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Spironolactone (By mouth)

Treats high blood pressure, heart failure, edema (fluid retention), or high levels of aldosterone (a hormone). This medicine is a potassium-sparing diuretic (water pill).

What works?

Learn more about the effects of these drugs. The most reliable research is summed up for you in our featured article.

Spironolactone is used in combination with other medicines to treat high blood pressure (hypertension) and heart failure. Lowering blood pressure can reduce the risk of strokes and heart attacks. Spironolactone is also used to lessen the need for hospitalization for heart failure. Spironolactone is also used to diagnose and treat hyperaldosteronism, a condition in which the adrenal gland produces… Read more
Brand names include
Aldactone, Carospir
Drug classes About this
Antiandrogen, Cardiovascular Agent
Combinations including this drug

What works? Research summarized

Evidence reviews

Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne

The evidence suggests a lack of evidence to show whether spironolactone can reduce hirsutism and acne. Hirsutism in women (excessive hair growth) is most often caused by an increased production of male hormones. Spironolactone (`Aldactone' or `Spirotone') is an anti‐androgen, which can be taken with or without the oral contraceptive pill to try and reduce hirsutism. From the studies included in this review, there is some evidence to show that spironolactone is an effective treatment to decrease the degree of hirsutism, but insufficient evidence for the management of acne vulgaris. It appears to be more effective than finasteride 5mg/day, metformin and low dose cyproterone acetate.

Spironolactone for the treatment of high blood pressure

Spironolactone is a medication that has been used to treat high blood pressure since the 1960s. While there is some belief spironolactone reduces blood pressure, there are concerns due to the potential for this drug to cause adverse effects. The aim of this review was to determine the extent to which spironolactone reduces blood pressure, the nature of spironolactone’s adverse effect profile, and to determine the clinical impact of its use for hypertension. The search revealed 5 cross‐over trials with a total of 137 patients that received both spironolactone followed by placebo or vice verse, in a random order. One other trial was found that randomly gave 42 patients either spironolactone (22 patients) or placebo (20 patients). The daily doses of spironolactone used in these studies ranged from 25‐500 mg daily. Studies followed patients for 4 to 8 weeks of therapy. None of the studies reported on the clinical impact of spironolactone (i.e. whether spironolactone reduced heart attacks or strokes compared to placebo). Overall reporting of adverse effects was poor so no conclusions can be drawn about the adverse effect profile. This meta‐analysis shows that spironolactone reduces systolic/diastolic blood pressure by approximately 20/7 mm Hg compared to placebo.

Spironolactone for diabetic nephropathy: a systematic review

Bibliographic details: Wang H, Zhang GL, Zhang QB, Deng JL.  Spironolactone for diabetic nephropathy: a systematic review. Chinese Journal of Evidence-Based Medicine 2009; 9(1): 71-75

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Summaries for consumers

Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne

The evidence suggests a lack of evidence to show whether spironolactone can reduce hirsutism and acne. Hirsutism in women (excessive hair growth) is most often caused by an increased production of male hormones. Spironolactone (`Aldactone' or `Spirotone') is an anti‐androgen, which can be taken with or without the oral contraceptive pill to try and reduce hirsutism. From the studies included in this review, there is some evidence to show that spironolactone is an effective treatment to decrease the degree of hirsutism, but insufficient evidence for the management of acne vulgaris. It appears to be more effective than finasteride 5mg/day, metformin and low dose cyproterone acetate.

Spironolactone for the treatment of high blood pressure

Spironolactone is a medication that has been used to treat high blood pressure since the 1960s. While there is some belief spironolactone reduces blood pressure, there are concerns due to the potential for this drug to cause adverse effects. The aim of this review was to determine the extent to which spironolactone reduces blood pressure, the nature of spironolactone’s adverse effect profile, and to determine the clinical impact of its use for hypertension. The search revealed 5 cross‐over trials with a total of 137 patients that received both spironolactone followed by placebo or vice verse, in a random order. One other trial was found that randomly gave 42 patients either spironolactone (22 patients) or placebo (20 patients). The daily doses of spironolactone used in these studies ranged from 25‐500 mg daily. Studies followed patients for 4 to 8 weeks of therapy. None of the studies reported on the clinical impact of spironolactone (i.e. whether spironolactone reduced heart attacks or strokes compared to placebo). Overall reporting of adverse effects was poor so no conclusions can be drawn about the adverse effect profile. This meta‐analysis shows that spironolactone reduces systolic/diastolic blood pressure by approximately 20/7 mm Hg compared to placebo.

Aldosterone antagonists for preventing the progression of chronic kidney disease

People who have chronic kidney disease (CKD) are at increased risk of heart disease and worsening kidney disease needing treatment with dialysis or a kidney transplant. Increased amounts of protein in the urine are a sign of kidney stress and are linked to a greater chance of worsening kidney function. Treatments that lower urine protein levels and protect kidney function are available and include angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers. However, protection of kidney function with these two drugs may be incomplete and adding aldosterone blockers (for example, spironolactone or eplerenone) may better protect kidney function. The use of numerous drugs may also increase side‐effects. This review of available trials showed that adding aldosterone antagonist treatment to standard therapy reduced protein release into the urine and lowered blood pressure but had uncertain effects on kidney function and survival. Treatment also increases the amount of potassium in the blood which may require treatment changes, extra blood tests and is potentially harmful. Whether aldosterone blockers protect kidney function to lower the chances needing dialysis or kidney transplantation or prevent heart disease in people who have CKD is unclear and not answered by existing research.

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