Spironolactone

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Apr 04, 2023

Warnings

Spironolactone Risks, Warnings, and Complications

Spironolactone can cause serious problems in some people. Talk to your doctor or pharmacist about other treatment options for your condition if you are at increased risk of complications from spironolactone use.

HYPERKALEMIA: Spironolactone can cause hyperkalemia (too much potassium in the body). The risk of this happening is higher in people with a pre-existing kidney disorder or diabetes and in those taking potassium supplements, potassium-based salt substitutes, or other medications that can increase potassium. Signs and symptoms of high potassium may include fast heartbeat, chest pain, shortness of breath, nausea, vomiting, and serious heart problems such as a heart attack. Your health care professional will perform check serum potassium levels before starting you on spironolactone and regular potassium monitoring during treatment.
WORSENING KIDNEY FUNCTION: In a small number of people, spironolactone can cause kidney damage or kidney failure. This risk of this happening is higher in people with pre-existing kidney problems or those who take other medications that can damage the kidneys, such as nonsteroidal anti-inflammatory drugs (NSAIDs), other blood pressure medications (ACE inhibitors and ARBs), and certain antibiotics and cancer treatments. Your healthcare provider may order tests to keep an eye on your kidney function while you are on this medicine. Keep all your healthcare appointments during treatment.
ELECTROLYTE ABNORMALITIES: Taking spironolactone can lead to low levels of electrolytes such as sodium, calcium, and magnesium in the blood. These electrolytes are used by the body for many important functions. Low levels of electrolytes can cause symptoms such as muscle weakness, muscle cramps, fast or irregular heartbeat, fainting, or seizures. Your provider will check electrolytes levels before starting you on spironolactone and regularly during treatment.
BREAST PAIN AND ENLARGEMENT: Spironolactone can cause breast enlargement and pain in both men and women, especially at high doses. This side effect is more common and noticeable in males who can develop gynecomastia (enlarged male breasts). This effect can occur within 1-2 months of starting spironolactone or a year later. It is usually reversible. Talk to your healthcare provider for other treatment options if this is a bothersome side effect.
ALLERGIC REACTIONS: Rarely, spironolactone can cause an allergic reaction with signs and symptoms such as skin rash, hives, itching, swelling of the face, eyes, lips, tongue, or throat, and difficulty breathing or swallowing. Seek emergency medical care if this happens.

Precautions Before Starting Spironolactone

Tell your doctor if you are allergic to spironolactone, any of the active or inactive ingredients in spironolactone formulations, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Spironolactone may not be right for people with certain medical conditions such as Addison’s disease, other conditions that affect potassium homeostasis, kidney disease, or liver disease.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Spironolactone

Keep all your medical appointments while on spironolactone. Your doctor may adjust your dose based on your response to the medicine. They may order certain laboratory tests during treatment to monitor for side effects.

Spironolactone can cause drowsiness, dizziness, lightheadedness, low blood pressure, and fainting, especially if you get up quickly from a sitting or lying position to standing. Arise slowly when you get out of bed. Avoid drinking alcohol because it can make these side effects worse.

Follow your doctor’s dietary instructions and avoid eating too much salt (sodium). To prevent electrolyte abnormalities, do not take potassium-based salt substitutes while on spironolactone without talking to your doctor. Also, talk to your provider about dietary potassium intake and eating high potassium foods such as bananas, raisins, prunes, avocados, sweet potatoes, and orange juice.

Tell your doctor if you become pregnant while on spironolactone.

Tell all your healthcare providers you are on spironolactone before any surgery, including dental procedures.

Spironolactone Drug Interactions

Certain other drugs can affect spironolactone drug metabolism. Possible interactions between spironolactone and other medicines can increase the risk of severe adverse effects. The following medications can have drug interactions with spironolactone:

Eplerenone (Inspra), a medication used to treat high blood pressure and heart failure.
Certain antibiotics including trimethoprim (Primsol, in Bactrim) and aminoglycosides such as gentamicin, streptomycin, neomycin (Neo-Rx, Neo-Fradin), kanamycin, amikacin, and tobramycin (Tobi).
Aspirin and other nonsteroidal anti-inflammatory medications (NSAIDS) such as indomethacin (Indocin, Tivorbex), ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
Angiotensin receptor blockers(ARBs) such as valsartan (Exforge, Diovan, in Diovan HCT), olmesartan (Benicar, Benicar HCT, Tribenzor, in Azor), candesartan (Atacand, in Atacand HCT), irbesartan (Avapro, in Avalide), eprosartan (Teveten, in Teveten HCT), azilsartan (Edarbyclor, Edarbi), losartan (Cozaar, in Hyzaar), and telmisartan (Micardis, in Micardis HCT).
Angiotensin-converting enzyme (ACE) inhibitors such as enalapril (Vasotec), lisinopril (in Prinzide, in Zestoretic), ramipril (Altace), fosinopril, benazepril (Lotensin, in Lotrel), moexipril (Univasc, in Uniretic), captopril (Capoten), perindopril, (Aceon), quinapril (Accupril, in Accuretic, in Quinaretic), and trandolapril (Mavik, in Tarka).
Anti-seizure medications such as barbiturates (for example, phenobarbital).
Cholesterol-lowering drugs like cholestyramine (Prevalite).
Cancer drugs like cisplatin.
Heart medications such as digoxin (Lanoxin).
Diuretics or water pills including potassium-sparing diuretics such as triamterene (Dyrenium, in Dyazide, in Maxzide) and amiloride (Midamor).
Anticoagulants (medications used to prevent or dissolve a blood clot) such as heparin, low-molecular-weight heparin, and enoxaparin (Lovenox).
Psychiatric medications such as lithium (Lithobid).
Narcotic pain medications.
Oral steroids such as prednisone (Rayos), methylprednisolone (Medrol), and dexamethasone.
Potassium supplements.

The above list may not describe all the other medicines that can have potentially dangerous interactions with spironolactone. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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