>45%) found no reduction in death from cardiovascular events, aborted cardiac arrest, or hospitalizations when spironolactone was compared to placebo. Of note, a recent randomized, double-blinded study of spironolactone in patients with symptomatic heart failure with "preserved" ejection fraction (i.e. Spironolactone should be considered a good add-on agent, particularly in those patients "not" yet optimized on ACE inhibitors and beta-blockers. Likewise, it has shown benefit for and is recommended in patients who recently suffered a heart attack and have an ejection fraction less than 40%, who develop symptoms consistent with heart failure, or have a history of diabetes mellitus. People in the study's intervention arm also had fewer symptoms of heart failure and were hospitalized less frequently. In a randomized evaluation which studied people with severe congestive heart failure, people treated with spironolactone were found to have a relative risk of death of 0.70 or an overall 30% relative risk reduction compared to the placebo group, indicating a significant death and morbidity benefit of the medication. Current recommendations from the American Heart Association are to use spironolactone in patients with NYHA Class II-IV heart failure who have a left ventricular ejection fraction of less than 35%. While loop diuretics remain first-line for most people with heart failure, spironolactone has shown to reduce both morbidity and mortality in numerous studies and remains an important agent for treating fluid retention, edema, and symptoms of heart failure. Spironolactone is also commonly used to treat symptoms of hyperandrogenism, such as due to polycystic ovary syndrome, in women. High doses of spironolactone, which are needed for considerable antiandrogenic effects, are not recommended for men due to the high risk of feminization and other side effects. Spironolactone is the most commonly used medication in the treatment of hirsutism in the United States. Some of these uses include acne, seborrhea, hirsutism, and pattern hair loss in women. For this reason, it is frequently used to treat a variety of dermatological conditions in which androgens play a role.
Spironolactone has antiandrogenic activity. Spironolactone is also used to treat Bartter's syndrome due to its ability to raise potassium levels. The classification of spironolactone as a "potassium-sparing diuretic" has been described as obsolete. On its own, spironolactone is only a weak diuretic because it primarily targets the distal nephron ( collecting tubule), where only small amounts of sodium are reabsorbed, but it can be combined with other diuretics to increase efficacy. The most common use of spironolactone is in the treatment of heart failure. Spironolactone is used primarily to treat heart failure, edematous conditions such as nephrotic syndrome or ascites in people with liver disease, essential hypertension, low blood levels of potassium, secondary hyperaldosteronism (such as occurs with liver cirrhosis), and Conn's syndrome (primary hyperaldosteronism). In 2019, it was the 63rd most commonly prescribed medication in the United States, with more than 11 million prescriptions. It is on the World Health Organization's List of Essential Medicines. Spironolactone was discovered in 1957, and was introduced in 1959. Spironolactone belongs to a class of medications known as potassium-sparing diuretics. It is a steroid that blocks the effects of the hormones aldosterone and testosterone and has some estrogen-like effects. Spironolactone has not been well studied in pregnancy and should not be used to treat high blood pressure of pregnancy. In those with liver or kidney problems, extra care should be taken. Ĭommon side effects include electrolyte abnormalities, particularly high blood potassium, nausea, vomiting, headache, rashes, and a decreased desire for sex.
In 2021, it was shown to be beneficial in the treatment of COVID-19 when paired with dexamethasone. It is also used in the treatment of high blood pressure, low blood potassium that does not improve with supplementation, early puberty in boys, acne and excessive hair growth in women, and as a part of transgender hormone therapy in transfeminine people. Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease.