Spironol – composition, action and dosage of a diuretic

Proven content

Spironol is a drug belonging to the group of diuretics, i.e. diuretics that work with the kidneys. The active substance of Spironol is spironolactone. This drug can only be purchased at a pharmacy with a prescription. It is available in the form of plain tablets and film-coated tablets. What are the indications and contraindications for the use of Spironol? How to dose the drug to make it effective? Can taking Spironol cause any side effects? How much does Spironol cost and are there any substitutes for it on the pharmaceutical market?

Spironol – general characteristics of the drug

Spironol is a diuretic and is usually used in patients struggling with edema caused by heart, kidney or liver disorders.

This preparation increases the volume of water and sodium that are excreted from the body by the kidneys. At the same time, it retains potassium in the body, which is very important for e.g. the proper functioning of the heart. The active substance of this preparation is spironolactone.

Spironol is available only on prescription. At the pharmacy you can buy:

1. Spironol in tablets of 25 mg in packages containing 20 or 100 pieces
2. Spironol in 50 mg film-coated tablets in packages of 30 or 60 pieces;
3. Spironol in 100 mg film-coated tablets in packs of 20.

Spironol tablets are round, flat on both sides, almost white to cream in color, with a score line that is scored on one side of the tablet. The score line is only to facilitate breaking for ease of swallowing and not to divide into equal doses.

Spironol film-coated tablets, on the other hand, have a clear film and are almost white to cream in color. The film-coated tablets are biconvex and round with an engraving of “50” or “100” on one side of the tablet and a horizontal line on the other side to facilitate breaking. The diameter of the coated tablet is approx. 9 mm.

The entity responsible for the production and distribution of the drug Spironol is Gedeon Richter. Gedeon Richter is a company belonging to an international pharmaceutical concern. Until August 2018, the Polish concern was represented by two companies: Gedeon Richter Polska and Gedeon Richter Marketing Polska. On September 1, 2018, the two companies merged and currently Gedeon Richter Polska operates a production section, a research and production center, as well as sales and marketing. The beginning of the concern was a pharmacy opened in 1901 in Budapest. The pharmacy mainly produced organotherapeutic drugs – made from animal organs.

What are diuretics and when should they be used? Read on: Diuretics, or diuretics

Spironol – composition and action of the drug

Spironol is a diuretic and its active ingredient is spironolactone. Spironolactone belongs to the diuretics of the aldosterone antagonist group. Aldosterone, on the other hand, is a steroid hormone of the adrenal cortex, the main task of which is to regulate the water and electrolyte balance. The effect of this action is the retention of sodium and water in the body, with an increased excretion of potassium and hydrogen ions.

Spironolactone prevents aldosterone from binding to its receptors, thus preventing an increase in blood pressure. As a result, sodium excretion in urine and water volume excreted are increased, but without increasing potassium excretion.

Therefore, spironolactone is classified as a potassium-sparing diuretics.

After oral administration, this drug is rapidly absorbed from the gastrointestinal tract. Spironolactone is metabolized in the liver to its active metabolites. The biological half-life of spironolactone is approximately 1,3 hours, and its active metabolites approximately 8,9–23 hours. This compound is excreted as metabolites mainly in the urine and, to a lesser extent, in the faeces.

In addition to the active substance, Spironol also includes auxiliary substances. The composition of the drug depends on the form of the preparation:

1. excipients of the drug Spironol in tablets – rice starch, lactose monohydrate, sodium lauryl sulfate, talc and magnesium stearate;
2. excipients of Spironol in film-coated tablets – rice starch, lactose monohydrate, sodium lauryl sulfate, sodium carboxymethyl starch, talc, magnesium stearate, hypromellose (HPMC 606) and macrogol 20. 

Does spironolactone have anything to do with complications of COVID-19? Check: Polish scientists are checking whether spironolactone prevents lung fibrosis in COVID-19

Spironol – indications for the use of the drug

Spironol is a diuretic and its use is especially recommended in the following cases:

1. congestive heart failure;
2. cirrhosis of the liver with ascites and edema;
3. malignant ascites;
4. nephrotic syndrome;
5. diagnosis and treatment of primary hyperaldosteronism;
6. hypertension – as an additional drug in patients who do not respond adequately to other antihypertensive drugs. 

