SpironolactoneNursing considerations

Side effects by what to assess

Sources: [1][2][3][4][5][6]

Blood glucose

Why

Hyperglycemia

When

Periodically

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2]

eGFR (glomerular filtration rate)

Why

Renal function and hyperkalemia risk

When

Before starting and periodically

Act on

Heart failure: standard start above 50; consider 25 mg every other day for 30 to 50

Normal

90 to 120 mL/min/1.73 m². Below 60 for 3 or more months points to chronic kidney disease.

Sources: [1][2][3]

Potassium

Why

Hyperkalemia

When

Within 1 week of starting or titrating, then regularly; more often with renal impairment or other potassium-raising drugs

Act on

Heart failure: start only if 5.0 mEq/L or less. If hyperkalemia occurs, reduce the dose or stop and treat it

Normal

3.7 to 5.2 mEq/L.

Sources: [1][2][3]

Serum creatinine

Why

Worsening renal function from diuresis

When

Periodically

Normal

0.7 to 1.3 mg/dL in men and 0.5 to 0.95 mg/dL in women.

Sources: [1][2]

Sodium

Why

Hyponatremia

When

Periodically with electrolytes

Normal

135 to 145 mEq/L.

Sources: [1][2]

High-alert status

Potassium-sparing diuretics are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

None on the current Aldactone label.

Sources: [1]

Antidote or reversal

No specific antidote. Overdose may cause drowsiness, confusion, rash, nausea, vomiting, dizziness, or diarrhea; hyperkalemia is most likely with renal impairment. Give supportive care for fluids, electrolytes, and vital functions, and stop the drug if hyperkalemia develops.

Sources: [1]

Patient teaching

• Avoid potassium supplements, potassium salt substitutes, and large amounts of high-potassium foods
• Tell the prescriber before taking NSAIDs or aspirin
• Breast enlargement or tenderness and menstrual changes can occur; report them
• Rise slowly; alcohol can add to dizziness
• Full effect may take about 2 weeks; keep taking it even when feeling well
• Keep appointments for potassium and kidney blood tests

Sources: [1][2][3][4][5]

Sound-alike and look-alike names

None listed in the ISMP list of confused drug names.

Sources: [1]

Adult dose

Heart failure

25 mg once daily if potassium is 5.0 mEq/L or less and eGFR above 50; may increase to 50 mg once daily. If hyperkalemia develops, reduce to 25 mg every other day. Consider 25 mg every other day to start when eGFR is 30 to 50.

Hypertension (add-on)

25 to 100 mg per day, once or in divided doses; titrate every 2 weeks. Doses above 100 mg/day usually add little.

Edema (cirrhosis or nephrotic syndrome)

100 mg per day to start (range 25 to 200 mg), once or divided. As the only diuretic, give at least 5 days before raising the dose.

Primary hyperaldosteronism

100 to 400 mg daily before surgery; lowest effective dose for long-term use when surgery is not an option.

Sources: [1][2][3][4]

Renal adjustment

Hyperkalemia risk rises with renal impairment, so monitor potassium closely. In heart failure, start at 25 mg every other day when eGFR is 30 to 50 mL/min/1.73 m2.

Sources: [1][2]

Hepatic adjustment

In cirrhosis with ascites, start in the hospital at the lowest dose and titrate slowly. Clearance is reduced, and sudden fluid or electrolyte shifts can trigger hepatic encephalopathy or coma.

Sources: [1][2]

Mechanism

Spironolactone and its active metabolites compete with aldosterone for its receptor at the sodium-potassium exchange site in the distal tubule. The kidney then excretes more sodium and water while holding on to potassium. It also counters the secondary aldosteronism driven by edema states and other diuretics.

Sources: [1][2]