spironolactone (Rx)

Brand and Other Names:Aldactone, CaroSpir
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg

Oral suspension (CaroSpir)

  • 5mg/mL

Primary Hyperaldosteronism

Tablet only

Short-term preoperative treatment of patients with primary hyperaldosteronism

Long-term maintenance therapy for patients with discrete aldosterone-producing adrenal adenomas who are not candidates for surgery or for patients with bilateral micro or macronodular adrenal hyperplasia (idiopathic hyperaldosteronism)

100-400 mg PO qDay in preparation for surgery initially

May be used as long-term maintenance therapy at the lowest effective for patients who are considered unsuitable for surgery

Edematous Conditions

Management of edema in patients with cirrhosis of the liver when edema are unresponsive to fluid and sodium restriction or nephrotic syndrome when treatment of the underlying disease, fluid restriction and sodium intake, and the use of other diuretics produce an inadequate response

Tablet

  • 100 mg qDay or divided q12hr for 5 days initially; then adjust does based on patient response; range: 25-200 mg PO qDay or divided q12hr

PO suspension

  • 75 mg PO qDay or divided doses initially; if sole therapy, administer for ≥5 days before increasing dose to obtain effect

Essential Hypertension

Adjunctive therapy for hypertension, to lower blood pressure

Tablets

  • 25-100mg PO qDay or divided q12hr initially; may adjust dosage to patient response q2weeks

PO suspension

  • 20-75 mg PO qDay or divided doses initially; may adjust dosage to patient response q2weeks
  • See Dosing Considerations

Congestive Heart Failure

Indicated for treatment of NYHA Class III-IV heart failure and reduced ejection fraction (EF) to increase survival, manage edema, and reduce the need for hospitalization for heart failure

ACC/AHA guidelines recommend aldosterone antagonist to be added to an ACE inhibitor or ARB, plus a beta-blocker; patient conditions may also require additional medications (eg, loop diuretics, hydralazine, nitrates, digoxin)

Tablet

  • 25mg/day PO initially if serum potassium ≤5 mEq/L and eGFR >50 mL/min/1.73 m²; if tolerated, may increase to 50 mg/day as clinically indicated; if 25 mg/day not tolerated, reduce frequency to qoD

PO suspension

  • 20 mg PO qDay; if initial 20 mg dose is tolerated, dosage can be increased to 37.5 mg as clinically indicated

Hypokalemia

Range: 25-100 mg PO qDay

Hirsutism (Off-label)

Women with hirsutism

50-200 mg PO qDay or divided q12hr

Acne (Off-label)

Females with hormonal acne

50-200 mg PO qDay or divided q12hr

Dosing Modifications

Renal impairment

  • Patients with renal impairment are at increased risk of hyperkalemia; monitor potassium closely
  • PO suspension for treatment of patients who develop hyperkalemia on 20 mg PO qDay may reduce dose to 20 mg PO qOD
  • Patients who develop hyperkalemia on 25 mg PO qDay may reduce to 25 mg PO qOD
  • CrCl >50 mL/min/1.73 m²: 20 mg qDay (oral suspension); 25 mg qDay (tablets)
  • CrCl 30-50 mL/min/1.73 m²: Consider initiating at 10 mg qDay (oral suspension) and 25 mg qOD (tablets)

Overdose Management

May use normal saline for volume replacement

May use dopamine or norepinephrine to treat hypotension

Treat hyperkalemia with IV glucose (dextrose 25% in water), concurrently with rapid-acting insulin and IV sodium bicarbonate; oral/rectal solutions of Kayexalate in sorbitol can be used if needed

If dysrhythmia due to decreased K+ or Mg+ suspected, replace aggressively

Discontinue treatment if no symptoms after 6 hr

Dosing Considerations

Oral formulation

  • PO suspension formulation is not therapeutically equivalent to tablet
  • If PO suspension requires a dose titration >100 mg, use tablet
  • For hypertension: Doses >75 mg/day may not provide additional reductions in blood pressure

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg

Edema (Off-label)

CHF, cirrhosis, ascites, and nephrotic syndrome

1-3.3 mg/kg/day PO or divided q12hr; not to exceed 3.3 mg/kg/day or up to 100 mg/day  

Hypertension (Off-label)

Among therapeutic options recommended by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents

1-3.3 mg/kg/day PO or divided q12hr; not to exceed 3.3 mg/kg/day or 100 mg/day  

Hyperaldosteronism (Orphan)

Orphan designation for primary hyperaldosteronism

Sponsor

  • CMP Pharma, Inc; PO Box 147, 8026 US Highway 264A; Farmville, NC 27828

Substantially excreted by the kidney, and risk of adverse reactions to this drug may be greater in patients with impaired renal function; monitor renal function

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Interactions

Interaction Checker

and spironolactone

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              Serious - Use Alternative (10)

              • amiloride

                amiloride and spironolactone both increase serum potassium. Avoid or Use Alternate Drug.

                amiloride, spironolactone. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Hyperkalemia.

              • cyclosporine

                spironolactone and cyclosporine both increase serum potassium. Avoid or Use Alternate Drug. Coadministration not recommended

              • drospirenone

                drospirenone and spironolactone both increase serum potassium. Avoid or Use Alternate Drug.

                drospirenone, spironolactone. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Hyperkalemia.

              • eplerenone

                spironolactone, eplerenone. Mechanism: pharmacodynamic synergism. Contraindicated. Hyperkalemia.

              • lofexidine

                lofexidine, spironolactone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              • potassium acid phosphate

                spironolactone and potassium acid phosphate both increase serum potassium. Avoid or Use Alternate Drug.

              • potassium chloride

                spironolactone and potassium chloride both increase serum potassium. Avoid or Use Alternate Drug.

              • potassium citrate

                spironolactone and potassium citrate both increase serum potassium. Avoid or Use Alternate Drug.

              • potassium phosphates, IV

                spironolactone and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.

              • triamterene

                spironolactone and triamterene both increase serum potassium. Avoid or Use Alternate Drug.

                spironolactone, triamterene. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Hyperkalemia.

              Monitor Closely (142)

              • acebutolol

                acebutolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • aceclofenac

                spironolactone and aceclofenac both increase serum potassium. Modify Therapy/Monitor Closely.

              • acemetacin

                spironolactone and acemetacin both increase serum potassium. Modify Therapy/Monitor Closely.

              • albuterol

                spironolactone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • aldesleukin

                aldesleukin increases effects of spironolactone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • amifostine

                amifostine, spironolactone. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • ampicillin

                ampicillin increases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.

              • arformoterol

                spironolactone increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • aspirin

                spironolactone and aspirin both increase serum potassium. Modify Therapy/Monitor Closely.

                aspirin decreases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. When used concomitantly, spironolactone dose may need to be titrated to higher maintenance dose and the patient should be observed closely to determine if the desired effect is obtained.

              • aspirin rectal

                spironolactone and aspirin rectal both increase serum potassium. Modify Therapy/Monitor Closely.

                aspirin rectal decreases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. When used concomitantly, spironolactone dose may need to be titrated to higher maintenance dose and the patient should be observed closely to determine if the desired effect is obtained.

              • aspirin/citric acid/sodium bicarbonate

                spironolactone and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Modify Therapy/Monitor Closely.

                aspirin/citric acid/sodium bicarbonate decreases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. When used concomitantly, spironolactone dose may need to be titrated to higher maintenance dose and the patient should be observed closely to determine if the desired effect is obtained.

              • atenolol

                atenolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • avanafil

                avanafil increases effects of spironolactone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • benazepril

                benazepril and spironolactone both increase serum potassium. Use Caution/Monitor.

              • bendroflumethiazide

                spironolactone increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • betaxolol

                betaxolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • bisoprolol

                bisoprolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • bretylium

                spironolactone, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

              • bumetanide

                spironolactone increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • buprenorphine, long-acting injection

                buprenorphine, long-acting injection decreases effects of spironolactone by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Opioids can reduce diuretic efficacy by inducing antidiuretic hormone release.

              • canagliflozin

                spironolactone and canagliflozin both increase serum potassium. Use Caution/Monitor.

              • candesartan

                candesartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • captopril

                captopril, spironolactone. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Risk of hyperkalemia. Monitor blood pressure and potassium.

              • carbenoxolone

                spironolactone increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • carbidopa

                carbidopa increases effects of spironolactone by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              • carvedilol

                carvedilol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • celecoxib

                spironolactone and celecoxib both increase serum potassium. Modify Therapy/Monitor Closely.

              • celiprolol

                celiprolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • chlorothiazide

                spironolactone increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • chlorthalidone

                spironolactone increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • cholestyramine

                cholestyramine, spironolactone. unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemic metabolic acidosis reported when coadministered.

              • cholic acid

                spironolactone increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.

              • choline magnesium trisalicylate

                spironolactone and choline magnesium trisalicylate both increase serum potassium. Modify Therapy/Monitor Closely.

              • cyclopenthiazide

                spironolactone increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • dichlorphenamide

                dichlorphenamide, spironolactone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

              • diclofenac

                spironolactone and diclofenac both increase serum potassium. Modify Therapy/Monitor Closely.

              • diflunisal

                spironolactone and diflunisal both increase serum potassium. Modify Therapy/Monitor Closely.

              • digoxin

                spironolactone and digoxin both increase serum potassium. Modify Therapy/Monitor Closely.

                spironolactone, digoxin. Mechanism: decreasing renal clearance. Use Caution/Monitor. False digoxin assay results may be obtained.

                spironolactone increases levels of digoxin by Other (see comment). Use Caution/Monitor. Comment: Spironolactone may cause false elevation of digoxin assay.

              • disopyramide

                spironolactone increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.

              • dobutamine

                spironolactone increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • dopexamine

                spironolactone increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • empagliflozin

                empagliflozin, spironolactone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of empagliflozin with diuretics results in increased urine volume and frequency of voids, which might enhance the potential for volume depletion.

              • enalapril

                enalapril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • ephedrine

                spironolactone increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • epinephrine

                spironolactone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • epinephrine racemic

                spironolactone increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • eprosartan

                eprosartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • esmolol

                esmolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • ethacrynic acid

                spironolactone increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • etodolac

                spironolactone and etodolac both increase serum potassium. Modify Therapy/Monitor Closely.

              • fenbufen

                spironolactone and fenbufen both increase serum potassium. Modify Therapy/Monitor Closely.

              • fenoprofen

                spironolactone and fenoprofen both increase serum potassium. Modify Therapy/Monitor Closely.

              • fentanyl

                fentanyl decreases effects of spironolactone by Other (see comment). Modify Therapy/Monitor Closely. Comment: Fentanyl can reduce the efficacy of diuretics by inducing antidiuretic hormone release. Fentanyl may also lead to acute urinary retention by causing bladder sphincter spasm (particularly in men with enlarged prostates).

              • fentanyl intranasal

                fentanyl intranasal decreases effects of spironolactone by Other (see comment). Modify Therapy/Monitor Closely. Comment: Fentanyl can reduce the efficacy of diuretics by inducing antidiuretic hormone release. Fentanyl may also lead to acute urinary retention by causing bladder sphincter spasm (particularly in men with enlarged prostates).

              • fentanyl transdermal

                fentanyl transdermal decreases effects of spironolactone by Other (see comment). Modify Therapy/Monitor Closely. Comment: Fentanyl can reduce the efficacy of diuretics by inducing antidiuretic hormone release. Fentanyl may also lead to acute urinary retention by causing bladder sphincter spasm (particularly in men with enlarged prostates).

              • fentanyl transmucosal

                fentanyl transmucosal decreases effects of spironolactone by Other (see comment). Modify Therapy/Monitor Closely. Comment: Fentanyl can reduce the efficacy of diuretics by inducing antidiuretic hormone release. Fentanyl may also lead to acute urinary retention by causing bladder sphincter spasm (particularly in men with enlarged prostates).

              • finerenone

                spironolactone and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.

              • flucloxacillin

                flucloxacillin increases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.

              • flurbiprofen

                spironolactone and flurbiprofen both increase serum potassium. Modify Therapy/Monitor Closely.

              • formoterol

                spironolactone increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • fosinopril

                fosinopril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • furosemide

                spironolactone increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • gentamicin

                spironolactone increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • hydrochlorothiazide

                spironolactone increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • ibuprofen

                spironolactone and ibuprofen both increase serum potassium. Modify Therapy/Monitor Closely.

              • ibuprofen IV

                spironolactone and ibuprofen IV both increase serum potassium. Modify Therapy/Monitor Closely.

