Spironolactone, Oral Tablet

Overview of spironolactone

1. Spironolactone oral tablet is available as a brand-name drug and a generic drug. Brand name: Aldactone.
2. Spironolactone also comes as an oral suspension.
3. Spironolactone is used to reduce swelling from liver disease and nephrotic syndrome. It’s also used to treat high blood pressure, heart failure, and excessive aldosterone secretion.

What is spironolactone?

Spironolactone is a prescription drug. It comes as an oral tablet and an oral suspension (a kind of liquid mixture). This article focuses on the oral tablet.

Spironolactone oral tablet is available as the brand-name drug Aldactone and as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in all strengths or forms as the brand-name drug.

This drug may be taken as part of a combination therapy with other medications.

Why it’s used

This drug is used to reduce swelling from liver disease and nephrotic syndrome (a kidney problem). It’s also used to treat high blood pressure, heart failure, and hyperaldosteronism (excessive secretion of the hormone aldosterone).

How it works

This drug belongs to a group of drugs called aldosterone antagonists (blockers), or potassium-sparing diuretics. These drugs are often used to treat similar conditions.

Spironolactone works by blocking aldosterone activity. The way a drug works is referred to as its mechanism of action.

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 your body from ridding itself of potassium.

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

How long it lasts

After you take a dose of spironolactone, it takes about 1.5 hours for half of the dose to leave your body. This is known as the drug’s half-life. The drug will have its greatest effect in your body during this time.

How often you take spironolactone depends on the condition you’re taking the drug to treat. Studies have determined the dosages that help keep an effective level of the drug in the body for the different conditions spironolactone treats. Your doctor will recommend the right dosage of spironolactone for your condition.

After you stop taking spironolactone, your body should clear the drug in about a day.

If you have questions about how long spironolactone lasts in your body, ask your doctor or pharmacist.

Off-label uses

Spironolactone oral tablet may be used off-label for certain conditions. With off-label use, doctors prescribe a drug for a purpose other than what the Food and Drug Administration (FDA) has approved it for. Examples of possible off-label uses of spironolactone are discussed below.

For acne

Spironolactone is often used off-label to treat acne. For this purpose, guidelines from the American Academy of Dermatology recommend the drug specifically for certain females.* The drug is not recommended for treating acne in males.*

Research into the effectiveness of spironolactone for treating acne is ongoing.

To find out more about taking spironolactone to treat acne, talk with your doctor or pharmacist.

For hair loss

Spironolactone may be used off-label to treat a certain kind of hair loss called female* pattern baldness. A small study suggests the drug may be effective for treating this condition, but more research is needed to confirm this.

Spironolactone is usually not prescribed for male* pattern baldness. This is because it also has the potential to cause gynecomastia (increased breast size in males†). In certain situations, a doctor may consider using spironolactone off-label for male pattern baldness.

To learn more about taking spironolactone to treat hair loss, talk with your doctor or pharmacist.

* In this article, we use the terms “male” and female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
† This side effect could also affect someone who was assigned female at birth but has a certain level of testosterone in their body.

Spironolactone side effects

Spironolactone can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking spironolactone. This list does not include all possible side effects.

For more information on the possible side effects of spironolactone, or tips on how to manage a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects that can occur with spironolactone include:

• diarrhea and abdominal cramps
• nausea and vomiting
• hyperkalemia (high potassium level)
• 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 to a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Spironolactone oral tablet may cause drowsiness. You should not drive, use machinery, or do similar tasks that require alertness until you know how this drug affects you.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Allergic reaction. Symptoms can include:
  • skin rash
  • hives
  • fever
  • difficulty breathing
  • swelling of your lips, mouth, tongue, or throat
• Fluid and electrolyte 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
• Gynecomastia (increased breast size in males*†).
• Severe skin reactions. Symptoms can include:
  • skin discoloration
  • blistering or peeling
  • loosening of your skin, including inside of your mouth

* In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
† This side effect could also affect someone who was assigned female at birth but has a certain level of testosterone in their body.

How to take spironolactone

The spironolactone dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using spironolactone to treat
• your age
• the form of spironolactone you take
• other medical conditions you may have

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Note: While spironolactone is available as an oral suspension (a kind of liquid mixture), this article focuses on the oral tablet form.

Drug forms and strengths

Generic: spironolactone

• Form: oral tablet
• Strengths: 25 milligrams (mg), 50 mg, 100 mg

Brand: Aldactone

• Form: oral tablet
• Strengths: 25 mg, 50 mg, 100 mg

Dosage for hypertension (high blood pressure)

Adult dosage (ages 18 to 64 years)

The typical starting dosage is 25 mg to 100 mg taken by mouth each day. It’s given as a single dose or split into two doses.

Child dosage (ages 0 to 17 years)

This medication isn’t approved for use in children ages 17 years and younger.

Older adult dosage (ages 65 years and older)

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

Dosage for edema (swelling) from nephrotic syndrome and liver disease

Adult dosage (ages 18 to 64 years)

The typical starting dosage is 100 mg taken by mouth each day. It’s given as a single dose or split into two doses. Some people may take as little as 25 mg per day or as much as 200 mg per day.

Child dosage (ages 0 to 17 years)

This medication isn’t approved for use in children ages 17 years and younger.

Older adult dosage (ages 65 years and older)

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

Dosage for heart failure

Adult dosage (ages 18 to 64 years)

The typical starting dosage is 25 mg taken by mouth once per day. Your doctor may increase or decrease your dosage 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 to 17 years)

This medication isn’t approved for use in children ages 17 years and younger.

Older adult dosage (ages 65 years and older)

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

Dosage for excessive aldosterone secretion

Adult dosage (ages 18 to 64 years)

The typical dosage is 100 mg to 400 mg daily in preparation for surgery. If you cannot have surgery, your doctor may give you the lowest effective dose of this drug long term.

Child dosage (ages 0 to 17 years)

This medication isn’t approved for use in children ages 17 years and younger.

Older adult dosage (ages 65 years and older)

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

Take as directed

Spironolactone is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you do not 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. Fluid may also build up in your body. 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 do not take it on schedule: If you don’t take this drug on schedule, your blood pressure might not be managed. 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 dangerous 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 this drug, contact your doctor right away. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

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

Spironolactone warnings

This drug comes with several warnings.

Potassium intake

This drug can cause hyperkalemia (high potassium levels). While taking this drug, you should watch your potassium intake. You should not 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.

If you’re concerned about your potassium intake, talk with your doctor or a nutritionist.

Enlarged breasts

This drug may cause gynecomastia (increased breast size in males*†). If this happens, your doctor may stop your treatment with this drug. This symptom usually goes away once you stop taking spironolactone.

* In this article, we use the term “male” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.
† This side effect could also affect someone who was assigned female at birth but has a certain level of testosterone in their body.

Low blood pressure and worsening kidney function

This drug may result in low blood pressure and worsening kidney function. Your doctor will monitor your blood pressure and kidney function while you take this drug.

Allergy warning

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

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

Call 911 or go to the nearest emergency room if you develop these symptoms.

Do not take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

Warnings for people with certain health conditions

For 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
• atypical body movements and shaking
• difficulty concentrating

For people with hyperkalemia: You should not take spironolactone if you have high potassium levels. The drug can worsen this condition.

For people with kidney disease: You have an increased risk of side effects from this drug. You also have an increased risk of high potassium levels. If you take this drug, you should monitor your potassium levels closely. Your doctor can check your potassium levels using a blood test.

For people with Addison’s disease: You should not take this drug if you have Addison’s disease. It can make your illness worse.

For people with heart disease: Do not 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.

Call your doctor if you have difficulty breathing or swelling in your legs. This means that your heart disease may be getting worse.

Warnings for other groups

For pregnant people: There haven’t been enough studies done to be certain how the drug might affect a fetus.

