Spironolactone + Hydrochlorothiazide

Indications

Spironolactone + Hydrochlorothiazide is used for: Oedema, Ascites, Congestive Heart Failure

Adult Dose

Oedema, Ascites, Congestive Heart Failure 1-8 tablets/day PO (spironolactone 25 mg/hydrochlorothiazide 25 mg) 1-4 tablets/day PO (spironolactone 50 mg/hydrochlorothiazide 50 mg) Hypertension, Hypokalemia (Diuretic Induced) 2-4 tablets/day PO (spironolactone 25 mg/hydrochlorothiazide 25 mg) 1-2 tablets/day PO (spironolactone 50 mg/hydrochlorothiazide 50 mg) Hepatic Impairment Acute or severe hepatic failure: Contraindicated

Child Dose

Renal Dose

Renal Impairment CrCL <30 mL/min: Hydrochlorothiazide efficacy decreased Not for administration in hyperkalemia, anuria, acute renal insufficiency, or significant impairment of renal excretory function

Administration

Contra Indications

Hypersensitivity to spironolactone, hydrochlorothiazide, or sulfonamides Acute renal failure Acute/severe hepatic failure Anuria Hyperkalemia Addison’s disease or other conditions associated with hyperkalemia Coadministration with eplerenone

Precautions

Somnolence and dizziness reported Caution with hepatic impairment Spironolactone May cause hyperkalemia; risk may be increased in patients with renal insufficiency, diabetes mellitus, or if coadministered with other drugs/diet that raise serum potassium levels Gynecomastia reported Hydrochlorothiazide May cause hypokalemia and hyponatremia; risk of hypokalemia may be increased in patients with cirrhosis, brisk diuresis, or if coadministered with other drugs that lower serum potassium May cause hypomagnesemia, which can then result in hypokalemia which appears difficult to treat despite potassium repletion May alter glucose tolerance and increase risk for hyperglycemia May increase serum levels of calcium and uric acid by decreasing urinary excretion; may also increase cholesterol and triglycerides Thiazides diuretics may add to or potentiate the action of other antihypertensive drugs Sensitivity reactions to thiazides may occur in patients with or without a history of allergy or bronchial asthma Sulfonamide derivatives, including thiazides, have been reported to exacerbate or activate systemic lupus erythematosus Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

Pregnancy-Lactation

Pregnancy Category: C Lactation: discontinue drug or do not nurse

Interactions

Adverse Effects

Side effects of Spironolactone + Hydrochlorothiazide : Frequency Not Defined Spironolactone Drowsiness Lethargy Headache Stevens-Johnson Syndrome Rash Urticaria Gynecomastia Impotence Menstrual disorders Abdominal cramping Diarrhea Gastritis Nausea/vomiting Drug rash with eosinophilia and systemic symptoms (DRESS) Toxic epidermal necrolysis Hydrochlorothiazide Anorexia Epigastric distress Hypotension Orthostatic hypotension Photosensitivity Anaphylaxis Anemia Confusion Erythema multiforme Stevens-Johnson syndrome Exfoliative dermatitis including toxic epidermal necrolysis Hypomagnesemia Dizziness Headache Hyperuricemia

Mechanism of Action

Spironolactone: Aldosterone antagonist with diuretic and antihypertensive effects; competitive binding of receptors at aldosterone-dependent Na-K exchange site in distal tubules results in increased excretion of Na+, Cl-, and H2O and retention of K+ and H+ Hydrochlorothiazide: Thiazide diuretic; inhibits sodium reabsorption in distal renal tubules, resulting in increased excretion of water and of sodium, potassium, and hydrogen ions