Cardiology · Mineralocorticoid receptor antagonist (non-selective)
Spironolactone (HF dose)
Dose
HF: 12.5–25 mg OD (max 50). Ascites: 100–400 mg OD.
Mechanism
Aldosterone antagonist → K-sparing diuresis + cardiac remodelling benefit.
Indications
- • HFrEF (RALES)
- • Resistant HTN (PATHWAY-2)
- • Ascites in cirrhosis
- • Primary hyperaldosteronism
Contraindications
- • K+ >5.0
- • CrCl <30
- • Addison disease
- • Concurrent K supplements
Use
Prognostic pillar of HFrEF alongside ARNI/β-blocker/SGLT2i.
Monitoring
U&E at 1, 4, 8, 12 weeks; K+ target <5.5; stop if >6.
Side effects
- • Hyperkalaemia
- • Gynaecomastia (10%)
- • Menstrual irregularities
- • AKI
Related in WardRound
Always confirm dose against your local formulary / BNF before prescribing.
