Spironolactone Dosages: Your GoodRx Guide

Spironolactone (Aldactone) is a diuretic (“water pill”) used to treat heart failure, high blood pressure, and swelling caused by fluid buildup (edema). It also treats hyperaldosteronism, a health condition where the body makes too much of a hormone called aldosterone. When needed, an oral suspension form of spironolactone, called CaroSpir, is also available.

If spironolactone is in your medicine cabinet, you might be curious about the best spironolactone dosage. In this guide, we’ll cover typical spironolactone dosages for its approved uses. But keep in mind you should always take the dosage recommended by your healthcare provider. They may personalize your dosage to your specific situation.

What’s the typical spironolactone dosage for adults?

The typical spironolactone dosage for adults depends on why you’re taking it. It also depends on which form you’re taking.

Spironolactone tablets are available as 25 mg, 50 mg, and 100 mg. The oral suspension is available as 25 mg/5 mL. Take your spironolactone at the same time each day. You can take your doses with or without food. But make sure you pick one way and do it consistently.

Keep in mind: The tablets and suspension come in different doses, and they aren’t interchangeable. Spironolactone is also only approved for adults; it’s not approved for kids or adolescents.

Heart failure

Both forms of spironolactone are approved to treat heart failure. They help reduce heart failure symptoms by removing extra fluid from your body.

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Tablets

The typical starting dosage for spironolactone tablets for heart failure is 25 mg by mouth once daily. Your healthcare provider may increase your dosage to 50 mg once daily depending on how you respond to the medication.

Certain people who develop high potassium levels (hyperkalemia) while taking 25 mg daily may have their dosage lowered to 25 mg every other day. If you have pre-existing kidney problems, this may be your starting dosage.

Suspension 

The typical starting CaroSpir dosage is 20 mg (4 mL) by mouth once daily. Your healthcare provider may increase your dosage to 37.5 mg (7.5 mL) once daily depending on how you respond to the medication. 

Like the tablets, if you develop high potassium levels while taking 20 mg every day, your dosage may go down to 20 mg every other day. You may start with this dosage if you have pre-existing kidney problems.

High blood pressure

Spironolactone helps treat high blood pressure by getting rid of excess sodium and fluid in your body. It’s often used in combination with other blood pressure medications.

Tablets

For high blood pressure, the typical starting dosage for spironolactone tablets ranges from 25 mg to 100 mg per day. You may take your dose once daily or split it into two smaller doses. Your healthcare provider will usually raise your dose every 2 weeks as needed until your blood pressure goals are met.

In general, there are no additional blood pressure benefits for a dosage greater than 100 mg per day.

Suspension

The typical starting CaroSpir dosage for high blood pressure ranges from 20 mg (4 mL) to 75 mg (15 mL) per day. You may take this amount in one dose or in two smaller doses. Like the tablets, your healthcare provider may raise your dose every 2 weeks as needed until you reach your target blood pressure.

A CaroSpir dosage greater than 75 mg per day doesn’t typically provide additional reductions in blood pressure.

Fluid retention

If you have fluid retention due to cirrhosis (advanced liver disease), spironolactone (tablets or suspension) is usually started in the hospital. Your dosage may be slowly increased at home after that.

You can also take spironolactone tablets at home if you have fluid retention due to a rare kidney condition called nephrotic syndrome.

Tablets

For fluid retention, the typical spironolactone starting dosage is between 25 mg and 200 mg per day. Doses may be taken once or twice a day. 

Your healthcare provider will usually have you start at a dosage of 100 mg to remove excess fluid. They may adjust your dosage up or down after that depending on how your body responds.

Suspension

The typical CaroSpir starting dosage for edema caused by advanced liver disease is 75 mg (15 mL) per day. Again, this amount may be given as one or two divided doses. 

If you need a spironolactone dosage greater than 100 mg (20 mL) per day, your healthcare provider may talk to you about switching to the tablet formulation. 

Hyperaldosteronism

Treating hyperaldosteronism typically includes surgical removal of the adrenal glands and/or a prescription for spironolactone tablets. CaroSpir isn’t approved for this use.

People who receive surgery may receive a short-term prescription for spironolactone to help prepare for the procedure. The typical spironolactone dosage for hyperaldosteronism ranges from 100 mg to 400 mg total per day. Most people can stop taking spironolactone after their surgery.

If surgery isn’t an option for you, you’ll likely take spironolactone tablets long-term to manage the condition. The lowest effective spironolactone dosage is ideal in this case.

Are there any dosage adjustments for medical conditions?

Yes. People who have kidney or liver problems tend to take a lower spironolactone dosage. What’s more, if you take certain medications or substances that interact with spironolactone, you may need to take a lower spironolactone dosage.

Dosage for people with kidney problems

If you have kidney problems, you’ll likely take a lower dose of spironolactone. Spironolactone leaves your body through your kidneys, so if you have kidney problems, the medication could build up and lead to new or worsening side effects, including hyperkalemia. 

Dosage for people with liver problems

If you have liver problems, your healthcare provider may also start spironolactone at a lower dose than usual.

If your liver isn’t working as well as it should, the risk of fluid and electrolyte imbalance goes up. Because of this, your healthcare provider may want you to take your first spironolactone dose in the hospital. This will help them monitor for any side effects or red flags. The dosage should be slowly increased so your treatment remains safe and tolerable.

What happens if you miss a dose of spironolactone?

If you forget to take your dose of spironolactone, take the missed dose as soon as you remember. But if it’s almost time for your next dose, skip the missed dose and take your next dose at the usual scheduled time. For your safety, don’t double up on doses.

What should you do if you take too much spironolactone?

If you take too much spironolactone, side effects are more likely to happen. This includes side effects like drowsiness, confusion, and rash. Nausea, vomiting, and diarrhea are also possible.

If you think you took too much spironolactone, contact your healthcare provider or right away. Calling Poison Control at 1-800-222-1222 is another option. This is an important precaution regardless if you’re experiencing symptoms. To treat a spironolactone overdose, they’ll likely recommend supportive care measures to address your symptoms and get the situation under control (if needed). In some cases, they could recommend gastric suction.

However, if you or someone you know has taken far more spironolactone than prescribed, go to the nearest emergency room.

How to save on spironolactone

There are many ways to save on spironolactone, which is available as both a brand-name and generic medication. 

• Save with GoodRx. GoodRx can help you save over 60% off the average retail price of the generic tablets. Generic spironolactone’s price at certain pharmacies is as low as $5.40 with a free GoodRx discount.

• Save with a copay savings card. You may be eligible to save as much as $225 on a 90-day supply of CaroSpir using a savings card from the manufacturer. There currently isn’t a generic version of CaroSpir.

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Written by:

Nikki Javit, PharmD

Nikki Javit, PharmD, is a clinical pharmacist with certifications in international travel medicine, immunization delivery, and pharmacogenomics. She received her bachelor’s of science in biology from Indiana University Bloomington and her doctor of pharmacy degree from Butler University.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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