spironolactone

Adult Dosing .

Dosage forms:  SUSP: 25 mg per 5 mL; TAB: 25 mg, 50 mg, 100 mg

Special Note

[formulation clarification]

Info: spironolactone tabs and susp not bioequivalent; reassess dose if switching between products; susp doses >100 mg may result in higher than expected conc; use tab form for doses >100 mg

heart failure w/ reduced ejection fraction, NYHA Class III-IV

[tablet form]

Dose: 25-50 mg/day PO divided qd-bid; Start: 25 mg PO qd, may incr. to 50 mg PO qd after 4wk; Info: for pts w/ K <5.1 mEq/L; may decr. dose to 25 mg PO qod if hyperkalemia on 25 mg PO qd; D/C if K >5.5 mEq/L

[suspension form]

Dose: 20-37.5 mg PO qd; Start: 20 mg PO qd, may incr. to 37.5 mg PO qd after 4wk; Info: for pts w/ K <5.1 mEq/L; may decr. dose to 20 mg PO qod if hyperkalemia on 20 mg PO qd; D/C if K >5.5 mEq/L

HTN, adjunct tx

[tablet form]

Dose: 25-100 mg/day PO divided qd-bid; Info: may adjust dose q2wk

[suspension form]

Dose: 20-75 mg/day PO divided qd-bid; Info: may adjust dose q2wk

edema

[tablet form]

Dose: 25-200 mg/day PO divided qd-bid; Start: 100 mg/day PO divided qd-bid; Info: for pts w/ cirrhosis or nephrotic syndrome; if given as monotherapy, may incr. dose after 5 days

[suspension form]

Dose: 75-100 mg/day PO divided qd-bid; Start: 75 mg/day PO divided qd-bid; Info: for pts w/ cirrhosis; if given as monotherapy, may incr. dose after 5 days

hyperaldosteronism, primary

[tablet form]

Dose: 100-400 mg PO qd

hypokalemia, diuretic-induced (off-label)

[25-100 mg/day PO divided qd-qid]

hirsutism, idiopathic (off-label)

[50-200 mg PO qd]

Info: may divide dose bid

acne vulgaris (off-label)

[50-200 mg PO qd]

Start: 25 mg PO qd

transgender hormone therapy, feminizing (off-label)

[100-300 mg/day PO divided qd-bid]

Info: adjust dose based on pt tx goals, clinical response, and testosterone levels; refer to WPATH or Endocrine Society guidelines

renal dosing

[heart failure w/ reduced ejection fraction, NYHA Class III-IV, tablet form]

eGFR 30-50: start 12.5 mg qd or 25 mg qod, may incr. to 25 mg qd after 4wk; eGFR <30: avoid use

HD/PD: not defined

[heart failure w/ reduced ejection fraction, NYHA Class III-IV, suspension form]

eGFR 30-50: consider starting 10 mg qd; eGFR <30: avoid use

HD/PD: not defined

[all other indications]

eGFR <30: avoid use in pts 65 yo and older

HD/PD: not defined

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised

Peds Dosing .

Dosage forms:  TAB: 25 mg, 50 mg, 100 mg

Special Note

[formulation clarification]

Info: spironolactone tabs and susp not bioequivalent; do not substitute on a mg to mg basis

diuresis (off-label)

[<1 mo]

Dose: 1-3 mg/kg/day PO divided qd-bid; Max: 100 mg/day

[1 mo and older]

Dose: 1-3.3 mg/kg/day PO divided bid-qid; Max: 100 mg/day

bronchopulmonary dysplasia (off-label)

[<1 mo]

Dose: 1-3 mg/kg/day PO divided qd-bid; Max: 100 mg/day; Info: use in combo w/ diuretic

[1 mo and older]

Dose: 1-3.3 mg/kg/day PO divided bid-qid; Max: 100 mg/day; Info: use in combo w/ diuretic

hyperaldosteronism test (off-label)

[125-375 mg/m^2/day PO divided bid-qid]

Max: 375 mg/m^2/day

precocious puberty (off-label)

[2 yo and older]

Dose: 2-5.7 mg/kg/day PO divided bid; Start: 1.5 mg/kg/day PO divided bid, may incr. dose q2wk; Max: 100 mg/day; Info: for male pts w/ testotoxicosis

renal dosing

[see below]

eGFR 30-50: give usual dose q24h; eGFR <30: avoid use

HD/PD: not defined

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised