Uses of spirolac 100: - Hypertension (high blood pressure) - Edema Oedema, Hirsutism, Hypertension, Hepatic cirrhosis w/ ascites and oedema, Hyperaldosteronism, Severe CHF, Hypokalaemia Anuria, hyperkalaemia, acute or progressive renal insufficiency. Addison's disease.

Potassium-sparing diuretics, Potassium-sparing diuretics & Aldosterone antagonists

Spironolactone is a specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. Spironolactone causes increased amounts of sodium and water to be excreted, while potassium is retained. Spironolactone acts both as a diuretic and as an antihypertensive drug by this mechanism. It may be given alone or with other diuretic agents which act more proximally in the renal tubule. Aldosterone interacts with a cytoplasmic mineralocorticoid receptor to enhance the expression of the Na+ K+ ATPase and the Na+ channel involved in a Na+ K+ transport in the distal tubule . Spironolactone bind to this mineralcorticoid receptor, blocking the actions of aldosterone on gene expression. Aldosterone is a hormone; its primary function is to retain sodium and excrete potassium in the kidneys.

How to use Spironolactone: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Spironolactone is to be taken with food. Administration: Should be taken with food. Adult Dose: Oral Oedema Adult: Initially, 100 mg daily, may adjust dose according to response up to 400 mg daily. Hepatic cirrhosis with ascites and oedema Adult: Depending on urinary Na/K ratio: If >1: Initially, 100 mg daily; if <1: Initially, 200-400 mg daily. Diagnosis of primary hyperaldosteronism Adult: Long test: 400 mg daily for 3-4 wk. Short test: 400 mg daily for 4 days. Preoperative management of hyperaldosteronism Adult: 100-400 mg daily. Long-term maintenance in the absence of surgery: Admin the lowest effective dose. Hypertension Adult: As monotherapy: Initially, 50-100 mg in 1-2 divided doses, may adjust dose after 2 wk. Severe congestive heart failure Adult: As adjunct: Initially, 25 mg once daily to max 50 mg daily. May reduce to 25 mg every other day if 25 mg once daily dose is not tolerated. Diuretic-induced hypokalaemia Adult: 25-100 mg daily. Hirsutism Women with hirsutism Adult: 50-200 mg qDay or divided q12hr Elderly: Initiate w/ the lowest dose then titrate upward if needed. Child Dose: Oral Hepatic cirrhosis with ascites and oedema Child: Initially, 3 mg/kg given in divided doses, may adjust according to response. Diagnosis of primary hyperaldosteronism Child: Initially, 3 mg/kg given in divided doses, may adjust according to response. Preoperative management of hyperaldosteronism Child: Initially, 3 mg/kg given in divided doses, may adjust according to response. Severe congestive heart failure Child: Initially, 3 mg/kg given in divided doses, may adjust according to response. Renal Dose: Renal impairment CrCl >50 mL/min/1.73 m²: 12.5-25 mg qDay; use maintenance dose of 25 mg qDay or q12hr after 4 weeks of treatment with potassium <5 mEq/L CrCl 30-49 mL/min/1.73 m²: 12.5 mg qDay or every other day; use maintenance dose of 12.5-25 mg qDay after 4 weeks of treatment with potassium <5 mEq/L CrCl <30 mL/min/1.73 m²: Avoid use

Increased risk of hyperkalaemia w/ other K-sparing diuretics or K supplements, ACE inhibitors, angiotensin II receptor antagonists, trilostane, heparin, LMWH. Increased risk of nephrotoxicity w/ ciclosporin, NSAIDs. Increased risk of lithium toxicity. May reduce ulcer-healing properties of carbenoxolone. May increase serum level of digoxin. May reduce vascular response to norepinephrine. Concurrent use w/ colestyramine may cause hyperkalaemic metabolic acidosis. Potentiation of orthostatic hypotension may occur w/ barbiturates or narcotics. Potentially Fatal: May enhance hyperkalaemic effect w/ eplerenone. Increased risk of lithium toxicity when used concurrently.

Anuria, hyperkalaemia, acute or progressive renal insufficiency. Addison's disease.

Common - Nausea - Vomiting - Leg cramps - Dizziness - Drowsiness - Confusion - Breast enlargement in male - Increased creatinine level in blood Drowsiness, dizziness, headache, lethargy, leg cramps, GI disturbances (e.g. diarrhoea, cramps), ataxia, mental confusion, rashes, pruritus, alopecia, hyponatraemia, electrolyte disturbances, gynaecomastia, hirsutism, menstrual irregularities, breast pain, deepening of the voice, impotence, leucopenia (including agranulocytosis), thrombocytopenia, transient elevation in BUN concentration. Rarely, breast enlargement. Potentially Fatal: Hyperkalaemia.

Pregnancy: Spironolactone should not be used during pregnancyLactation: Canrenone, an active metabolite of Spironolactone, appears in breast milk. If use of the drug is deemed essential an alternative method of infant feeding should be instituted.

Precaution: Patient at risk of developing hyperkalaemia and acidosis, w/ DM. Renal and hepatic impairment. Elderly. Pregnancy and lactation. Patient Counselling This drug may cause dizziness and somnolence, if affected do not drive or operate machinery. Monitoring Parameters Monitor serum electrolytes periodically; BP, renal function. Lactation: Metabolite excreted into breast milk; discontinue breastfeeding or do not use drug

Symptoms of overdosage include drowsiness, mental confusion, dizziness, diarrhea and vomiting etc. Patients should induce vomiting or evacuate the stomach by lavage during Spironolactone overdoasge.

Store in a cool and dry place protected from light. Keep out of reach of children.

Potassium-sparing diuretics, Potassium-sparing diuretics & Aldosterone antagonists

Spironolactone acts on the distal renal tubules as a competitive antagonist of aldosterone. It increases the excretion of sodium chloride and water while conserving potassium and hydrogen ions.

Pregnancy: Spironolactone should not be used during pregnancyLactation: Canrenone, an active metabolite of Spironolactone, appears in breast milk. If use of the drug is deemed essential an alternative method of infant feeding should be instituted.