What are the causes and symptoms of excess water in the body? Check: Water retention in the body

Spironol – contraindications to the use of the drug

The drug Spironol, despite its effectiveness in getting rid of excess water and sodium ions from the body, cannot be used by every patient struggling with this type of ailments.

Contraindications to the use of Spironol are:

1. allergic to spironolactone or any of the other ingredients of this medicine;
2. acute renal failure and severe renal impairment;
3. impotence;
4. Addison’s disease and other conditions associated with hyperkalemia;
5. hyperkalemia;
6. simultaneous use of eplerenone or other potassium-sparing diuretics;
7. severe kidney disease;
8. breast-feeding;
9. use in children and adolescents with severe or moderate renal insufficiency.

What are the causes of edema and what may they indicate? Read on: Edema: how they arise and what they testify to

Spironol – precautions

Before and during the use of Spironol, follow the precautions included in the package leaflet.

Particular care should be taken when using Spironol in the following cases:

1. if you suffer from kidney disease, especially in children with high blood pressure, or liver disease. The doctor will assess the patient’s condition during a routine visit;
2. if you have difficulty passing urine;
3. if you suffer from a disease related to electrolyte disturbances in the blood, such as potassium or sodium;
4. if you suffer from severe heart failure;
5. if you are pregnant.  

It is also worth noting that the use of Spironol may affect driving and operating machinery. After using this preparation, dizziness and drowsiness may occur, which negatively affects the ability to drive a car or operate machinery.

How to deal with water retained in the body? Read on: What to do in the event of water retention in the body?

Spironol – method of use and dosage of the drug

Always use Spironol exactly as described in the package leaflet or as directed by your doctor or pharmacist.

In the case of Spironol, the number of tablets taken depends on the severity of the disease and symptoms. The tablets should be taken once a day with a meal.

The dose of Spironol for adults ranges from 25 mg to 400 mg daily spironolactone depending on the disease being treated. If Spironol is taken by children, the number of tablets depends on the child’s weight. The doctor determines the dose individually. In the elderly, on the other hand, treatment is started with the lowest possible dose.

How to recognize and treat edema of kidney origin? Read: Edema of renal origin

Spironol – misuse of the drug

Taking more than the recommended dose of the drug or omitting the indicated dose during the day is considered inappropriate use of Spironol.

If the patient applies too much Spironol, contact your doctor immediately or go to the casualty department of your nearest hospital.

Symptoms of overdose with Spironol These include: drowsiness, dizziness, nausea, vomiting, diarrhea, feeling dehydrated and confusion. A rash may appear as flat red areas on the skin with small raised bumps. A very large overdose may lead to changes in the levels of sodium and potassium in the blood with weakness, tingling, pricking or numbness of the skin and / or muscle cramps.

However, if you miss a dose, take it as soon as possible, unless it is almost time for your next dose. Do not use a double dose to make up for a forgotten dose.

How to take medication correctly? Check: How to take medications effectively?

Spironol – side effects

The drug Spironol, like any other drug, may cause side effects in patients. It is important to report any suspected adverse reactions after authorization of the medicinal product so that the benefit / risk balance of the medicinal product can be monitored.

The frequency classification of adverse body reactions (ADRs) is based on the following principles: very common (≥1 / 10), common (≥1 / 100 to <1/10), uncommon (≥1 / 1 to <000/1), rare (≥ 100 / 1 to <10 / 000), very rare (<1 / 1), not known (cannot be estimated from the available data).

Side effects after using Spironol by frequency of occurrence are:

1. very common side effects (may affect more than 1 in 10 people): increase in the amount of potassium in the blood;
2. common side effects (may affect up to 1 in 10 people): confusion, dizziness, vomiting or nausea, itchy skin, rash, cramps in the muscles or muscles of the legs, kidney failure or impaired kidney function, breast enlargement in men, breast pain (in men ), general malaise;
3. uncommon side effects (may affect up to 1 in 100 people): changes in the breasts, such as benign breast tumors (in men), electrolyte disturbances such as high levels of calcium in the blood, abnormal liver function, skin allergy, with itching and wheals , rash like hives, menstrual disorders in women, breast pain (in women);
4. frequency of side effects unknown: reduced number of white cells in the blood, reduced number of cells that help fight infection – white blood cells, which make infections easier to fight off, reduced number of cells involved in blood clotting, which increases risk of bleeding or bruising, changes in sex drive (libido) in both men and women, digestive disorders, gastritis, a condition where the skin develops fluid-filled blisters (pemphigoid), hair loss, excessive hair growth. 

