Spironolactone | Side Effects, Dosage, Uses & More
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Generic Name:

spironolactone, Oral tablet

All Brands

  • Aldactone
SECTION 1 of 5

Highlights for spironolactone

Oral tablet
1

Spironolactone is an oral drug that’s used to reduce swelling from congestive heart failure, liver disease, nephrotic syndrome (kidney problem), ascites, and pulmonary edema. It’s also used to treat hypertension (high blood pressure), heart failure, low potassium levels caused by other blood pressure medications, and excessive aldosterone secretion and diagnosis.

2

Your dose will depend on the condition being treated and any side effects that you have. Doses range from 25 mg taken by mouth once every other day to 200 mg taken as one dose or split into 2 doses. Your doctor will decide a dose that’s right for you.

3

You may not be able to take this drug if you have certain conditions. These include not making any urine (anuria), high potassium levels, and Addison’s disease. You also shouldn’t take this drug if you’re pregnant or breast-feeding or take the medicine eplerenone.

4

Serious side effects include very high potassium levels, breast enlargement, and serious skin reactions.

5

This drug has been shown to cause tumors in rats. It’s important to only take this medicine if your doctor prescribes it to you.

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 effects that may be dangerous.

Appropriate use warning: This drug has been shown to cause tumors in rats during long-term exposure. It’s important to only take this medicine if your doctor prescribes it to you. 

Potassium intake

While taking this drug, you should watch your potassium intake.  You shouldn’t take potassium supplements, eat a diet rich in potassium, or consume salt substitutes containing potassium. Having too much potassium in your body can lead to severe problems. This can even be fatal. Talk to your doctor or a nutritionist if you are concerned about your potassium intake.

Gallbladder and liver

In rare cases, this drug can be dangerous to your gallbladder and liver. Go to the emergency room right away if you have these symptoms:

  • extreme tiredness
  • loss of appetite
  • nausea
  • yellowing of your skin or the whites of eyes
  • itching

Enlarged breasts

This drug may cause you to have enlarged breasts (gynecomastia). This can happen in both men and women. If this happens, your doctor may stop treatment with this drug. This symptom usually goes away once you stop taking this drug.

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 all strengths or forms as the brand.  Talk to your healthcare provider to see if the generic will work for you.

This drug may be taken as part of a combination therapy with other water pills that work on a different part of the kidney.

Why it's used

This drug is an oral drug that’s used to reduce swelling from congestive heart failure, liver disease, nephrotic syndrome (kidney problem), ascites, and pulmonary edema. It’s also used to treat high blood pressure, heart failure, low potassium levels caused by other blood pressure medications, and excessive aldosterone secretion and diagnosis.

How it works

This drug belongs to a class of drugs called aldosterone antagonists (blockers), or potassium-sparing diuretics. A class of drugs is a group of medications that work in a similar way. They are often used to treat similar conditions. 

More Details

How it works

This drug belongs to a class of drugs called aldosterone antagonists (blockers), or potassium-sparing 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 works by blocking aldosterone activity. Aldosterone is a chemical made by the body that can cause water retention. This makes certain heart, kidney, and liver conditions worse. By blocking aldosterone, your body won’t retain fluid. This process also stops potassium from being excreted by your body.

This drug may lower your blood pressure by blocking aldosterone’s effect on your blood vessels. 

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spironolactone Side Effects

Oral tablet

More Common Side Effects

The more common side effects that occur with spironolactone include:

  • diarrhea and abdominal cramping

  • nausea and vomiting

  • high potassium levels

  • leg cramps

  • headache

  • dizziness

  • drowsiness

  • itching

  • irregular menstrual cycles or bleeding after menopause

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

Call your doctor right away if you have any of these serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

  • Allergic reactions. Symptoms can include:

    • skin rash
    • hives
    • fever
    • trouble breathing
    • swelling of your lips, mouth, tongue, or throat
  • Electrolyte and/or fluid problems. Symptoms can include:

    • mouth dryness
    • extreme thirst
    • extreme weakness and tiredness
    • fast heart rate and dizziness
    • not being able to urinate
  • Dangerously high potassium levels. Symptoms can include:

    • muscle weakness
    • not being able to move your legs and arms
    • extreme tiredness
    • tingling or numb feeling in your hands or feet
    • slow heart rate
  • Breast enlargement (gynecomastia). Symptoms can include:

    • growth of breast tissue in males and females
  • Severe skin reactions. Symptoms can include:

    • redness, blistering, peeling or loosening of your skin, including inside of your mouth
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug may cause drowsiness. You shouldn’t drive, use machinery, or do similar 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.
SECTION 3 of 5

spironolactone May Interact with Other Medications

Oral tablet

Spironolactone can interact with other medications, herbs, or vitamins you might be taking. An interaction is when a substance changes the way a drug works. This can be harmful or cause the drugs that you take to not work as well. To help prevent interactions, your doctor should manage all of your medications carefully. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

The use of drinks that contain alcohol can increase your risk of a sedative effect. You may have slowed reflexes, poor judgment, and sleepiness. This can be dangerous. If you drink alcohol, talk to your doctor.

Medications that might interact with this drug

Blood pressure drugs

These drugs can increase the amount of potassium in your body to unsafe levels if taken with spironolactone.

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 to unsafe levels when taken with spironolactone. Taking these drugs together may also lower your blood pressure too much.

These drugs include:

  • 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 to unsafe levels if taken with spironolactone.

These drugs include:

  • cholestyramine

Barbiturates

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

These drugs include:

  • amobarbital
  • butabarbital
  • butalbital
  • methohextal
  • pentobarbital
  • phenobarbital
  • secobarbital
  • thiopental

Corticosteroids

These drugs can decrease the amount of potassium in your body to unsafe levels if taken with spironolactone.

