Spironolactone/hydrochlorothiazide | Side Effects, Dosage, Uses & More

Generic Name:

hydrochlorothiazide-spironolactone, Oral tablet

All Brands

  • Aldactazide
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Highlights for hydrochlorothiazide-spironolactone

Oral tablet
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Spironolactone/hydrochlorothiazide is a combination of two drugs in a single tablet that work in different ways to treat hypertension (high blood pressure). It’s also used to treat edema (swelling caused by fluid buildup in your body) in your limbs if you have heart failure, kidney disease, or liver disease.

2

This drug shouldn’t be given as a first treatment for high blood pressure or swelling. This combination medicine should be used only if you’re already taking the drugs separately and the combination is more convenient for you to take.

3

Common side effects include constipation, headache, breast enlargement, stomach upset, irregular menstrual cycles, and reduced sex drive and sexual dysfunction.

4

Before starting this drug, tell your doctor if you have liver or kidney disease, allergies to medications, or are pregnant or nursing. Also, let your doctor know if you’re taking any other prescription or over-the-counter medications.

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Your doctor will decide a dose that’s right for you based on your response to this drug. The usual dose for high blood pressure is 50–100 mg spironolactone/50–100 mg hydrochlorothiazide taken by mouth each day. The standard dose for swelling is 25–200 spironolactone/25–200 hydrochlorothiazide per day.

IMPORTANT INFORMATION

FDA warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Warning: You should only use this drug to treat high blood pressure and swelling in your limbs (edema) caused by heart failure, kidney disease, or liver disease. You shouldn’t take this drug unless you have to because spironolactone has been shown to cause tumors in rats.

This drug shouldn’t be given as a first treatment for high blood pressure or swelling. This combination medicine should be used only if you’re already taking the drugs separately and the combination is more convenient for you to take. Your doctor will regularly monitor you during treatment with this drug to make sure it’s still right for you.

High blood potassium

You shouldn’t take potassium supplements, salt substitutes containing potassium, or eat a diet rich in potassium while you’re taking this drug. This can lead to complications from high potassium levels in your body. Talk to your doctor or a nutritionist if you’re concerned about your potassium intake.

Skin reactions

This drug may cause rare but serious skin reactions. These include Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms. Call your doctor or call 9-1-1 right away if you have these symptoms:

  • raised welts
  • facial swelling
  • fever
  • trouble breathing

Breast growth

This drug may cause breast growth, in both men and women. If this occurs, your doctor may stop treatment with this drug. This symptom usually goes away once you stop taking the medication.

Drug features

This drug is a prescription drug. It’s available as an oral tablet.

This drug is available as a generic drug. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

This drug is a combination of two drugs in a single form. It’s important to know about all the drugs in the combination because they each may have unique traits.

This drug may be taken as part of a combination therapy with other medications for high blood pressure.

Why it's used

This drug is used to treat high blood pressure. It’s given when one of these medicines, or a similar medication, isn’t enough to lower your high blood pressure.

More Details

How it works

Spironolactone belongs to a class of drugs called potassium sparing diuretics. Hydrochlorothiazide belongs to a class of drugs called thiazide diuretics.

More Details

Why it's used

This drug is used to treat high blood pressure. It’s given when one of these medicines, or a similar medication, isn’t enough to lower your high blood pressure.

This drug is also used to treat swelling in your limbs caused by fluid buildup in your body from heart failure, kidney disease, or liver disease.

How it works

Spironolactone belongs to a class of drugs called potassium sparing diuretics. Hydrochlorothiazide belongs to a class of drugs called thiazide diuretics. A class of drugs is a group of medications that work in a similar way. They are often used to treat similar conditions.

This drug is a combination of these two diuretics that work by removing extra water from your body. This lowers your blood pressure.

