Spironolactone

February 2024 in “ Practical Diabetes ”

Sana Fatima, Andrea Llano, Gerry McKay

spironolactone mineralocorticoid receptor antagonist potassium-sparing diuretic anti-androgenic female pattern hair loss acne vulgaris hirsutism

TLDR Spironolactone helps reduce hospital visits and death from heart issues, lowers blood pressure, but has unclear effects on heart failure with normal heart pump function and can cause high potassium and breast enlargement in men.

Spironolactone is a mineralocorticoid receptor antagonist and potassium-sparing diuretic with anti-androgenic properties. It is used for hypertension, primary hyperaldosteronism, heart failure, ascites, acne vulgaris, hirsutism, and female pattern hair loss. The RALES trial showed that treatment with 25mg spironolactone was associated with a 35% reduction in the risk of hospitalisation and 30% reduction in risk of death from cardiac causes in 1663 patients with moderate to severe heart failure. The PATHWAY-2 study found that spironolactone was effective in lowering blood pressure in patients with resistant hypertension. However, its role in patients with heart failure with preserved ejection fraction is less clear. It is also being investigated for its potential benefits in patients with diabetes and hypertension. Common side effects include hyperkalaemia and gynaecomastia.

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