Treatment for hypertension and edema includes the use of spironolactone, which is also used in the treatment of other conditions. Additionally, spironolactone is also used as off label treatment for hirsutism. The following sections offer detailed information about the drug, its mechanism of action, the benefits, and possible spironolactone emotional side effects with long-term or short-term use. This is intended to help users and caregivers be aware of the possible undesirable effects and take suitable precautionary and preventive measures to mitigate and manage the side effects.

Overview and mechanism of action of spironolactone

Belonging to the category of aldosterone receptor antagonists, spironolactone works by promoting the excretion of water and sodium. It also retains potassium, and it is this action that gives the drug its category name as a potassium-sparing diuretic.  By retaining potassium and excreting water, sodium delivers antihypertensive outcomes. It works by inhibiting specific receptors in the distal tube, and it was initially intended for the outcomes of this action. Over a period of time, other properties of the drug were uncovered, and this changed its use to include various other conditions. For instance, it is used for treating heart failure, hypertension, and hyperaldosteronism, among other conditions. As outlined above, it also possesses certain properties that make it suitable as an off-label treatment of hirsutism, acne, and hair loss in females. It also happens to be a drug that is part of combined treatment used as part of a gender change treatment regimen.

Strength and dosage 

The medication comes in an oral formulation and comes as tablets in three different strengths – 25 mg, 50 mg, and 100 mg. Apart from the tablet form, it is also available as an oral suspension. Dosage of the medication is determined by various factors, including the condition being treated, the health of the individual, other medications in use, gender, age, and other existing conditions. It is also governed by the health of the kidneys and the history of side effects of the medication. Ideally, patients are started off on a lower dosage to ascertain effectiveness and outcomes. Depending on the outcome or the absence of side effects, the dosage is gradually increased to the desired levels. The information provided below is intended to serve as a reference and is not to be taken as the actual dosage for the mentioned conditions. The actual dosage will be determined by the treating specialist.

When prescribed for hypertension, the dosage of spironolactone is between 25 mg to 100 mg daily, and in most instances, the medication is recommended to be taken as a single dose. However, depending on the conditions, the dosage may also be changed to multiple doses, as determined by the doctor.

When prescribed for heart conditions, the dosage is typically 25 mg daily in a single dose. In certain conditions, the dosage may be increased to 50mg daily, which is also to be taken in a single dose. As this happens to be a potassium-sparing diuretic, there is a possibility of potassium levels increasing with regular use. Depending on relevant tests to check the potassium levels, the dosage may be lowered to 25 mg daily to bring down potassium levels.

When prescribed for edema, the ideal dosage is relatively on the higher side and could be anywhere between 25 mg daily to 200 mg daily. In the event of higher dosages, the starting dose could be as high as 100 mg daily. In most instances, the medication is prescribed to be taken as a single dose, however, depending on the condition, the medication may also be prescribed to be taken in multiple doses.

When prescribed for hyperaldosteronism, spironolactone is given in dosages that could be anywhere between 100 mg daily to 400 mg daily. This is another condition where the dosage is relatively higher. While the condition is also treated surgically, in certain instances, the patient is recommended medications in place of surgery. In such circumstances, the medication is to be taken lifelong.

General information on dosage

Regardless of the condition, dosages are always started off with lower strengths and increased gradually after assessing the outcomes. As the medication is typically intended to be taken on ta long-term basis, it is important to follow intake instructions to avoid possible spironolactone emotional side effects. For instance, there is every possibility of individuals missing a dose; in such instances, it is necessary to avoid the urge to take a double dose to make up for the missed dose. It may be necessary to skip the missed dose and continue the regimen of daily dosage. In the event of the missed dose being noticed within a short period after the time to take the medication, the patient may take the missed dose. However, if it is close to the next scheduled dose, it may be necessary to skip the dose.

Commonly reported side effects of spironolactone

Without exception, all medications and drugs come with the possibility of undesirable effects. The exact nature of unwanted effects may differ from person to person, with some experiencing mild or moderate effects, while others may experience serious or adverse effects. It is necessary to bear in mind that a section of users, may not experience any side effects whatsoever; therefore, it is wrong to assume that all patients will undergo unwanted outcomes. Effects that are mild in nature are more likely to be relatively common in occurrence, while effects that are strong in nature may be relatively rare in occurrence.

Mild effects may not generally require any medication intervention and may resolve naturally in a few days, while strong effects may require some form of medical intervention. Here is a compilation of reported side effects of spironolactone, across categories of undesirable effects. This is neither competing nor exhaustive in nature and is intended to be a broad reference of the types of side effects.

Frequently occurring effects

This includes possible vomiting sensations, with feelings of nausea. Patients are likely to experience headaches, and appear confused. Diarrhea is another possible outcome of the medication, and this may require to be treated symptomatically. Similarly, patients may experience cramps in the stomach or the legs. The patient may experience either dizziness or drowsiness, and may also end up with menstrual problems, apart from a disinclination towards sexual activities. Female patients are likely to experience pain in the nipples, or the breast, apart from itching sensations. As outlined earlier, these effects are likely to resolve naturally in a few days without the need for treatment. However, in the event of persistence, or if the effects appear to intensify, it is necessary to seek medical intervention.

Rarely occurring effects

The following effects are known to occur rarely and belong to the category of serious effects that may require medical intervention. Depending on the condition, and the intensity, it may require emergency intervention at a healthcare facility. Patients experiencing any kind of skin condition such as the outbreak of rashes, formation of blisters, or peeling of the skin, require medical attention to check for Stevens-Johnson syndrome, a skin reaction that is regarded as severe in nature. Patients are also known to experience peeling of the skin or the formation of blisters in the mouth or the nose. This may also occur on the eyes or on the genitals.

The medication is known to cause an imbalance of electrolytes, and this, in turn, could result in undesirable consequences, such as hyperkalemia and hyponatremia. Serious side effects also include renal complications, such as possible kidney failure. Other conditions that may be experienced include the development of breasts in male patients, medically known as gynecomastia. The condition results in swelling of breast tissue, in addition to the tissue, turning tender or soft, making it appear similar to female breasts.

This is generally experienced when the dosage is on the higher side. It is important to note that this change or effect is experienced by males alone, and women on the medication do not experience any similar changes in their breasts. The silver lining of this side effect is that the breast will return to normalcy after the drug is discontinued. There are possible allergic reactions to the medication. Most patients are likely to trivialize allergic reactions; however, it is necessary to bear in mind that allergic reactions can develop into serious consequences.

Symptoms that need to be monitored

There are possible kidney complications in patients with low levels of blood pressure or patients who end up with dehydration during the course of treatment. As the mechanism of action of the medication is known to cause loss of fluid, patients need to check for dehydration to prevent possible spironolactone emotional side effects. For instance, individuals who experience a dry mouth, patients who suddenly urinate with lesser frequency or volume, or patients who observe a distinct change in color of the urine are to consider these symptoms as indicative of dehydration. There are similarly distinct indications of low blood pressure levels that need to be monitored. A lightheaded feeling or dizzy feelings are to be considered indicative of low blood pressure.

Kidney complications can be identified through symptoms such as cramps in the muscle, a sudden disinterest in food, and a reduction in frequency or stoppage of urination. Retention of fluid in the feet and the legs are also symptoms of edema that point to complications in the kidneys.

Precautions

It is necessary to take certain precautions when on the medication. For instance, it is necessary to take periodic blood tests to monitor levels of electrolytes and to check the functioning of the kidneys. The medication is not to be combined with drugs of certain categories such as Eplerenone, ACE inhibitors, ARBs, heparin, and other potassium-sparing diuretics.

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