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hydrochlorothiazide-spironolactone Side Effects

Oral tablet

Most Common Side Effects

The more common side effects that occur with spironolactone/hydrochlorothiazide include:

  • constipation

  • headache

  • upset stomach and nausea

  • breast growth in males or females

  • irregular menstrual cycles

  • reduced sex drive or performance

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life-threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • Allergic reactions. Symptoms can include:

    • skin rash
    • itching
    • hives
    • fever
    • trouble breathing
    • swelling of your lips, mouth, tongue, or throat
  • Eye problems. Symptoms can include:

    • eye pain
    • changes in vision
  • Low blood pressure. Symptoms can include:

    • tiredness
    • feeling faint or dizzy
  • Severe skin reactions. Symptoms can include:

    • redness, blistering, peeling, or loosening of your skin, including inside the mouth
  • Liver problems. Symptoms can include:

    • yellowing of the whites of your eyes or skin
  • Kidney problems. Symptoms can include:

    • trouble urinating
    • unusual weakness or tiredness
  • Bleeding problems. Symptoms can include:

    • unusual bleeding
    • black or tarry stools
  • Muscle pain. Symptoms can include:

    • cramps
    • numbness or tingling in your hands or feet
  • Gout pain. Symptoms can include:

    • pain and swelling in your joints, especially your big toe
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug may cause drowsiness. You shouldn’t drive, use machinery, or do other tasks that require alertness until you know how this drug affects you.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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hydrochlorothiazide-spironolactone May Interact with Other Medications

Oral tablet

Spironolactone/hydrochlorothiazide can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol Interaction

The use of drinks that contain alcohol with spironolactone/hydrochlorothiazide may cause your blood pressure to drop to unhealthy levels. Avoid drinking alcohol while taking this drug.

Medications that might interact with this drug

Blood pressure drugs

These drugs can increase the amount of potassium in your body too much if taken with spironolactone/hydrochlorothiazide.

These drugs include:

  • angiotensin-converting enzyme (ACE) inhibitors, such as:
    • benazepril
    • captopril
    • clizapril
    • enalapril
    • enalaprilat
    • fosniopril
    • imidapril
    • moexipril
    • perindopril
    • qunapril
    • ramipril
    • trandolapril
  • angiotensin II receptor blockers (ARBs), such as:
    • irbesartan
    • losartan
    • olmesartan
    • telmisatan
    • valsartan
  • direct renin inhibitors, such as:
    • aliskiren
  • potassium-sparing diuretics, such as:
    • eplerenone
    • triamterene
  • heparin and low molecular weight heparin (LMWH)
  • potassium supplements

Pain drugs

These drugs can increase the amount of potassium in your body too much if taken with spironolactone/hydrochlorothiazide.

These drugs include:

  • indomethacin Cox-2 Inhibitors, such as:
    • celecoxib
  • non-steroidal anti-inflammatory drugs (NSAIDs), such as:
    • diclofenac
    • ibuprofen
    • indomethacin
    • keoprofen
    • ketorolac
    • meloxicam
    • nabumetone
    • naproxen
    • piroxicam
  • narcotics, such as:
    • codeine
    • dihydrocodein
    • fentanyl
    • hydrocodone
    • hydromorphone
    • levorphanol
    • mepiridine
    • methadone
    • morphine
    • opium
    • oxycodone
    • oxymorphone
    • tramadol

Cholesterol drugs

These drugs can increase the amount of potassium in your body too much if taken with spironolactone/hydrochlorothiazide.

These drugs include:

  • cholestyramine

Corticosteroids

These medications can decrease the amount of potassium in your body too much if taken with spironolactone/hydrochlorothiazide.

These drugs include:

  • dexamethasone
  • methylprednisolone
  • prednisolone
  • prednisone

Narcotics and barbiturates

These drugs can lower your blood pressure too much if taken with spironolactone/hydrochlorothiazide.

These drugs include:

  • barbiturates, such as:
    • amobarbital
    • butabarbital
    • butalbital
    • methohextal
    • pentobarbital
    • phenobarbital
    • secobarbital
    • thiopental

Mood stabilizer drugs

Spironolactone/hydrochlorothiazide can increase the effects of these medications in your body.

These drugs include:

  • lithium

Heart drugs

Spironolactone/hydrochlorothiazide can increase the effects of these medications in your body.

These drugs include:

  • digoxin

Skeletal muscle relaxants

Spironolactone/hydrochlorothiazide can increase the effects of these medications in your body.

These drugs include:

  • cyclobenzaprine

Anesthesia

Spironolactone/hydrochlorothiazide can decrease the effects of these medications in your body.

These drugs include:

  • norepinephrine

Diabetes drugs

The dose of these medications may need to be changed if you take them with spironolactone/hydrochlorothiazide.

These drugs include:

  • amylin analogs, such as:
    • pramlintide
  • biguanides, such as:
    • metformin
  • GLP 1 agonists, such as:
    • exenatide
    • liraglutide
    • lixisentaide
  • DPP4 inhibitors, such as:
    • saxagliptin
    • sitagliptin
  • insulins, such as:
    • insulin aspart
    • iinsulin detemir
    • insulin glargine
    • insulin glulisine
    • insulin lispro
    • insulin NPH
    • insulin regular
  • meglitinides, such as:
    • nateglinide
    • repaglinide
  • sulfonylureas, such as:
    • glimepriide
    • glipizide
    • glyburide
  • SGLT-2 inhibitors, such as:
    • canagliflozin
    • dapagliflozin
    • empagliflozin
  • thiazolidinediones, such as:
    • pioglitazone
    • rosiglitazone

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People who don’t produce urine (anuria)

You shouldn’t take this drug if you have anuria or aren’t making urine. This drugs causes you to excrete water and salts from your body. If you’re unable to excrete urine from your body, then the water and salts cannot leave your body.

People with liver disease

If you have liver disease or liver damage, talk to your doctor about whether this drug is safe for you. You shouldn’t take this drug if you have severe liver disease. This drug may cause you to go into a coma.

People with kidney disease

You shouldn’t take this drug if you have kidney disease or kidney damage. This drug will raise your risk for electrolyte changes, such as too much nitrogen in your blood.

People with Addison’s disease

You shouldn’t take this drug if you have Addison’s disease. This drug can make your condition worse.

People with acute myopia and glaucoma

This drug can cause temporary nearsightedness and glaucoma. Your risk of these vision issues is higher if you have a history of eye problems. Tell your doctor right away if you have vision changes or eye pain after starting treatment with this drug. If left untreated, you can have permanent vision loss.

People with electrolyte imbalances

This drug can cause changes to your body’s electrolytes. You can have high levels of potassium, or low levels of sodium or magnesium. This can lead to serious problems. Your risk is higher if you have a history of electrolyte problems.

People with diabetes, high cholesterol, or gout

This drug can cause changes in your blood sugar, cholesterol levels, triglycerides, blood acid levels, or calcium levels. Tell your doctor if you have diabetes, high cholesterol, or gout before taking this drug.

People with lupus

Taking this drug can make your lupus worse. Tell your doctor if you have lupus before taking this drug.

Pregnant women

This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. This drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Women who are breast-feeding

This drug may pass into breast milk and may cause side effects in a child who is breast-fed.

Talk to your doctor if you breast-feed your baby. You may need to decide whether to stop breast-feeding or stop taking this medication.

For seniors

Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

For children

This medicine hasn’t been studied in children and shouldn’t be used in children younger than 18 years.

When to call the doctor

Call your doctor or go to the emergency room if you have:

  • chest pain
  • headache
  • jaw pain
  • upper back pain
  • nausea or vomiting
  • trouble breathing

These may be symptoms of a heart attack.

Allergies

This drug can cause a severe allergic reaction. Symptoms include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

Don’t take this drug again if you’ve ever had an allergic reaction to it before, or if you’re allergic to sulfa or drugs containing sulfa. Taking it a second time after an allergic reaction could be fatal.