Despite this lack of research, spironolactone should be used during pregnancy only if the potential benefit justifies the potential risk. Tell your doctor if you’re pregnant or plan to become pregnant. If you become pregnant while taking this drug, contact your doctor right away.

For people who are breastfeeding: A metabolite (a substance that results from the breakdown of a drug) from spironolactone passes into breast milk. This may cause side effects in a child who is breastfed. Talk with your doctor if you breastfeed your child. They may recommend that you stop breastfeeding or suggest a different medication for your condition.

For older adults: Older adults may process drugs more slowly. A usual adult dose may cause levels of spironolactone to be higher than usual. If you’re an older adult, you may need a lower dose or a different dosage schedule.

For children: This medication should not be used in children ages 17 years and younger.

Spironolactone may interact with other medications

Spironolactone can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with spironolactone. This list does not contain all drugs that may interact with spironolactone.

Before taking spironolactone, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drugs and supplements that increase potassium blood levels

Taking certain medications with spironolactone can increase the amount of potassium in your body to unsafe levels. Examples of these drugs include:

• angiotensin converting enzyme (ACE) inhibitors, such as:
  • benazepril (Lotensin)
  • captopril
  • enalapril (Vasotec)
  • fosinopril
  • moexipril
  • perindopril
  • quinapril
  • ramipril (Altace)
  • trandolapril
• angiotensin II receptor blockers (ARBs), such as:
  • irbesartan (Avapro)
  • losartan (Cozaar)
  • olmesartan (Benicar)
  • telmisartan (Micardis)
  • valsartan (Diovan)
• direct renin inhibitors, such as:
  • aliskiren (Tekturna)
• heparin and low molecular weight heparin (LMWH)
• potassium supplements
• potassium-sparing diuretics, such as:
  • triamterene (Dyrenium)
  • eplerenone (Inspra) (This drug should not be used with spironolactone.)

Pain drugs

Taking certain pain drugs with spironolactone can result in kidney damage and increased blood pressure. Examples of these pain drugs include:

• nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
  • diclofenac (Zipsor)
  • ibuprofen (Advil)
  • indomethacin (Indocin)
  • ketoprofen
  • ketorolac (Sprix)
  • meloxicam (Mobic)
  • nabumetone
  • naproxen (Aleve)
  • piroxicam (Feldene)

Cholesterol drugs

Taking certain cholesterol drugs with spironolactone can increase the amount of potassium and acid in your body to unsafe levels. Examples of these drugs include:

• cholestyramine (Prevalite)

Lithium

Taking lithium (Lithobid) with spironolactone can increase the effects of lithium. Your doctor may lower your dosage of lithium if you take these drugs together.

Digoxin

Taking digoxin (Lanoxin) with spironolactone may increase the effects of digoxin. Your doctor may monitor you more closely for side effects if you take these drugs together.

Spironolactone cost and coupons

Whether you have health insurance or not, cost may be a factor when you’re considering spironolactone. What you’ll pay for spironolactone may depend on several things, such as your treatment plan and the pharmacy you use.

Here are a few things to consider regarding cost:

• Cost information and savings coupons: You can visit Optum Perks to get price estimates of what you’d pay for spironolactone when using coupons from the site. See the coupon options below. (Note: Optum Perks coupons cannot be used with any insurance copays or benefits.)
• Savings programs: If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. In addition, you can visit Medicine Assistance Tool and NeedyMeds, two websites offering resources that may help decrease the price you pay for spironolactone.

You can also check out this article to learn more about saving money on prescriptions.

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Important considerations for taking spironolactone

Keep these considerations in mind if your doctor prescribes spironolactone for you.

General

• This drug can be taken with or without food.

Storage

• Store spironolactone at room temperature between 68°F and 77°F (20°C and 25°C).
• Don’t freeze this drug.
• Keep it away from light.
• Keep it away from high temperature.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

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 your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

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

Prior authorization

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.