spironolactane

[Deb]

Dr. Fett,
What are the guidelines/uses for spironolactane? My doctor keeps saying he plans on putting me on it, but it's been 5 months now since diagnosis and I'm still not on it.

[JAMESFETT]

I think spironolactone is useful early in heart failure treatment in conjunction with the use of lasix or other diuretic. Its primary function is to prevent loss of potassium, so if one takes it, the dosage must not be too high (usual 25 mg, max 50 mg) and careful if also supplementing potassium, because one does not want to have either hyper or hypo kalemia. When lasix is no longer necessary one may also wish to phase out spironolactone, since the excess loss of potassium is no longer an issue. Spironolactone in and of itself may be beneficial in treating heart failure, whether that is from some other unexplained benefit than excess fluid elimination, I don't know. If you're several months out from initial diagnosis there may be no benefit from taking spironolactone--unless you still have excess fluid accumulation and need lasix to control it.

JD

[amyls]

Dr Fett,
Sorry to jump in here, but because of my kidneys I am on HCTZ 50 mg and potassium 60mg. Should I ask my nephrologist about this med?? I Have hypercalcimia...it's off the charts when I don't take the HCTZ.. the first time (a couple yrs ago)my 24 hr urine calcium level was 650...then last yr on HCTZ 25 mg it was 350...so they increased it to the 50mg. Is the spironolactone only a cardiac drug, or should I suggest it at my next appt in the summer? I also have chronically low potassium, even on the 60mg it hovers around 3.5.

thanks
amy

[JAMESFETT]

Yes, talk with your nephrologist. If things are quite stable, no more problem with kidney stones, reasonable control of potassium, I would think there is no need to complicate things by the addition of spironolactone. In other words, it does not seem to be urgently important.

JD