Dosing & Uses
Dosage Forms & Strengths
Edema, Ascites, Congestive Heart Failure
1-8 tablets/day PO (spironolactone 25 mg/hydrochlorothiazide 25 mg)
1-4 tablets/day PO (spironolactone 50 mg/hydrochlorothiazide 50 mg)
Hypertension, Hypokalemia (Diuretic Induced)
2-4 tablets/day PO (spironolactone 25 mg/hydrochlorothiazide 25 mg)
1-2 tablets/day PO (spironolactone 50 mg/hydrochlorothiazide 50 mg)
Avoid spironolactone doses >25 mg/day in heart failure, or patients with CrCl< 30 mL/min; heart failure and risk of hyperkalemia is higher in older adults taking doses > 25 mg/day, or taking concomitant angiotensin-converting enzyme inhibitor, angiotensin-receptor blocker, NSAID, or potassium supplement
CrCL <30 mL/min: Hydrochlorothiazide efficacy decreased
Not for administration in hyperkalemia, anuria, acute renal insufficiency, or significant impairment of renal excretory function
Acute or severe hepatic failure: Contraindicated
Safety and efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
- Stevens-Johnson Syndrome
- Menstrual disorders
- Abdominal cramping
- Drug rash with eosinophilia and systemic symptoms (DRESS)
- Toxic epidermal necrolysis
- Epigastric distress
- Orthostatic hypotension
- Erythema multiforme
- Stevens-Johnson syndrome
- Exfoliative dermatitis including toxic epidermal necrolysis
Hypersensitivity to spironolactone, hydrochlorothiazide, or sulfonamides
Acute renal failure
Acute/severe hepatic failure
Addison’s disease or other conditions associated with hyperkalemia
Coadministration with eplerenone
Somnolence and dizziness reported
Caution with hepatic impairment
- May cause hyperkalemia; risk may be increased in patients with renal insufficiency, diabetes mellitus, or if coadministered with other drugs/diet that raise serum potassium levels
- Gynecomastia reported
- May cause hypokalemia and hyponatremia; risk of hypokalemia may be increased in patients with cirrhosis, brisk diuresis, or if coadministered with other drugs that lower serum potassium
- May cause hypomagnesemia, which can then result in hypokalemia which appears difficult to treat despite potassium repletion
- May alter glucose tolerance and increase risk for hyperglycemia
- May increase serum levels of calcium and uric acid by decreasing urinary excretion; may also increase cholesterol and triglycerides
- Thiazides diuretics may add to or potentiate the action of other antihypertensive drugs
- Sensitivity reactions to thiazides may occur in patients with or without a history of allergy or bronchial asthma
- Sulfonamide derivatives, including thiazides, have been reported to exacerbate or activate systemic lupus erythematosus
- Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)
Pregnancy & Lactation
Pregnancy Category: C
Lactation: discontinue drug or do not nurse
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.