In addition, it should be remembered that if a patient experiences the following side effects after taking Spironol, he should consult a doctor immediately:

1. itching and blistering of the skin around the lips and other parts of the body (Stevens-Johnson syndrome);
2. separation of the top layer of skin from the lower layers of skin all over the body (toxic epidermal necrolysis);
3. skin rash, fever and swelling (which may be symptoms of more serious conditions, drug rash with eosinophilia and systemic symptoms);
4. yellowing of the skin and eyes (jaundice) – Spironol can cause liver problems;
5. irregular heart beat which can be fatal, tingling sensation, paralysis (loss of muscle function) or difficulty breathing. These may be symptoms of an increase in the amount of potassium in your blood. 

What symptoms may indicate kidney problems? Check: Eight symptoms that could be a sign of a kidney problem

Spironol – interactions with other drugs

Before starting treatment with Spironol, inform the treating physician or pharmacist about all medications that he or she was taking or had recently taken. You should also inform what medications the patient plans to take in the near future.

Your doctor may change the dose of Spironol if you are taking any of the medications listed below:

1. digoxin lub carbenoxolone;
2. drugs for the treatment of high blood pressure, including ACE inhibitors;
3. other diuretics;
4. non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, indomethacin, mefenamic acid, or ibuprofen;
5. potassium supplements;
6. heparin or low molecular weight heparin (medicines used to prevent blood clots);
7. antipiryna?
8. medicines that can cause hyperkalaemia (high levels of potassium in the blood);
9. trimethoprim and trimethoprim with sulfamethoxazole. 

In addition, it should be remembered that Spironol reduces the body’s response to norepinephrine. Therefore, if a patient is to undergo surgery or surgery with anesthesia, the treating physician should be informed that Spironol is used.

Which drugs should never be combined with each other? Check: Dangerous interactions

Spironol and pregnancy and breastfeeding

The use of any medications or dietary supplements during pregnancy requires consultation with the attending physician. If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking Spironol.

Spironol should not be used by mothers who are breastfeeding. You should talk to your doctor who can advise you on a different way to feed your baby while you are taking this medicine.

What is worth knowing about proper supplementation during pregnancy? Check: Conscious choices. Diet and supplementation in pregnancy

Spironol — cena

The price of the drug Spinorol may differ depending on the city in which the diuretic will be bought or the pharmacy chosen by the patient. The price of the product also depends on the manufacturer, the number of tablets contained in the package and the content of the active substance:

1. price of the drug Spironol in tablets, drug dose 25 mg, 20 tablets – approx. PLN 6, after reimbursement: PLN 0-4;
2. price of the drug Spironol in tablets, drug dose 25 mg, 100 tablets – approx. PLN 23, after reimbursement: PLN 0-11;
3. price of the drug Spironol in coated tablets, drug dose 50 mg, 30 tablets – approx. PLN 11, after reimbursement: PLN 0-4;
4. price of Spironol in coated tablets, drug dose 50 mg, 60 tablets – approx. PLN 21, after reimbursement: PLN 0-6;
5. price of the drug Spironol in coated tablets, drug dose 100 mg, 20 tablets – approx. PLN 14, after reimbursement: PLN 0-4.

Spironol is 100% reimbursed for all eligible patients 75 years of age or older.

How much money does the average Pole spend on treatment? Check: The Pole is not expected to see a doctor

Spironol – substitutes

Products that have the same international name and exist in the same form do not have to be substitutes, because the use of a given drug is determined by the content of the active substance, i.e. the dose of the drug.

It should be remembered that even when the dose of the active substance is similar, the patient may not always use the substitute, because he may be allergic to any of the other excipients of the drug.

Therefore, before using a substitute for Spironol, read the package leaflet or consult your doctor or pharmacist.

The preparations containing the same ingredient as Spironol and showing similar properties include:

1. Finospir – a drug available in tablets, the manufacturer of which is the Orion concern. The dose of the drug may be 25, 50 or 100 mg;
2. Ismian – a drug available in coated tablets, produced by Accord Healthcare. The dose of the drug may be 25, 50 or 100 mg;
3. Verospiron – a drug available in tablets and hard capsules, produced by the Gedeon Richter concern. The dose of the drug may be 25, 50 or 100 mg.

When is it worth asking the pharmacy about drug substitutes? Check: Swap when you can