Aldactone (Spironolactone)
Also sold as: Aldactone, Spiromide, Lasilactone (with furosemide), Carospir, Espiro
Pregnancy
Cat D
Lactation
Caution
Schedule
H
Forms
Tablet 25mg, 50mg, 100mg
Indications
- Heart failure with reduced ejection fraction (HFrEF) — mortality benefit
- Liver cirrhosis with ascites
- Primary hyperaldosteronism
- Hypertension (especially with hypokalemia)
- Resistant hypertension (add-on)
- Acne in females (anti-androgenic effect)
- Hirsutism in females
Adult Dosing
Heart failure (HFrEF)
25-50 mg PO once daily
Ensure K+ < 5 mEq/L and eGFR > 30 before starting; monitor potassium
Ascites (cirrhosis)
100-400 mg PO once daily
Often combined with furosemide in 100:40 ratio (e.g., Spiro 100 + Furo 40)
Primary hyperaldosteronism
100-400 mg PO daily
Pre-operative or long-term if surgery not feasible
Acne / Hirsutism
50-200 mg PO daily
Off-label; takes 3-6 months to see effect
Pediatric Dosing
Ascites: 1.5-3 mg/kg/day. HF: specialist guidance.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| eGFR > 30 mL/min | Use with caution — monitor K+ |
| eGFR < 30 mL/min | AVOID — high risk of fatal hyperkalemia |
Hepatic Adjustment
Use with care in hepatic encephalopathy; fluid-electrolyte monitoring critical
Pregnancy & Lactation
Pregnancy: Category D
AVOID — anti-androgenic effects may feminize male fetus. Use alternative diuretic in pregnancy.
Lactation: Caution
Active metabolite canrenone excreted in breast milk. Not recommended.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| ACE inhibitors / ARBs / potassium supplements | Severe HYPERKALEMIA — potentially fatal; monitor K+ closely or avoid | Major |
| NSAIDs | Reduce diuretic effect and increase hyperkalemia risk | Major |
| Digoxin | Spironolactone reduces digoxin clearance — increases digoxin levels | Moderate |
| Lithium | Reduces lithium clearance — toxicity risk | Moderate |
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Side Effects
Common
- Hyperkalemia
- Gynecomastia in males (dose-dependent)
- Menstrual irregularities
- Breast tenderness
- Dizziness
- GI upset
Serious / Discontinue If
- Fatal hyperkalemia (especially with ACE inhibitors, renal impairment)
- Metabolic acidosis
- Hyponatremia
Contraindications
- Hyperkalemia (K+ > 5 mEq/L)
- Addison's disease
- eGFR < 30 mL/min
- Anuria
- Pregnancy
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Aldactone 25 | Pfizer | 15 tab ₹48 |
| Spiromide 25 | Sun Pharma | 15 tab ₹38 |
| Lasilactone (Spiro 50 + Furo 20) | Sanofi | 15 tab ₹85 |
Monitoring Required
- Serum potassium (at 1 week, 1 month, then 3-6 monthly)
- Serum creatinine / eGFR
- Serum sodium
- Blood pressure
- Signs of gynecomastia
Patient Counseling Points
- AVOID potassium-rich foods in excess: bananas, oranges, potatoes, salt substitutes (KCl)
- Avoid NSAIDs (ibuprofen, etc.)
- Males: breast tenderness/enlargement may occur — report to doctor
- Regular blood tests to monitor kidney function and potassium level
- Take with food to reduce GI upset
Stop Googling drug references mid-consultation
EasyClinic auto-flags Aldactone interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Priya Sharma, DM (Cardiology), Senior Cardiologist
Last reviewed: 2026-04-01
References
- BNF — Spironolactone
- RALES Trial
- ESC HF Guidelines 2023
- AASLD Cirrhosis Guidelines