              • imidapril

                imidapril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • indapamide

                spironolactone increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • indomethacin

                spironolactone and indomethacin both increase serum potassium. Modify Therapy/Monitor Closely.

              • irbesartan

                irbesartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • isoproterenol

                spironolactone increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • juniper

                juniper, spironolactone. Other (see comment). Use Caution/Monitor. Comment: Juniper may potentiate or interfere with diuretic therapy. Juniper has diuretic effects, but may cause kidney damage at large doses.

              • ketoprofen

                spironolactone and ketoprofen both increase serum potassium. Modify Therapy/Monitor Closely.

              • ketorolac

                spironolactone and ketorolac both increase serum potassium. Modify Therapy/Monitor Closely.

              • ketorolac intranasal

                spironolactone and ketorolac intranasal both increase serum potassium. Modify Therapy/Monitor Closely.

              • labetalol

                labetalol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • levalbuterol

                spironolactone increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • levodopa

                levodopa increases effects of spironolactone by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              • lisinopril

                lisinopril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • lornoxicam

                spironolactone and lornoxicam both increase serum potassium. Modify Therapy/Monitor Closely.

              • losartan

                losartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • lurasidone

                lurasidone increases effects of spironolactone by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

              • maraviroc

                maraviroc, spironolactone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

              • meclofenamate

                spironolactone and meclofenamate both increase serum potassium. Modify Therapy/Monitor Closely.

              • mefenamic acid

                spironolactone and mefenamic acid both increase serum potassium. Modify Therapy/Monitor Closely.

              • meloxicam

                spironolactone and meloxicam both increase serum potassium. Modify Therapy/Monitor Closely.

              • metaproterenol

                spironolactone increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • methyclothiazide

                spironolactone increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely. .

              • metolazone

                spironolactone increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • metoprolol

                metoprolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • midazolam

                spironolactone will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. midazolam dose may need to be adjusted

              • mitotane

                spironolactone decreases effects of mitotane by pharmacodynamic antagonism. Use Caution/Monitor.

              • moexipril

                moexipril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • nabumetone

                spironolactone and nabumetone both increase serum potassium. Modify Therapy/Monitor Closely.

              • nadolol

                nadolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • naproxen

                spironolactone and naproxen both increase serum potassium. Modify Therapy/Monitor Closely.

              • nebivolol

                nebivolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • nitroglycerin rectal

                nitroglycerin rectal, spironolactone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

              • noni juice

                spironolactone and noni juice both increase serum potassium. Use Caution/Monitor.

              • norepinephrine

                spironolactone increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • oliceridine

                oliceridine decreases effects of spironolactone by Other (see comment). Use Caution/Monitor. Comment: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. Monitor for signs of diminished diuresis and/or effects on blood pressure and increase dosage of the diuretic as needed. .

              • olmesartan

                olmesartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • ospemifene

                spironolactone, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely.

              • oxaprozin

                spironolactone and oxaprozin both increase serum potassium. Modify Therapy/Monitor Closely.

              • parecoxib

                spironolactone and parecoxib both increase serum potassium. Modify Therapy/Monitor Closely.

              • penbutolol

                penbutolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • perindopril

                perindopril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • pindolol

                pindolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • pirbuterol

                spironolactone increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • piroxicam

                spironolactone and piroxicam both increase serum potassium. Modify Therapy/Monitor Closely.

              • pivmecillinam

                pivmecillinam increases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.

              • potassium citrate/citric acid

                spironolactone and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

              • propranolol

                propranolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • pseudoephedrine

                spironolactone decreases effects of pseudoephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • quinapril

                quinapril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • ramipril

                ramipril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • repaglinide

                spironolactone will increase the level or effect of repaglinide by Other (see comment). Use Caution/Monitor. Spironolactone inhibits CYP2C8; repaglinice dose may need to be adjusted as it is metabolized by CYP2C8

              • sacubitril/valsartan

                sacubitril/valsartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • salicylates (non-asa)

                spironolactone and salicylates (non-asa) both increase serum potassium. Modify Therapy/Monitor Closely.

              • salmeterol

                spironolactone increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • salsalate

                spironolactone and salsalate both increase serum potassium. Modify Therapy/Monitor Closely.

              • sirolimus

                spironolactone will increase the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. sirolimus dose may need to be adjusted

              • sotalol

                sotalol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • succinylcholine

                spironolactone and succinylcholine both increase serum potassium. Modify Therapy/Monitor Closely.

              • sulfasalazine

                spironolactone and sulfasalazine both increase serum potassium. Modify Therapy/Monitor Closely.

              • sulindac

                spironolactone and sulindac both increase serum potassium. Modify Therapy/Monitor Closely.

              • tacrolimus

                spironolactone will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. tacrolimus dose may need to be adjusted

              • tadalafil

                tadalafil increases effects of spironolactone by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • telmisartan

                telmisartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • temocillin

                temocillin increases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.

              • terbutaline

                spironolactone increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • ticarcillin

                ticarcillin increases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.

              • timolol

                timolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • tolfenamic acid

                spironolactone and tolfenamic acid both increase serum potassium. Modify Therapy/Monitor Closely.

              • tolmetin

                spironolactone and tolmetin both increase serum potassium. Modify Therapy/Monitor Closely.

              • tolvaptan

                spironolactone and tolvaptan both increase serum potassium. Modify Therapy/Monitor Closely.

              • torsemide

                spironolactone increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • trandolapril

                trandolapril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

              • trimethoprim

                trimethoprim and spironolactone both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.

              • valsartan

                valsartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • warfarin

                spironolactone decreases effects of warfarin by unknown mechanism. Use Caution/Monitor. Interaction is theorized to result from increased concentration of clotting factors as a result of diuresis.

              • xipamide

                xipamide increases effects of spironolactone by pharmacodynamic synergism. Use Caution/Monitor.

              Minor (33)

              • agrimony

                agrimony increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • ammonium chloride

                spironolactone, ammonium chloride. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of systemic acidosis.

              • birch

                birch increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • brimonidine

                brimonidine increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • cadexomer iodine

                cadexomer iodine, spironolactone. Mechanism: decreasing renal clearance. Minor/Significance Unknown. Hyperkalemia.

              • calcium acetate

                spironolactone decreases levels of calcium acetate by increasing renal clearance. Minor/Significance Unknown.

              • calcium carbonate

                spironolactone decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

              • calcium chloride

                spironolactone decreases levels of calcium chloride by increasing renal clearance. Minor/Significance Unknown.

              • calcium citrate

                spironolactone decreases levels of calcium citrate by increasing renal clearance. Minor/Significance Unknown.

              • calcium gluconate

                spironolactone decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

              • cornsilk

                cornsilk increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • epoprostenol

                epoprostenol increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • forskolin

                forskolin increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • goldenrod

                goldenrod increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • iodinated glycerol

                iodinated glycerol, spironolactone. Mechanism: decreasing renal clearance. Minor/Significance Unknown. Hyperkalemia.

              • iodine

                iodine, spironolactone. Mechanism: decreasing renal clearance. Minor/Significance Unknown. Hyperkalemia.

              • magnesium chloride

                spironolactone increases levels of magnesium chloride by decreasing renal clearance. Minor/Significance Unknown.

              • magnesium citrate

                spironolactone increases levels of magnesium citrate by decreasing renal clearance. Minor/Significance Unknown.

              • magnesium hydroxide

                spironolactone increases levels of magnesium hydroxide by decreasing renal clearance. Minor/Significance Unknown.

              • magnesium oxide

                spironolactone increases levels of magnesium oxide by decreasing renal clearance. Minor/Significance Unknown.

              • magnesium sulfate

                spironolactone increases levels of magnesium sulfate by decreasing renal clearance. Minor/Significance Unknown.

              • maitake

                maitake increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • minoxidil

                spironolactone increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

              • nitazoxanide

                nitazoxanide, spironolactone. Either increases levels of the other by Mechanism: plasma protein binding competition. Minor/Significance Unknown.

              • octacosanol

                octacosanol increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • reishi

                reishi increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • shepherd's purse

                shepherd's purse, spironolactone. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

              • sulfadiazine

                spironolactone increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.

              • sulfamethoxazole

                spironolactone, sulfamethoxazole. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Hyperkalemia.

                spironolactone increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

              • sulfisoxazole

                spironolactone increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.

              • tizanidine

                tizanidine increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • treprostinil

                treprostinil increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

              • trimethoprim

                spironolactone, trimethoprim. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Hyperkalemia.

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              Adverse Effects

              Frequency Not Defined

              Gastric bleeding

              Ulceration

              Gastritis

              Decreased libido

              Inability to achieve or maintain erection

              Postmenopausal bleeding

              Breast and nipple pain

              Thrombocytopenia

              Fever

              Urticaria

              Maculopapular or erythematous cutaneous eruptions

              Anaphylactic reactions

              Vasculitis

              Hyperkalemia

              Electrolyte disturbances

              Hyponatremia

              Hypovolemia

              Lethargy

              Mental confusion

              Ataxia

              Dizziness

              Headache

              Drowsiness

              Renal dysfunction (including renal failure)

              Chloasma

              Drowsiness

              Lethargy

              Headache

              Mental confusion

              Rash

              Urticaria

              Stevens-Johnson syndrome

              Toxic epidermal necrolysis

              Drug rash with eosinophilia and systemic symptoms (DRESS)

              Gynecomastia

              Impotence

              Menstrual disorders

              Abdominal cramping

              Diarrhea

              Gastritis

              Nausea

              Vomiting

              Breast pain

              Leukopenia

              Electrolyte disturbances

              Leg cramps

              Dizziness

              Alopecia

              Pruritus

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              Warnings

              Black Box Warnings

              Spironolactone has been shown to be a tumorigen in chronic toxicity studies in rats; use only for specified indications

              Contraindications

              Hypersensitivity

              Addison disease or other conditions associated with hyperkalemia

              Coadministration with eplerenone

              Cautions

              Gynecomastia reported and usually reversible

              Hyponatremia, hypomagnesemia, hypocalcemia, hypochloremic alkalosis, and hyperglycemia may occur

              Asymptomatic hyperuricemia can occur and rarely gout may occur; monitor serum electrolytes, uric acid, and blood glucose periodically In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy

              Hyperkalemia may occur; monitor serum potassium within 1 week of initiation or titration of spironolactone and regularly thereafter; if hyperkalemia occurs, reduce dose or discontinue treatment and treat hyperkalemia

              Excessive diuresis may cause symptomatic dehydration, hypotension and worsening renal function, particularly in salt-depleted patients or those taking angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)

              Drug interactions overview

              • Coadministration of PO suspension and lithium reduces the renal clearance of lithium, inducing a high risk of lithium toxicity
              • Reported that of coadministration of PO suspension and an NSAID can reduce the diuretic, natriuretic, and antihypertensive effect of loop, potassium-sparing, and thiazide diuretics
              • NSAID administration can reduce diuretic, natriuretic, and antihypertensive effect of diuretics; when spironolactone and NSAIDs are used concomitantly, monitor closely to determine if the desired effect of the diuretic is obtained
              • Acetylsalicylic acid may reduce the efficacy of spironolactone; coadministration with acetylsalicylic acid may need to be titrated to higher maintenance dose and monitor closely to determine if the desired effect is obtained
              • Coadministration of spironolactone with potassium supplementation, salt substitutes containing potassium, a diet rich in potassium, or drugs that can increase potassium (eg, ACE inhibitors, ARBs, NSAIDs, heparin and low molecular weight heparin) may lead to severe hyperkalemia
              • Risk of worsening of renal function can also occur with concomitant use of nephrotoxic drugs (eg, aminoglycosides, cisplatin, NSAIDs); monitor volume status and renal function periodically
              • Spironolactone and its metabolites interfere with radioimmunoassays for digoxin and increase the apparent exposure to digoxin; use an assay that does not interact with spironolactone
              • Hyperkalemic metabolic acidosis reported in patients given spironolactone concurrently with cholestyramine
              • Spironolactone and its metabolites increase the apparent exposure to digoxin; in patients taking concomitant digoxin, measure serum digoxin concentrations before initiating spironolactone using an assay that does not interact with spironolactone; reduce digoxin concentrations by decreasing dose by approximately 15-30% or by modifying dosing frequency and continue monitoring
              • Spironolactone is an irreversible inhibitor for CYP2C8 and CYP3A4/5 in vitro; may increase exposure of other coadministered drugs that are metabolized by CYP2C8 and CYP3A4/5; dosage adjustments of drugs metabolized by CYP2C8 (eg, repaglinide) and CYP3A4/5 (eg, midazolam, sirolimus, and tacrolimus) may be necessary if they are given concurrently with spironolactone
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              Pregnancy & Lactation

              Pregnancy

              Based on mechanism of action and findings in animal studies, spironolactone may affect sex differentiation of the male during embryogenesis; rat embryofetal studies report feminization of male fetuses and endocrine dysfunction in females exposed to spironolactone in utero

              Limited available data did not demonstrate an association of major malformations or other adverse pregnancy outcomes with spironolactone; risks may occur to the mother and fetus associated with heart failure, cirrhosis, and poorly controlled hypertension during pregnancy

              Potential risk to the male fetus due to antiandrogenic properties of spironolactone; avoid spironolactone in pregnant women or advise a pregnant woman of the potential risk to a male fetus

              Disease-associated maternal and embryo/fetal risks

              • Pregnant women with CHF are at increased risk for preterm birth; stroke volume and heart rate increase during pregnancy, increasing cardiac output, especially during the first trimester; closely monitor pregnant patients with CHF
              • Pregnant women with symptomatic cirrhosis generally have poor outcomes (eg, hepatic failure, variceal hemorrhage, preterm delivery, fetal growth restriction, and maternal death); pregnant women with cirrhosis of the liver should be monitored and managed accordingly
              • Hypertension in pregnancy increases the maternal risk for preeclampsia, gestational diabetes, premature delivery, and delivery complications (eg, need for cesarean delivery, postpartum hemorrhage); hypertension increases the fetal risk for intrauterine growth restriction and death

              Lactation

              Not present in breastmilk; however, limited data from a lactating woman at 17 days postpartum reports the presence of the active metabolite, canrenone, in human breast milk in low amounts that are expected to be clinically inconsequential; in this case, there were no adverse effects reported for the breastfed infant after short term exposure to spironolactone; however, long term effects on a breastfed infant are unknown; there are no data on spironolactone effects on milk production

              Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

              Pregnancy Categories

              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.

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              Pharmacology

              Mechanism of Action

              Aldosterone antagonist with diuretic and antihypertensive effects; competitive binding of receptors at aldosterone-dependent Na-K exchange site in distal tubules results in increased excretion of Na+, Cl-, and water and retention of K+ and H+

              Increases testosterone clearance and estradiol production; blocks conversion of potent androgens to weaker ones in peripheral tissues

              Absorption

              Bioavailability: 73% (tablet)

              Onset: 2-4 hr (tablet)

              Duration: 2-3 days (tablet)

              Peak serum time: 2.6-4.3 hr (tablet); 0.5-1.5 hr (PO suspension); 2.5-5 hr (PO suspension, active metabolite)

              A high fat and high calorie meal (57% of the ~1000 kcal of the meal were from fat) increased the bioavailability of spironolactone (as measured by AUC) by ~90%

              Distribution

              Protein bound: 90%

              Metabolism

              Metabolized by the liver and kidneys

              Metabolites: Canrenone, 7-alpha-thiomethylspirolactone, 6-beta-hydroxy-7-alpha-thiomethylspirolactone (active)

              Elimination

              Half-life (tablet): 1.3-1.4 hr (parent drug); 16.5 hr (canrenone); 13.8 hr (7-α-[thiomethyl] spirolactone [TMS]); 15 hr (6-ß-hydroxy-7-α-[thiomethyl] spirolactone [HTMS])

              Half-life (PO suspension): 1-2 hr (parent drug); 10-35 hr (canrenone, 7-α-[thiomethyl] spirolactone [TMS], 6-ß-hydroxy-7-α-[thiomethyl] spirolactone [HTMS])

              Excretion (tablet): Urine (47-57%); feces (35-41%)

              Excretion (PO suspension): Urine

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              Administration

              Oral Administration

              Take with or without food; take consistently with respect to food

              Storage

              Tablet: Store below 77°F (25°C)

              PO suspension: Store at 68-77°F (20-25°C); excursions permitted to 59-86°F (15-30°C); shake well before use, dispense in a tight container as defined in the USP

