spironolactone
Spironolactone (Aldactone) is a type of potassium-sparing diuretic (water pill). It's used to treat heart failure, high blood pressure, and swelling from kidney or liver problems in adults. Because it blocks aldosterone (a hormone that affects sodium and potassium levels), spironolactone (Aldactone) can also treat conditions where there's too much aldosterone. Spironolactone (Aldactone) is taken by mouth, generally once or a few times a day, depending on your condition. Some common side effects of this medication include breast tenderness (males and females) and loss of libido (in males).
What is Spironolactone (Aldactone)?
What is Spironolactone (Aldactone) used for?
- Heart failure
- High blood pressure
- Swelling due to liver damage (cirrhosis)
- Swelling due to nephrotic syndrome (a rare kidney condition) - tablets only
- Primary aldosteronism (a hormone imbalance) - tablets only
How Spironolactone (Aldactone) works
Spironolactone (Aldactone) is a potassium-sparing diuretic (water pill) that's also an aldosterone antagonist. It blocks aldosterone (a hormone), so your kidneys can remove extra water and sodium. This helps lower the amount of fluid in your blood vessels and other areas of your body. It makes you urinate more without lowering the amount of potassium in your body, unlike other types of water pills.
Drug facts
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Side effects of Spironolactone (Aldactone)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Dizziness
- Headache
- Sleepiness
- Nausea
- Vomiting
- Diarrhea
- Stomach cramps
- Enlargement of male breasts
- Breast pain
- Lower sex drive
- Sexual dysfunction
- Irregular or lack of menstrual periods
- Leg cramps
- Higher potassium levels
- Lower sodium levels
Spironolactone (Aldactone) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- High potassium levels: muscle weakness, numbness, a tingling sensation, racing heart, trouble catching your breath, chest pain, nausea, vomiting
- Abnormal electrolyte levels: muscles cramps, fainting, irregular heartbeats, seizures
- Kidney failure: not urinating as much as usual, muscle cramps, nausea, vomiting, tiredness, swelling
- Serious skin reactions: sore throat, fever, tiredness, trouble swallowing, stinging sensation in the eyes, body aches, rash, itchiness, peeling or blistering of the skin
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The following Spironolactone (Aldactone) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Bleeding gums
bloody or black, tarry stools
bloody urine
blurred vision
breast pain
clay-colored stools
clear or bloody discharge from the nipple
cloudy urine
confusion
dark urine
decrease in urine output or decrease in urine-concentrating ability
difficulty with swallowing
dimpling of the breast skin
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
fast or irregular heartbeat
fever with or without chills
general feeling of tiredness or weakness
headache
hoarseness
increased thirst
indigestion
inverted nipple
loss of appetite
loss of consciousness
lower back or side pain
lump in the breast or under the arm
muscle pain or cramps
muscle spasms or twitching
painful or difficult urination
persistent crusting or scaling of the nipple
pinpoint red spots on the skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
redness or swelling of the breast
seizures
severe stomach pain
shakiness and unsteady walk
sore on the skin of the breast that does not heal
sores, ulcers, or white spots on the lips or in the mouth
stomach cramping, burning, or tenderness
swelling of the face, fingers, feet, ankles, or lower legs
swollen, painful, or tender lymph glands in the neck, armpit, or groin
tightness in the chest
trembling
troubled breathing
unpleasant breath odor
unsteadiness, trembling, or other problems with muscle control or coordination
unusual bleeding or bruising
unusual tiredness or weakness
vomiting
vomiting of blood or material that looks like coffee grounds
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Irregular heartbeat
nervousness
numbness or tingling in the hands, feet, or lips
rash with flat lesions or small raised lesions on the skin
reddened skin
weakness or heaviness of the legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Burning feeling in the chest or stomach
decreased interest in sexual intercourse
hair loss or thinning of the hair
inability to have or keep an erection
leg cramps
loss in sexual ability, desire, drive, or performance
pain in the nipples
sores, welts, or blisters
stomach upset
swelling of the breasts or breast soreness in both females and males
unusual dullness or feeling of sluggishness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Spironolactone (Aldactone)
Pros
- Taken by mouth
- Oral suspension available for adults who've difficulty swallowing tablets
- Lower-cost generics available
Cons
- Can make you urinate more often
- Need to get blood tests regularly to check your electrolytes and kidney health
- Can cause breast growth and lower sex drive in males
Pharmacist tips for Spironolactone (Aldactone)
- The spironolactone (Aldactone) tablets and spironolactone (CaroSpir) oral suspension aren't the same and can't be substituted for each other. When you pick up your prescription at the pharmacy, double check that you've received the correct form of spironolactone, as prescribed by your provider. Make sure to follow the dosing instructions your provider gave you.
- Spironolactone (Aldactone) can be taken with or without food. But it's best to take spironolactone (Aldactone) consistently, one way or the other, so that the level of this medication stays steady in your body.
- If you're taking the spironolactone (CaroSpir) oral suspension, store the medication at room temperature, and shake the bottle well before use. Use the dosing cup or syringe provided by your pharmacy to measure your doses. Don't use household kitchen or measuring spoons to measure your dose, since they might not be accurate and cause you to take the wrong amount of medication.
- Spironolactone (Aldactone) can make you urinate more often. Try to take the medication in the morning or afternoon to avoid the need to get up at night to use the restroom.
- Like many blood pressure medications, spironolactone (Aldactone) can cause dizziness the first few days you're taking it. This is because your body hasn't gotten used to having lower blood pressure. Be careful when getting up from a lying down or seated position so you don't get too dizzy or fall.
- If any side effects of spironolactone (Aldactone) (e.g., leg cramps, diarrhea, breast growth in males) become severe or bothersome, please let your healthcare provider know. Together, you and your provider can decide if continuing spironolactone (Aldactone) is the best option to treat your condition.
- It's very important to keep up with any regular blood tests your provider asks you to have done. This helps make sure that spironolactone (Aldactone) isn't causing problems with your electrolytes or kidneys.
- Avoid using potassium supplements or salt substitutes that contain potassium while taking spironolactone (Aldactone), unless your healthcare provider or dietitian tells you to do so. This can cause high levels of potassium in your blood, which can cause heart problems.
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Common questions about Spironolactone (Aldactone)
Yes, spironolactone (Aldactone) is considered a potassium-sparing diuretic. This means that it helps you get rid of extra fluids from your body without causing your potassium levels to drop. In addition, spironolactone (Aldactone) also has antiandrogen activities, meaning that it blocks male sex hormones, like testosterone. That's why this medication can cause side effects related to low testosterone levels, such as lower sex drive in males and breast tenderness in both males and females.
People who took spironolactone (Aldactone) during clinical studies didn't report weight gain as a side effect. If you experience sudden or unexpected weight gain after starting spironolactone (Aldactone), let your provider know. They can work with you to try to figure out the cause of weight gain and let you know if you need more medical attention.
Ask your provider how much water you should drink when taking spironolactone (Aldactone). The amount of water you need can differ depending on whether you have certain health conditions, such as kidney or heart problems. In general, you need to drink enough water to stay hydrated. Because spironolactone (Aldactone) causes you to urinate more, you're at higher risk for dehydration and electrolyte problems, which can be serious. You probably need to drink more water if you notice symptoms of dehydration, such as having dark-yellow urine, feeling thirsty, or having headaches.
Hair loss (alopecia) is one of the side effects reported by people who took spironolactone (Aldactone) in clinical studies. But there's not much information on whether the hair loss was caused by spironolactone (Aldactone) or something else, and how severe the hair loss was. Please note that providers sometimes prescribe spironolactone (Aldactone) off-label to limit hair growth in females with more severe cases of hirsutism (too much facial and body hair growth), a condition triggered by higher testosterone levels. Because spironolactone (Aldactone) lowers testosterone levels, it also causes less hair to grow. If you have questions about spironolactone (Aldactone) and hair loss, talk with your provider.
While spironolactone (Aldactone) isn't FDA-approved to treat acne, providers sometimes prescribe it off-label to help with acne for females. Once you start spironolactone (Aldactone), it might take a few weeks for your skin to be less oily and greasy, and less prone to breakouts. Some studies suggest that you need to take it for about 3 months to see more noticeable improvements to acne. If you've questions about spironolactone (Aldactone) and acne, talk with your provider.
If you're pregnant or thinking of becoming pregnant, talk with your provider before starting spironolactone (Aldactone). This medication isn't recommended for people who are pregnant because limited studies suggest that it can cause harm to developing babies. But at the same time, if you have high blood pressure and heart failure, it's important to manage these conditions during pregnancy for your health and that of your baby. Depending on what health conditions you have, your provider can talk with you about safer options.
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Risks and warnings for Spironolactone (Aldactone)
Spironolactone (Aldactone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
High blood potassium levels
- Risk factors: Kidney problems | Diabetes | Taking other medications that raise potassium levels | Using potassium-based salt substitutes
Spironolactone (Aldactone) can raise your blood potassium levels, which can be serious. Your risk is higher if you've kidney problems or are taking other medications that can raise your potassium levels. Your healthcare provider will check your potassium levels a week after you start spironolactone (Aldactone) and regularly after that to make sure it's within a safe range. If your potassium level is too high, then your provider might lower your dose of spironolactone (Aldactone) or ask you to stop taking it all together. Let your provider know if you feel symptoms of high potassium levels, such as tiredness, muscle weakness, numbness, nausea, or vomiting.
Low blood pressure and kidney problems
- Risk factors: Kidney problems | Taking other medications that can cause kidney problems
Because spironolactone (Aldactone) causes you to urinate more, it can sometimes lead to dehydration, low blood pressure, and kidney problems. The risk is higher for people who already have kidney problems or are also taking other medications that can cause kidney problems, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics. Your provider might order blood tests from time to time to check your kidney health while you're taking spironolactone (Aldactone).
Abnormal electrolyte levels
Spironolactone (Aldactone) can lower sodium, calcium, and magnesium levels in your blood. These electrolytes are important for many bodily functions. When they're too low, you can experience muscle cramps, fainting, irregular heart beats, or even seizures. Your healthcare provider will be checking these electrolytes before you start spironolactone (Aldactone) and regularly after starting to make sure it's safe to keep taking it.
In addition, though rare, spironolactone (Aldactone) can also raise your blood sugar levels and uric acid levels. Sometimes, higher uric acid levels might trigger a gout attack. To be safe, your provider will also check these labs through blood work occasionally, while you're taking spironolactone (Aldactone).
Breast pain or swelling
- Risk factors: Taking high doses of spironolactone (Aldactone)
Spironolactone (Aldactone) can cause breast pain or swelling in males and females, especially with higher doses of the medication. Some people have this side effect within 1 to 2 months of starting spironolactone (Aldactone), while others might not experience it until they've been taking the medication for a year or more. It usually goes away when you stop taking spironolactone (Aldactone). If the breast pain or swelling bothers you, talk to your healthcare provider about other options to treat your condition.
Spironolactone (Aldactone) dosage
Typical dosage for Spironolactone (Aldactone)
Please note: The spironolactone (Aldactone) tablets and spironolactone (CaroSpir) oral suspension aren't the same and can't be substituted for each other. See FAQs for more information.
Tablets
- Heart failure: The typical starting dose is 25 mg by mouth once daily. Your provider will adjust your dose as needed. The typical maintenance dose ranges from 25 mg every other day, to 50 mg daily.
- High blood pressure: The typical dose ranges from 25 mg to 100 mg by mouth daily, taken as a single dose or in divided doses.
- Swelling (from kidney or liver problems): The typical starting dose is 100 mg by mouth daily, taken as a single dose or in divided doses. The typical maintenance dose ranges from 25 mg to 200 mg daily, as a single dose or in divided doses.
- Primary hyperaldosteronism: The typical dose is to take 100 mg to 400 mg by mouth daily, leading up to surgery. For people who aren't able to receive surgery, take as instructed by your provider.
Oral suspension
- Heart failure: The typical starting dose is 20 mg by mouth once daily. Your provider will adjust your dose as needed. The typical maintenance dose ranges from 10 mg daily to 37.5 mg daily.
- High blood pressure: The typical dose ranges from 20 mg to 75 mg by mouth daily, taken as a single dose or in divided doses.
- Swelling (from liver problems): The typical starting dose is 75 mg by mouth daily, taken as a single dose or in divided doses.
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Interactions between Spironolactone (Aldactone) and other drugs
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Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aceclofenac
- Acemetacin
- Alacepril
- Amtolmetin Guacil
- Arginine
- Arsenic Trioxide
- Aspirin
- Benazepril
- Bromfenac
- Bufexamac
- Captopril
- Celecoxib
- Choline Salicylate
- Cilazapril
- Clonixin
- Delapril
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Digoxin
- Dipyrone
- Droperidol
- Droxicam
- Enalaprilat
- Enalapril Maleate
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Fosinopril
- Ibuprofen
- Imidapril
- Indomethacin
- Ketoprofen
- Ketorolac
- Levomethadyl
- Lisinopril
- Lithium
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Moexipril
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Pentopril
- Perindopril
- Phenylbutazone
- Piketoprofen
- Piroxicam
- Potassium
- Potassium Phosphate
- Pranoprofen
- Proglumetacin
- Propyphenazone
- Proquazone
- Quinapril
- Ramipril
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sodium Salicylate
- Sotalol
- Spirapril
- Sulindac
- Temocapril
- Tenoxicam
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Trandolapril
- Trimethoprim
- Valdecoxib
- Zofenopril
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Digitoxin
- Gossypol
- Licorice
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Spironolactone (Aldactone) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Spironolactone (Aldactone) will not be safe for you to take.
- High potassium levels
- Addison's disease
- Take eplerenone (Inspra) at the same time
What are alternatives to Spironolactone (Aldactone)?
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