Spironolactone (ALDACTONE) is a diuretic (water pill) that removes less of the mineral potassium from the body than other types of diuretics do. It is approved for treatment of several conditions, including high blood pressure and heart failure. Treatment with spironolactone has been shown to greatly reduce the rate of complications and death in patients with severe heart failure. Doctors sometimes prescribe it for high blood pressure instead of another diuretic in the hope that it will...
Spironolactone (ALDACTONE) is a diuretic (water pill) that removes less of the mineral potassium from the body than other types of diuretics do. It is approved for treatment of several conditions, including high blood pressure and heart failure. Treatment with spironolactone has been shown to greatly reduce the rate of complications and death in patients with severe heart failure. Doctors sometimes prescribe it for high blood pressure instead of another diuretic in the hope that it will prevent potassium depletion, but there is no guarantee that this will work.
Spironolactone can cause severe adverse effects. It is especially dangerous for people with kidney disease., It can cause kidney failure, hyperkalemia (high blood potassium levels),,,, muscle paralysis and mental confusion in older adults. These effects may be fatal.
Close laboratory monitoring of blood potassium levels is necessary in patients using spironolactone. Because of its dangers, spironolactone is not the best drug for treating high blood pressure or water retention. Older adults should not use spironolactone just for its ability to keep potassium in the body. Patients who need extra potassium can adjust their diet or take potassium supplements. Both methods are equally effective (see our article on "Potassium Supplementation") and are safer than using spironolactone. The only reason an older adult should use this drug is to control a rare condition in which the body releases too much aldosterone (a hormone that regulates potassium and sodium levels).
Combining spironolactone with an angiotensin-converting enzyme inhibitor (ACE) inhibitor or an angiotensin II receptor blocker (ARB) increases the risk of hyperkalemia. Strict prescribing protocols must be followed in patients taking spironolactone with an ACE inhibitor or ARB, which also are used to treat hypertension and heart failure, or with the antibiotic trimethoprim-sulfamethoxazole (BACTRIM, COTRIM, SEPTRA, SEPTRA DS), another drug that increases the risk of severe hyperkalemia.
(Read more in the December 2011 Worst Pills, Best Pills News.)
Bleeding and ulcers
Spironolactone also appears to be associated with an increased risk of upper gastrointestinal adverse events (bleeding and ulcers). This risk may be more pronounced when spironolactone is combined with ulcer-inducing drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen [MOTRIN]), platelet inhibitors (for example, clopidogrel [PLAVIX]), corticosteroids (for example, prednisone [DELTASONE]) or anticoagulants (for example, warfarin [COUMADIN]).
First-line treatment for high blood pressure
If you have high blood pressure, the best way to reduce or eliminate your need for medication is by improving your diet, losing weight, exercising, and decreasing your salt and alcohol intake. Mild hypertension can be controlled by proper nutrition and exercise. If these measures do not lower your blood pressure enough and you need medication, the diuretic hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE) is the drug of choice, starting with a low dose of 12.5 milligrams daily. It also costs less than other blood pressure drugs.
There is growing evidence that thiazide diuretics, such as hydrochlorothiazide, significantly decrease the rate of bone mineral loss in both men and women because they reduce the amount of calcium lost in the urine. Research now suggests that thiazide diuretics may protect against hip fracture.
If your high blood pressure is more severe, and hydrochlorothiazide alone does not control it, another family of high blood pressure-lowering drugs may be added to your treatment. In this case, your doctor would prescribe the hydrochlorothiazide and the second drug separately, with the dose of each drug adjusted to meet your needs, rather than using a product that joins the drugs in a fixed combination.
Whatever drugs you take for high blood pressure, once your blood pressure has been normal for a year or more, a cautious decrease in dose and renewed attention to nondrug treatment may be worth trying, according to The Medical Letter on Drugs and Therapeutics.
An editorial in BMJ stated the following:
Treatment of hypertension is part of preventive medicine and like all preventive strategies, its progress should be regularly reviewed by whoever initiates it. Many problems could be avoided by not starting antihypertensive treatment until after prolonged observation... Patients should no longer be told that treatment is necessarily for life: the possibility of reducing or stopping treatment should be mentioned at the outset.
Patients taking several types of commonly used antihypertensive medications, particularly diuretics, beta-blockers, ACE inhibitors and ARBs (except losartan [COZAAR]), are at increased risk of developing gout, a type of arthritis.
There is also evidence that combining NSAIDs with a diuretic plus either an ACE inhibitor or an ARB increases the risk of kidney injury.