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How to Take hydrochlorothiazide-spironolactone (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Hypertension

Brand: Aldactazide

Form: Oral tablet
Strengths:
  • 25 mg spironolactone/25 mg hydrochlorothiazide
  • 50 mg spironolactone/50 mg hydrochlorothiazide

Generic: Spironolactone/hydrochlorothiazide

Form: Oral tablet
Strengths:
  • 25 mg spironolactone/25 mg hydrochlorothiazide
Adult dosage (ages 18–64 years):

The standard maintenance dose is 50–100 mg spironolactone/50–100 mg hydrochlorothiazide taken by mouth each day. This can be given in a single dose or in separate doses. Your doctor will decide a dose that’s right for you.

Child dosage (ages 0–17 years):

This medicine hasn’t been studied in children and shouldn’t be used in children younger than 18 years.

Senior dosage (ages 65 years and older):

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Dosage Warnings:

Sometimes using separate tablets of spironolactone and hydrochlorothiazide may be better to treat your condition. Your doctor may suggest this if your dose isn’t available in the combination tablets.

Edema

Brand: Aldactazide

Form: Oral tablet
Strengths:
  • 25 mg spironolactone/25 mg hydrochlorothiazide
  • 50 mg spironolactone/50 mg hydrochlorothiazide

Generic: Spironolactone/hydrochlorothiazide

Form: Oral tablet
Strengths:
  • 25 mg spironolactone/25 mg hydrochlorothiazide
Adult dosage (ages 18–64 years):

Doses range from 25–200 mg spironolactone/25–200 mg hydrochlorothiazide taken by mouth each day. This can be given in a single dose or in separate doses. Your doctor will decide a dose that’s right for you.

Child dosage (ages 0–17 years):

This medicine hasn’t been studied in children and shouldn’t be used in children younger than 18 years.

Senior dosage (ages 65 years and older):

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Dosage Warnings:

Sometimes using separate tablets of spironolactone and hydrochlorothiazide may be better to treat your condition. Your doctor may suggest this if your dose isn’t available in the combination tablets.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug comes with serious risks if you don't take it as prescribed.

If you don't take it at all

If you don’t take this drug, your blood pressure will stay high. This can lead to a heart attack or stroke.

If you stop taking it suddenly

If you stop taking this drug suddenly, your blood pressure may spike. You may have the following symptoms:

  • headache
  • confusion
  • chest pain
  • sweating
  • nausea
  • vomiting

If you don't take it on schedule

If you do not take this drug on schedule, your blood pressure might not be controlled. This can lead to a heart attack or stroke.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then wait and only take one dose at that time. Never try to catch up by taking two doses at once. This could cause toxic side effects.

If you take too much

If you take too much of this drug, you may have the following symptoms:

  • drowsiness
  • confusion
  • skin rash
  • nausea
  • vomiting
  • dizziness
  • diarrhea
  • changes in your body’s electrolytes, which can cause irregular heart rate or muscle pain and cramping

If you think you’ve taken too much of the drug, act right away. Call your doctor or local poison control center, or go to the nearest emergency room.

How to tell this drug is working

You won’t physically be able to feel if this drug is working. However, you may be able to tell this drug is working if you check your blood pressure and it’s lower or if your swelling gets better. Your doctor may ask you to check your blood pressure at home using a blood pressure monitor.

This drug is used for long-term treatment.

Store this drug carefully

  • Store this drug below 77°F (25°C).
  • Don’t freeze this drug.
  • Keep it away from light.
  • Keep it away from high temperature.
  • Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

Prescription is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt this medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t leave this medicine in the car, especially when the temperature is hot or freezing.

Self-management

You may need to check your blood pressure at home using a blood pressure monitor. These are available for purchase at most pharmacies. You should keep a log with the date, time of day, and your blood pressure readings. Bring this diary with you to your doctor appointments.

Clinical monitoring

While you’re taking this drug, your doctor will check your:

  • heart function
  • kidney function
  • liver function
  • electrolyte levels
  • blood pressure

Sun sensitivity

The hydrochlorothiazide part of this drug increases your sensitivity to the sun. When you’re out in the sun, you should wear sunscreen and long sleeves.

Hidden costs

You may need to purchase a home blood pressure monitor. These are available at most pharmacies.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

What does the pill look like?

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on September 23, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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