Spironolactone Adverse Reactions
- abdominal pain
- agranulocytosis
- amenorrhea
- anorexia
- ataxia
- azotemia
- bradycardia
- confusion
- diarrhea
- drowsiness
- erythema
- fever
- gastritis
- gynecomastia
- headache
- hirsutism
- hyperkalemia
- hyponatremia
- impotence (erectile dysfunction)
- infertility
- lethargy
- libido decrease
- maculopapular rash
- mastalgia
- menstrual irregularity
- metabolic acidosis
- nausea/vomiting
- polyuria
- postmenopausal bleeding
- renal failure (unspecified)
- secondary malignancy
- urticaria
- weakness
Spironolactone Adverse Reactions
Spironolactone-induced hyperkalemia can cause life-threatening cardiac arrhythmias, and it is more likely to occur in patients with renal insufficiency, diabetes mellitus, or in geriatric patients. Signs and symptoms of hyperkalemia include reduced muscular weakness, paresthesia, fatigue, flaccid paralysis of the extremities, sinus bradycardia, shock, and ECG changes. Patients who receive potassium supplements or patients with impaired renal function who are also receiving spironolactone therapy are particularly at risk for developing hyperkalemia, and periodic serum electrolyte, creatinine, and BUN determinations should be made. If hyperkalemia occurs, spironolactone should be discontinued immediately, and specific measures should be taken to reduce serum potassium levels.
Spironolactone therapy alone usually does not affect electrolyte levels other than potassium, but hyponatremia can result from a combination of spironolactone with other diuretic therapy.
A reversible hyperchloremic metabolic acidosis can occur in patients with decompensated hepatic cirrhosis who are receiving spironolactone. This effect is usually associated with hyperkalemia and can occur regardless of renal function.
Spironolactone is similar in structure to steroid compounds and can produce some of the same adverse effects. In men, spironolactone may cause gynecomastia, libido decrease, and impotence (erectile dysfunction). Women taking spironolactone may experience menstrual irregularity, postmenopausal bleeding, breast tenderness or mastalgia, hirsutism, deepened voice, and amenorrhea. Such endocrine effects may produce a medication-induced infertility. These effects usually are reversible following discontinuance of therapy.
While a cause-and-effect relationship has not been established for the development of a secondary malignancy, breast cancer has been reported in patients receiving spironolactone.
Adverse GI effects reported during spironolactone therapy include anorexia, nausea/vomiting, diarrhea, gastritis, abdominal pain, gastric bleeding, and ulceration.
Adverse nervous system effects that have been reported in patients receiving spironolactone therapy include headache, drowsiness, lethargy, ataxia, weakness, and mental confusion. Muscular weakness may be a sign of drug-induced hyperkalemia.
Other adverse effects reported with spironolactone therapy include azotemia, renal dysfunction, renal failure (unspecified), fever, urticaria, maculopapular rash, erythema, azotemia, and, rarely, agranulocytosis.
Due to the diuretic action of spironolactone, polyuria can be troublesome for some patients during therapy.
[ Last revised: 6/6/2002 ]
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