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[medical citation needed] The most common use of spironolactone is in the treatment of heart failure. [36] 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 RALES trial established spironolactone as a vital component of therapy for patients with severe heart failure, demonstrating significant reductions in mortality and hospitalization and improvements in symptoms. The trial's findings have been instrumental in shaping current heart failure treatment guidelines and improving patient outcomes.
However, spironolactone is metabolized to three active metabolites, which give it prolonged activity (13.8 – 16. 5 hours). Spironolactone has a long half-life and is excreted 47-51% through kidneys. Patients with chronic kidney disease therefore require close monitoring when taking the drug. Spironolactone is also eliminated through feces (35-41%
They are typically used as an adjunct in management of hypertension, cirrhosis, and congestive heart failure. [3] The steroidal aldosterone antagonists can also be used for treatment of primary hyperaldosteronism. Spironolactone, a steroidal aldosterone antagonist, is also used in management of female hirsutism and acne from PCOS or other ...
Heart failure - Giving 2.5 times of previous oral dose twice daily for those with acute decompensated heart failure is a reasonable strategy. However, daily assessment of clinical response is needed to adjust the subsequent doses. [6] Edema - Volume overload associated with liver cirrhosis, heart failure, or nephrotic syndrome [11]
Sleep apnea is an under-recognized risk factor for heart failure. Uncontrolled sleep apnea may increase the risk of heart failure by up to 140%. [4] Weight reduction – through physical activity and dietary modification, as obesity is a risk factor for heart failure and left ventricular hypertrophy. Effective weight management has been shown ...
Eplerenone may have a lower incidence than spironolactone of sexual side effects such as feminization, gynecomastia, impotence, low sex drive and reduction of size of male genitalia. [18] This is because other antimineralocorticoids have structural elements of the progesterone molecule, causing progestogenic and antiandrogenic outcomes. [ 4 ]
Cardiovascular agents generally have narrow therapeutic indices, implying that small differences in dose or blood concentration may give rise to adverse drug reactions. [45] Serious acute toxicity may result from accidental, intentional or iatrogenic overdose. [46] Therefore, patients need to be aware of any unusual and serious side effects.
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