Spironolactone Contraindications and Precautions
- anuria
- diabetic nephropathy
- hyperkalemia
- renal failure
- acid/base imbalance
- breast-feeding
- diabetes mellitus
- elderly
- hepatic disease
- hyponatremia
- menstrual irregularity
- metabolic acidosis
- pregnancy
- renal disease
- renal impairment
- respiratory acidosis
Spironolactone Contraindications and Precautions
Spironolactone is contraindicated in patients with hyperkalemia (serum potassium greater than 5.5 mEq/L) or who are receiving other potassium-sparing agents. Patients receiving spironolactone should not receive potassium supplementation or increase their dietary intake of potassium unless they have refractory hypokalemia; serum potassium, creatinine, and BUN levels should be monitored. Spironolactone-induced hyperkalemia can cause life-threatening cardiac arrhythmias, and it is more likely to occur in patients with impaired renal function, diabetes mellitus, or in elderly patients; these patients should have periodic serum electrolyte, creatinine, and BUN levels monitored. Spironolactone should be used with caution in these patients. The precaution for spironolactone in patients with diabetes mellitus is primarily due to the risk of hyperkalemia and not the risk of inducing hyperglycemia, which may occur with thiazide or loop diuretics. Elderly patients also may be more sensitive to the hypotensive and diuretic effects of spironolactone. Spironolactone is also contraindicated in patients with anuria, diabetic nephropathy or any renal disease associated with severe renal impairment (CrCl < 10 ml/min) or renal failure. The dose of spironolactone should be adjusted in patients with moderate renal impairment (CrCl 10 - 50 ml/min). Serum potassium, creatinine, and BUN levels should be monitored in patients receiving spironolactone.
Patients with significant acid/base imbalance should have their condition corrected before diuretics are initiated. Close monitoring of the acid-base status is required in debilitated patients or severely ill patients in whom respiratory acidosis or metabolic acidosis may occur (e.g., cardiopulmonary disease or uncontrolled diabetes). These patients are at a higher risk for developing sudden metabolic acidosis or respiratory acidosis, with resultant rapid increases in serum potassium concentrations that could be exacerbated by potassium-sparing diuretic therapy.
Spironolactone should be used with caution in patients with preexisting hyponatremia. Spironolactone may worsen this condition.
Spironolactone-induced fluctuations in serum electrolyte concentration can occur rapidly and precipitate hepatic encephalopathy in susceptible patients. Therefore, the drug should be used with caution in patients with hepatic disease.
Spironolactone can cause antiandrogenic and endocrine effects and should be used with caution in patients with menstrual irregularity or breast enlargement.
The safety of spironolactone administration during pregnancy has not been established, so the drug should be administered to pregnant women only when the potential benefits to the mother outweigh the potential risk to the fetus. Spironolactone is classified as pregnancy category D. In general, diuretics are contraindicated in pregnant women with mild edema who have no other health problems. The major metabolite of spironolactone, canrenone, is distributed in breast milk, so the drug probably should not be used during breast-feeding. If the drug is absolutely necessary, an alternative method of infant feeding should be initiated.
[ Last revised: 6/6/2002 ]
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