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Aldactone oral
              -
              50 mg tablet
              Aldactone oral
              -
              100 mg tablet
              Aldactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              100 mg tablet
              spironolactone oral
              -
              50 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              100 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              50 mg tablet
              spironolactone oral
              -
              100 mg tablet
              spironolactone oral
              -
              50 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              100 mg tablet
              spironolactone oral
              -
              50 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              100 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              100 mg tablet
              spironolactone oral
              -
              50 mg tablet
              spironolactone oral
              -
              50 mg tablet
              spironolactone oral
              -
              50 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              100 mg tablet
              spironolactone oral
              -
              25 mg tablet
              spironolactone oral
              -
              100 mg tablet
              spironolactone oral
              -
              50 mg tablet
              CaroSpir oral
              -
              25 mg/5 mL suspension
              CaroSpir oral
              -
              25 mg/5 mL suspension

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              spironolactone oral

              SPIRONOLACTONE - ORAL

              (spir-ON-oh-LAK-tone)

              COMMON BRAND NAME(S): Aldactone

              USES: Spironolactone is used to treat high blood pressure and heart failure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to treat swelling (edema) caused by certain conditions (such as heart failure, liver disease) by removing excess fluid and improving symptoms such as breathing problems.This medication is also used to treat conditions in which the body is making too much of a natural substance (aldosterone).Spironolactone is known as a "water pill" (potassium-sparing diuretic).

              HOW TO USE: Take this medication by mouth, as directed by your doctor. If stomach upset occurs, take it with food or milk. It is best to take your dose early in the day (before 6 p.m.) to prevent having to get up during the night to urinate. Consult your doctor or pharmacist if you have any questions.If you are using the liquid form of this medication, shake the bottle well before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. You may take the liquid form of this medication with or without food, but it is important to choose one way and take it the same way with every dose.Dosage is based on your medical condition and response to therapy. In children, the dosage is also based on body weight.Take this medication regularly in order to get the most benefit from it. Remember to use it at the same time(s) each day as directed. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.Take this medication exactly as prescribed. Do not increase your dose, take it more often than prescribed, or stop using this medicine without first consulting your doctor. Your condition may become worse when the drug is suddenly stopped.Inform your doctor if your condition worsens (e.g., if you notice an increase in your routine blood pressure readings).

              SIDE EFFECTS: Drowsiness, dizziness, lightheadedness, stomach upset, diarrhea, nausea, vomiting, or headache may occur. To minimize lightheadedness, get up slowly when rising from a seated or lying position. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: increased thirst, signs of kidney problems (such as change in the amount of urine), mental/mood changes, unusual fatigue/weakness, muscle spasms, menstrual period changes, breast pain, breast enlargement (gynecomastia) in men, sexual function problems, signs of infection (e.g., fever, persistent sore throat), severe stomach/abdominal pain, persistent nausea/vomiting, vomit that looks like coffee grounds, dark urine, yellowing of the eyes/skin, easy bruising/bleeding.This medication may lead to high levels of potassium, especially in patients with kidney problems. If not treated, very high potassium levels can be fatal. Tell your doctor right away if you notice any of the following serious side effects: slow/irregular heartbeat, muscle weakness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking spironolactone, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, liver problems, untreated mineral imbalance (such as high potassium, low sodium), decreased adrenal gland function (Addison's disease).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist. Limit foods high in potassium such as bananas, tomatoes, potatoes, and low-salt milk. Consult your doctor or pharmacist for more details, including recommendations.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Older adults may be more sensitive to the side effects of this drug, especially the effects on potassium (see Side Effects section).This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.This medication passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: See also Precautions section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: lithium, drugs that may increase the level of potassium in the blood (such as amiloride, cyclosporine, eplerenone, tacrolimus, triamterene, birth control pills containing drospirenone).Some products have ingredients that could raise your blood pressure or worsen your swelling. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).This medication may interfere with certain laboratory tests (including digoxin or cortisol levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as kidney/liver function, blood mineral levels such as potassium) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.If you are taking this medication for high blood pressure, lifestyle changes such as stress reduction programs, exercise, and dietary changes may increase the effectiveness of this medicine. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.Have your blood pressure checked regularly while taking this medication. Discuss with your doctor and learn how to monitor your own blood pressure. Inform your doctor of your blood pressure readings.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised July 2020. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

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              • View the formulary and any restrictions for each plan.
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              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.

              Tier Description
              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.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.