The starting dose is 100 mg / day, which may be increased as needed at two-week intervals to 400 mg / day.

Mechanism of action

Spironolactone is a specific aldosterone antagonist acting primarily at the aldosterone-dependent sodium and potassium ion exchange site, located in the distal contoured tubule of the kidney, leading to increased sodium and water elimination and increased potassium retention.

Possible side effects

Some of the side effects of spironolactone may include benign breast neoplasm, leukopenia, thrombocytopenia, electrolyte disturbances, libido, confusion, dizziness, gastrointestinal and nausea disorders, abnormal liver function, Steve-Johnson syndrome, toxic epidermal necrolysis, drug eruption. , thinning hair, hypertrichosis, itching, hives, leg cramps, acute renal failure, breast pain, menstrual disorders, gynecomastia and malaise.


Spironolactone should not be used by people who are hypersensitive to the components of the formula, people with acute renal failure, significant impairment of kidney function, anuria, Addison’s disease, hyperkalemia or who are using a medicine called eplerenone.

by Abdullah Sam
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