Spironolactone Oral: Dosing and Precautions
Spironolactone guidance for oedema associated with heart failure, hepatic cirrhosis, and nephrotic syndrome.
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source date listed on the source page
Guide category
Oral drugs
Safety boundary
Prescription medicine information for clinician-guided use.
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Therapeutic action
Potassium-sparing diuretic, antagonist of aldosterone.
Indications
Oedema associated with heart failure, hepatic cirrhosis, and nephrotic syndrome.
Forms and strengths
- 25 mg tablet.
Dose
When weight is stable, administer the lowest possible maintenance dose in order to prevent adverse effects.
The daily dose can be administered in 2 to 3 divided doses or once daily.
Adjunctive therapy in heart failure
- Adult: 25 mg once daily.
Ascites in hepatic cirrhosis
- Adult: 100 to 400 mg daily.
Oedema in nephrotic syndrome
- Adult: 100 to 200 mg daily.
Duration
According to clinical response; avoid prolonged use.
Contra-indications, adverse effects, precautions
- Do not administer to patients with severe renal impairment, anuria, hyperkalaemia above 5 mmol/litre, or hyponatraemia.
- Do not combine with potassium salts, potassium-sparing diuretics, or lithium.
- Avoid or closely monitor combination with angiotensin-converting enzyme inhibitors and digoxin and reduce dosages as needed.
- May cause hyperkalaemia, hyponatraemia, metabolic acidosis in decompensated cirrhosis, gynecomastia, metrorrhagia, impotence, amenorrhoea, gastrointestinal disturbances, headache, skin rash, and drowsiness.
- Administer with caution in patients with hepatic impairment, renal impairment, or diabetes.
- Monitor plasma potassium levels regularly.
- Pregnancy: avoid and use only if clearly needed; spironolactone is not indicated in the treatment of pregnancy-related oedema.
- Breast-feeding: no contra-indication.
- In children with oedema, the daily dose is 1 to 3 mg/kg once daily or 0.5 to 1.5 mg/kg 2 times daily.
Source
MSF Essential drugs practical guidelines (January 2026)
This page combines source-derived medicine reference sections with Kenza editorial context, while leaving out the Storage and Remarks sections from the source batch.
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