Lapis ISSN 2398-2969

Spironolactone

Synonym(s): Cardalis, Prilactone, Tempora

Contributor(s): Sarah Pellett, Livia Benato

Introduction

Name

  • Spironolactone.

Class of drug

  • Adosterone antagonist.

Description

Chemical name

  • Spironolactone.
  • Active metabolite: 7a-thiomethyl-spironolactone.

Molecular formula

  • C24H32O45S.

Storage requirements

  • Store in a dry place in the original blister pack.
  • Protect from light.
  • Any unused product should be disposed of in accordance with local requirements.

Uses

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Indications

  • Treatment (in combination with standard therapy) of congestive heart failure caused by regurgitation in dogs.
  • Licensed for use in dogs.

Not licensed for use in rabbits.

  • May be of benefit in the treatment of heart failure in rabbits. Patients unresponsive to fureosemide, vasodilator and digoxin (if indicated) may benefit with the addition of spironolactone.
  • Doses are extrapolated from feline medicine and not tested in rabbits.
  • Efficacy and safety of spironolactone in rabbits is unknown.

Administration

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Pharmacokinetics

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Precautions

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Interactions

with other drugs

  • Not recommended to be given with NSAIDs to dogs with renal insufficiency:
    • Can extrapolate this to rabbits.
    • The administration of NSAIDs with spironolactone may lead to a significant reduction of urinary sodium excretion.
  • Can be given in combination with furosemide   Furosemide  and pimobendan   Pimobendan  .
  • Spironolactone administration in combination with other potassium-sparing drugs (ACE inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers) may lead to hyperkalemia   Hypokalemia  :
    • In a recent clinical trial, an increased incidence of hyperkalemia was NOT observed when combining spironolactone with ACE inhibitors.
    • Regular monitoring is still advised, especially in dogs with renal insufficiency as there may be a risk of hyperkalemia.
  • Spironolactone decreases digoxin   Digoxin  elimination and as a consequence would raise digoxin plasma concentration. Monitor digoxin serum levels after 10 days of therapy. Use 0.5-2.0 ng/ml as a guide to therapeutic levels. Significant individual variation has been recorded.
  • Spironolactone may cause both induction and inhibition of cytochrome P450 enzymes and may affect the metabolism of other drugs using these pathways.

Monitor kidney function and serum potassium levels before initiating treatment with spironolactone and ACE inhibitors.

Monitor sodium and potassium levels during long-term treatment with spironolactone.

Adverse Reactions

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Shaheen N, Mahboob T, Siddiqui M A et al (2005) Effect of repeated treatment with low dose of spironolactone on electrolytes and osmolality. Pakistan J Pharmacol 22 (1), 23-28 PAKJP.
  • Ahmida M H, Abdel-Gayoum A A & El-Fakhri M M (2001) Effect of spironolactone on cisplatin-induced nephrotoxicity in rabbits. Human Exp Toxicol 20 (9), 453-459 PubMed.

Other sources of information

  • Raftery A (2013) Cardiovascular Disease. In:Clinical Veterinary Advisor. Birds and Exotic Pets. Eds: Mayer J & Donnelly T M. Elsevier, Missouri. pp 341.
  • Oglesbee B (2011) Congestive Heart Failure. In:Blackwell's Five Minute Consult - Rodents.Wiley-Blackwell, Chichester. pp 376-378.

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