Spironolactone is taken by mouth once daily in the form of 25, 50, or 100 mg tablets.1 The dosage varies widely depending on the condition and its severity.
The American College of Cardiology Foundation and American Heart Association (ACCF/AHA) recommends spironolactone as a fourth-line antihypertensive in daily doses between 25 and 100 mg.2
Low doses are used to treat patients with heart failure as well.1-3 The ACCF/AHA recommends an initial dose of 12.5 – 25 mg spironolactone once daily to treat New York Heart Association (NYHA) Class II-IV heart failure with reduced ejection fraction (HFrEF).3 Alternatively, patients may take a dosage of 25 mg every other day.1 The American College of Cardiology(ACC)/AHA also recommend spironolactone to treat select patients with heart failure with preserved ejection fraction (HFpEF).3 A mean dose of 25 mg daily for eight months was demonstrated to reduce risk of hospitalization (hazard ratio [HR]=0.82).4
Larger doses of spironolactone are used for diagnosis and treatment of primary hyperaldosteronism (PA).1 For a short test diagnosis of PA, patients receive a daily dose of 400 mg for four days. If there is an observed increase in serum potassium during spironolactone administration but decreases when discontinued, clinicians may presume a diagnosis of primary hyperaldosteronism. When used to treat pre-surgical patients with PA, spironolactone is taken as a daily dose of 100– 400 mg. Patients may also use spironolactone for long-term maintenance treatment for PA. Studies have shown that the lowest effective dose may range from 50 – 400 mg/d.5-7
Based on findings from various studies, the Food and Drug Administration (FDA) recommends a starting dose of 100 mg daily to treat edematous conditions resulting from congestive heart failure, hepatic cirrhosis, and nephrotic syndrome.1 However, the Eighth Joint National Committee (JNC-8) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the World Health Organization (WHO) recommends a lower starting dose of 25 – 50 mg/d.8,9 Depending on each individual’s response, the daily dose may be adjusted to fall within a range of 25 – 200 mg.10
Spironolactone can be used to treat hypokalemia induced by other diuretics with a daily dose of 25 – 100 mg.1
Although not approved by the FDA, spironolactone has been used for acne and hirsutism in women.11-14 Studies have shown that daily administration of 50 – 200 mg has been effective in treating these conditions.11-14
References
- Aldactone [package insert]. New York, NY: Pfizer, Inc.; 2018.
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2017.
- Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017.
- Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2014;370(15):1383-1392.
- Brown JJ, Davies DL, Ferriss JB, et al. Comparison of Surgery and Prolonged Spironolactone Therapy in Patients with Hypertension, Aldosterone Excess, and Low Plasma Renin. Br Med J. 1972;2(5816):729-734.
- Catena C, Colussi G, Nadalini E, et al. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med. 2008;168(1):80-85.
- Sechi LA, Novello M, Lapenna R, et al. Long-term renal outcomes in patients with primary aldosteronism. JAMA. 2006;295(22):2638-2645.
- Organization WH. 20th WHO Essential Medicines List (EML). 2017; http://www.who.int/medicines/publications/essentialmedicines/en/. Accessed Oct 2, 2017.
- James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee (jnc 8). JAMA. 2014;311(5):507-520.
- Aldactone (sprionolactone) [package insert]. New York, NY: Pfizer, Inc.; 2018.
- Brown J, Farquhar C, Lee O, Toomath R, Jepson RG. Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane Database of Systematic Reviews. 2003(4).
- Goodfellow A, Alaghband-Zadeh J, Carter G, et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984;111(2):209-214.
- Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: an effective treatment for acne vulgaris in women. Br J Dermatol. 1986;115(2):227-232.
- Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol. 2000/09/01/ 2000;43(3):498-502.
