Spironolactone : Practice guide

Spironolactone is a medication that belongs to the class of potassium-sparing diuretics, primarily utilized for its ability to manage fluid retention without causing potassium levels to drop significantly.

Mechanism of Action

• Aldosterone Antagonism: Spironolactone acts by blocking aldosterone receptors in the kidneys. Aldosterone promotes sodium and water retention while facilitating potassium excretion. By inhibiting aldosterone's action, spironolactone encourages the excretion of sodium and water, thereby reducing fluid accumulation and sparing potassium.

Aldosterone normally tells the kidneys to save sodium (salt) and water, but to get rid of potassium. When spironolactone blocks aldosterone, the kidneys excrete more sodium and water, which is the diuretic effect, but they also retain more potassium. If too much potassium is retained, it can build up in the blood, leading to hyperkalemia.

Clinical Indications

• • Congestive Cardiac Failure: Spironolactone is used to manage symptoms associated with congestive heart failure, helping to reduce fluid accumulation and the resultant stress on the heart.

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  • Hepatic Cirrhosis with Ascites and Edema: In patients with liver cirrhosis, spironolactone can help manage ascites (abdominal fluid accumulation) and peripheral edema (swelling), improving comfort and potentially reducing complications.

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  • Malignant Ascites: For ascites resulting from cancer, spironolactone may be used to alleviate fluid buildup and associated...