These drugs include:

  • dexamethasone
  • methylprednisolone
  • prednisolone
  • prednisone

Lithium

Spironolactone can increase the effects of lithium. Your doctor may lower your dose of lithium if you take these drugs together.

Heart drugs

Spironolactone can increase the effect of heart drugs. Your doctor may need to adjust your dose of your heart drug.

These drugs include:

  • digoxin

Anesthesia drugs

Spironolactone can decrease the effects of some anesthesia drugs.

These drugs include:

  • norepinephrine

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.
Drug warnings
anuria
People who don’t make urine (anuria)

You shouldn’t take this drug if you have anuria or don’t produce urine.

liver disease
People with liver disease

Taking this drug when you have liver disease may lead to a coma. Tell your doctor right away if you have the following symptoms, which may be signs of hepatic coma:

  • confusion
  • poor judgment
  • foggy memory
  • abnormal body movements and shaking
  • trouble concentrating
kidney disease
People with kidney disease

You should not take this drug if you have kidney disease or kidney damage. This drug can increase your risk for electrolyte changes, such as too much nitrogen in your blood stream.

Addison’s disease
People with Addison’s disease

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

heart disease
People with heart disease

Don’t take potassium supplements, eat a diet high in potassium, or take drugs that increase potassium levels if you have heart failure and you’re taking this drug. Dangerously high potassium levels are more likely if you have heart failure. This can be fatal.

Pregnant women
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.

breast-feeding
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.

seniors
For seniors

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

children
For children

This medicine shouldn’t be used in children younger than 18 years.

call the doctor
When to call the doctor

Call your doctor if you have trouble breathing or swelling in your legs. This means that your heart disease is getting worse.

allergies
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. Taking it a second time after an allergic reaction could be fatal.

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How to Take spironolactone (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. 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

Generic: spironolactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg

Brand: Aldactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg
Adult dosage (ages 18–64 years)

The starting dose is 50–100 mg taken by mouth each day. It’s given as a single dose or split into two doses.

Child dosage (ages 0–17 years)

This medication isn’t approved for use 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.

Treat low potassium levels (hypokalemia) from other blood pressure medications

Generic: spironolactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg

Brand: Aldactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg
Adult dosage (ages 18–64 years)

The dose ranges from 25–100 mg per day.

Child dosage (ages 0–17 years)

This medication isn’t approved for use 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.

Reduce swelling (edema) from congestive heart failure, nephrotic syndrome, liver disease, and ascites

Generic: spironolactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg

Brand: Aldactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg
Adult dosage (ages 18–64 years)

The starting dose is 100 mg taken by mouth each day. It’s given as a single dose or split into two doses. Some people may start as low as 25 mg per day or as high as 200 mg per day.

Child dosage (ages 0–17 years)

This medication isn’t approved for use 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.

Heart failure

Generic: spironolactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg

Brand: Aldactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg
Adult dosage (ages 18–64 years)

The starting dose is 12.5–25 mg taken by mouth once per day. Your doctor may increase or decrease your dose based on how you respond to the drug. Some people may take 50 mg once per day and others may take 25 mg once every other day.

Child dosage (ages 0–17 years)

This medication isn’t approved for use in children younger than 18 years.

Senior dosage (ages 65 years and older)

Seniors should take 12.5–25 mg once per day for heart failure. You shouldn’t take more than 25 mg per day.

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.

Excessive aldosterone secretion and diagnosis

Generic: spironolactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg

Brand: Aldactone

Form: Oral tablet
Strengths: 25 mg, 50 mg, 100 mg
Adult dosage (ages 18–64 years)
  • For the long test for excessive aldosterone diagnosis: 400 mg taken once per day for 3–4 weeks.
  • For the short test excessive aldosterone diagnosis: 400 mg taken once per day for 4 days.
  • People waiting for surgical correction of this excessive aldosterone secretion: 100–400 mg taken per day until the day of your surgery.
Child dosage (ages 0–17 years)

This medication isn’t approved for use 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.

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 do not take this drug,  your blood pressure will stay high. This can lead to a heart attack or stroke. Your body may also become overloaded with fluid. This can cause serious worsening of kidney and liver disease.

If you stop taking it suddenly

If you stop taking this drug, you may start retaining water. You may also have a sudden increase in your blood pressure. This can lead to a heart attack or stroke.  

If you don't take it on schedule

If you don’t 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 before 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 the drug is working

You may not be able to tell whether this drug is working or not. It’s important that you take your medicine every day as directed by your doctor. Your doctor will monitor your condition and be able to tell if this drug is working. You may need to buy your own blood pressure monitoring machine to check your blood pressure at home.

This drug is used for long-term treatment.

Store this drug carefully

  • Store this drug at room temperature. Keep it from 68°F to 77°F (20°C to 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.

A prescription for this medication 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 security staff the pharmacy prescription label for your medication. Be sure to carry with you the box your medication came in, which has this label.
  • Don’t put this medicine in your glove compartment or leave it 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 the following:

  • heart function
  • kidney function
  • liver function
  • electrolytes
  • blood pressure

Hidden costs

You may need to purchase a home blood pressure monitor to check your blood pressure at home. 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 better suited for you than others. Talk to your doctor about other options that may work for you.

What does the pill look like?

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How Much Does spironolactone Cost?

Oral tablet

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Lowest price for spironolactone

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These prices represent the lowest priced national pharmacies for spironolactone on GoodRx. They may be lower than your insurance.

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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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