Spironolactone is a diuretic that, unlike most, holds on to potassium rather than losing it. That makes it valuable in heart failure and liver disease, and it also makes high potassium the main thing to watch for.
Heart failure, fluid retention in liver disease, resistant high blood pressure, and primary hyperaldosteronism. It is also used at low doses for acne and hirsutism in women, though that is off-label.
Once daily, usually in the morning, with or after food. Taking it later in the day means being up at night.
Blood tests check kidney function and potassium before starting and regularly afterwards — these are the point of the monitoring, not a formality.
Avoid potassium-based salt substitutes such as LoSalt, and do not take potassium supplements unless specifically told to.
Risk rises alongside ACE inhibitors, sartans, anti-inflammatories such as ibuprofen, and in kidney impairment or dehydration. Tell any prescriber you take spironolactone.
Pause it during dehydrating illness — vomiting, diarrhoea, fever — and ask for a sick day rules card.
Breast tenderness or enlargement in men (gynaecomastia) is a well-recognised effect and a common reason for switching. It is worth reporting rather than living with.
Also common: dizziness on standing, headache, nausea, and in women irregular periods.
It is generally avoided in pregnancy — speak to your prescriber if you are planning one.
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