Spironolactone Side Effects

The generic drug spironolactone (brand name drug Aldactone) is a prescription medication belonging to a group of drugs called aldosterone antagonists. Please continue reading to learn more about this medication’s uses, side effects, and risks.

What is the drug spironolactone used for?

Spironolactone is used to treat:

High blood pressure
Edema (fluid retention) caused by kidney disease (nephrotic syndrome) or liver disease (liver cirrhosis)
Heart failure
Low potassium levels
Hyperaldosteronism (too much aldosterone) (the hormone aldosterone is secreted by the adrenal glands)

There may be other uses of spironolactone oral tablet, such as for precocious puberty, myasthenia gravis, and abnormal facial hair in females when the cause is due to the adrenal glands of the kidney.

Note: Your doctor or pharmacist can give you further information.

How does spironolactone work?

Spironolactone causes the kidneys to remove excess fluid and sodium from the body while retaining potassium. This is why it is called a potassium-sparing diuretic (water pill).

What is the typical dosage of spironolactone?

Spironolactone comes in 25 mg, 50 mg, and 100 mg tablets. It is also available as an oral suspension under the brand name Carospir. The dose of spironolactone depends on the condition being treated. The typical starting dosage is 25 mg. Maintenance doses are usually 25 mg to 100 mg once daily by mouth. Doses up to 400 mg per day may be prescribed for some conditions.

If your doctor prescribes spironolactone, read the prescription label carefully and take it exactly as directed. If you miss a dose, take it as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take spironolactone according to your regular dosing schedule. Do not take extra medicine to make up for a missed dose.

What are the common side effects of spironolactone?

Possible spironolactone side effects are listed below. Talk to your doctor if the side effects are severe or do not get better after a few days after your body has had time to adjust to the medicine.

Nausea, vomiting, diarrhea, stomach pain or cramps
Headache
Drowsiness
Tiredness
Restlessness
Irregular menstrual periods
Vaginal bleeding in postmenopausal women
Painful breasts in men and women
Breast enlargement in men
Erectile dysfunction (difficulty maintaining an erection)
Low sex drive
Increased hair growth
Deepening of the voice

Some spironolactone side effects are more serious. Call your doctor without delay or seek emergency medical attention if you develop the following symptoms:

Difficulty breathing or swallowing
Skin rash, hives, itching (allergic reaction)
Muscle weakness, muscle pain, or muscle cramps
Numbness, tingling, pain, or burning sensation in the hands or feet
Inability to move the arms or legs
Stomach pain in the right upper part of the abdomen
Nausea
Yellowing of the skin or eyes
Signs of dehydration such as thirst, dry mouth, dizziness, headache, unsteadiness
Fast or slow heartbeat
Confusion
Fainting
Extreme tiredness or lack of energy
Unusual bleeding or bruising
Vomiting blood
Blood in stools
Loss of appetite
Fever and flu-like symptoms
Decreased urination

Does spironolactone cause weight gain?

No. It’s actually the opposite. This medication helps the kidneys remove excess fluid from the body. If excess weight is due to fluid retention, taking spironolactone may result in weight loss.

What are the cons of taking spironolactone?

Like most medications, spironolactone has some pros and cons. The cons of taking spironolactone include the risk of side effects, especially at higher doses. Additionally, this medication will make you urinate more often. Also, you need to have regular blood tests while on spironolactone to monitor electrolytes, kidney function, and liver function. The frequency is decided by your doctor. Spironolactone may not be suitable for people with certain medical conditions such as high potassium levels, some forms of kidney disease, Addison’s disease, or heart disease.

What are spironolactone drug interactions?

Drug interactions between spironolactone and other prescription drugs can lead to serious adverse effects. For example, a drug combination of potassium supplements or potassium-containing salt substitutes and spironolactone can lead to dangerously high potassium levels, explained further below. Other medicines that may interact with spironolactone include:

Certain antibiotics called aminoglycosides (gentamicin, neomycin, streptomycin, and others)
Medications used to lower blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors (lisinopril, enalapril, others) and angiotensin receptor blockers (ARBs) (losartan, valsartan, others)
Nonsteroidal anti-inflammatory medications (NSAIDS) (aspirin, ibuprofen, naproxen, others)
Other diuretics (water pills) including potassium-sparing diuretics
Narcotic pain medications
Oral steroids
Potassium supplements
Barbiturates
Cholesterol-lowering medications like cholestyramine
Cancer drugs like cisplatin
Heart medications like digoxin
Psychiatric medications like lithium
Anticoagulants like low molecular weight heparin

Tell your doctor and pharmacist about all the medications you take to avoid potentially dangerous interactions.

Is spironolactone a high-risk medication?

Like all medications, spironolactone carries some risks. These include:

High Potassium Levels

Potassium-sparing diuretics like spironolactone decrease the loss of potassium from the body and prevent potassium levels from getting too low. However, taking spironolactone can lead to high potassium levels. The risk is greater in people with kidney problems and diabetes and those taking certain medications, potassium supplements, or potassium-based salt substitutes. Too much potassium can lead to a racing heart, chest pain, shortness of breath, nausea, vomiting, and other serious problems, including a heart attack. Keep all your healthcare appointments while on spironolactone. Your provider will check potassium levels before starting you on this medicine and regularly while you are on it.

Electrolyte Imbalances

Spironolactone affects the levels of electrolytes such as sodium, calcium, and magnesium in the blood. These electrolytes play important roles in many bodily functions. Low electrolyte levels can lead to irregular heartbeat, muscle cramps, fainting, and seizures.

Orthostatic Hypotension

Spironolactone can cause low blood pressure. One presentation of this is when you stand up quickly from a lying or sitting position. This is called orthostatic hypotension. Make sure you alert your doctor if you experience any dizziness and falls due to low blood pressure, especially when you first start spironolactone and after dose adjustments. Remember, drinking alcohol can worsen side effects like dizziness and drowsiness, increasing your risk of falls.

Worsening Kidney Function

Rarely, spironolactone can cause kidney damage. The risk of this happening is higher in people with pre-existing kidney problems or who take other drugs that can also damage the kidneys, such as excessive amounts of nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen), certain antibiotics, certain medications prescribed for high blood pressure, and certain cancer drugs. Your healthcare professional may order occasional blood tests to monitor your kidney function while on spironolactone.

Breast Pain and Swelling

Spironolactone can cause breast pain and swelling, especially at higher doses, and especially in males. These side effects can occur within a couple of months of starting spironolactone or a year later. The breast swelling and pain usually go away after stopping spironolactone. Tell your healthcare provider if this side effect is bothersome.

Allergic Reactions

Very rarely, spironolactone can cause a severe allergic reaction. Seek emergency medical care if you develop a severe skin rash, hives, itching, swelling of the face, lips, tongue, or throat, chest pain, or trouble breathing or swallowing.

Overdose

In case of an overdose of spironolactone, call your local poison control center or the national poison control center at 1-800-222-1222 and seek immediate medical attention at your nearest emergency room. Make sure you dispose of unused medication properly to prevent accidental overdoses.

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