Spironolactone/Hydrochlorothiazide: Difference between revisions

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Spironolactone, an ingredient of ALDACTAZIDE, has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions). ALDACTAZIDE should be used only in those conditions described under Indications and Usage. Unnecessary use of this drug should be avoided.
Spironolactone, an ingredient of ALDACTAZIDE, has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions). ALDACTAZIDE should be used only in those conditions described under Indications and Usage. Unnecessary use of this drug should be avoided.
Fixed-dose combination drugs are not indicated for initial therapy of edema or hypertension. Edema or hypertension requires therapy titrated to the individual patient. If the fixed combination represents the dosage so determined, its use may be more convenient in patient management. The treatment of hypertension and edema is not static but must be reevaluated as conditions in each patient warrant.
Fixed-dose combination drugs are not indicated for initial therapy of edema or hypertension. Edema or hypertension requires therapy titrated to the individual patient. If the fixed combination represents the dosage so determined, its use may be more convenient in patient management. The treatment of hypertension and edema is not static but must be reevaluated as conditions in each patient warrant.
|fdaLIADAdult=<h4>Condition 1</h4>
|fdaLIADAdult======congestive heart failure, hepatic cirrhosis, or nephrotic syndrome=====


* Dosing Information
* Dosing Information (Optimal dosage should be established by individual titration of the components)


:: (Dosage)
:* 25-200 mg/day depending on the response to the initial titration
:* usually maintaining dosage: 100 mg/day
 
=====Essential hypertension=====
* Dosing Information
 
:* 50-100 mg/day (depending on the results of titration of the individual ingredients)
|offLabelAdultNoGuideSupport======Acne vulgaris=====
 
* Dosing information
 
:* 50-200 mg PO
:* optimal dosage: 150-200 mg PO <ref name="pmid8112074">Vincenzi C, Trevisi P, Farina P, Stinchi C, Tosti A (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8112074 Facial contact dermatitis due to spironolactone in an anti-acne cream.] ''Contact Dermatitis'' 29 (5):277-8. PMID: [http://pubmed.gov/8112074 8112074]</ref><ref name="pmid2449021">Hatwal A, Bhatt RP, Agrawal JK, Singh G, Bajpai HS (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2449021 Spironolactone and cimetidine in treatment of acne.] ''Acta Derm Venereol'' 68 (1):84-7. PMID: [http://pubmed.gov/2449021 2449021]</ref><ref name="pmid6235834">Goodfellow A, Alaghband-Zadeh J, Carter G, Cream JJ, Holland S, Scully J et al. (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6235834 Oral spironolactone improves acne vulgaris and reduces sebum excretion.] ''Br J Dermatol'' 111 (2):209-14. PMID: [http://pubmed.gov/6235834 6235834]</ref>
 
=====Ascites of patients in cirrhosis of liver=====
 
* Dosing information
 
:* 100-400 mg/day (300-600 mg/day satisfies 50%-90% patients)
:* recommended initial dosage: 100-200 mg PO qd
:* 225 mg/day <ref name="pmid9075669">Fernández-Esparrach G, Guevara M, Sort P, Pardo A, Jiménez W, Ginès P et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9075669 Diuretic requirements after therapeutic paracentesis in non-azotemic patients with cirrhosis. A randomized double-blind trial of spironolactone versus placebo.] ''J Hepatol'' 26 (3):614-20. PMID: [http://pubmed.gov/9075669 9075669]</ref>
 
=====Proteinuria in Chronic renal failure=====
 
* Dosing information
 
:* 25 mg/day <ref name="pmid17035949">Bianchi S, Bigazzi R, Campese VM (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17035949 Long-term effects of spironolactone on proteinuria and kidney function in patients with chronic kidney disease.] ''Kidney Int'' 70 (12):2116-23. [http://dx.doi.org/10.1038/sj.ki.5001854 DOI:10.1038/sj.ki.5001854] PMID: [http://pubmed.gov/17035949 17035949]</ref>
 
=====Proteinuria in diabetic nephropathy=====
 
* Dosing information
 
:*  25 mg in addition to an [[ACE]] inhibitor or [[angiotensin]] II receptor antagonist <ref name="pmid16775595">Schjoedt KJ, Rossing K, Juhl TR, Boomsma F, Tarnow L, Rossing P et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16775595 Beneficial impact of spironolactone on nephrotic range albuminuria in diabetic nephropathy.] ''Kidney Int'' 70 (3):536-42. [http://dx.doi.org/10.1038/sj.ki.5001580 DOI:10.1038/sj.ki.5001580] PMID: [http://pubmed.gov/16775595 16775595]</ref>
 
=====Hirsutism=====
 
* Dosing information
 
:* spironolactone plus cyproterone/ethinyl estradiol or flutamide alone were both significantly effective for the treatment of women with moderate to severe hirsutism in a prospective, randomized, clinical trial <ref name="pmid18389188">Karakurt F, Sahin I, Güler S, Demirbas B, Culha C, Serter R et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18389188 Comparison of the clinical efficacy of flutamide and spironolactone plus ethinyloestradiol/cyproterone acetate in the treatment of hirsutism: a randomised controlled study.] ''Adv Ther'' 25 (4):321-8. [http://dx.doi.org/10.1007/s12325-008-0039-5 DOI:10.1007/s12325-008-0039-5] PMID: [http://pubmed.gov/18389188 18389188]</ref>
 
=====Idiopathic edema=====
 
* Dosing information
 
:* spironolactone 50-200 mg every morning or hydrochlorothiazide 25 mg every morning <ref name="pmid3081532">Gaby AR (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3081532 Idiopathic edema: 'overlooked' causes.] ''Hosp Pract (Off Ed)'' 21 (2):21. PMID: [http://pubmed.gov/3081532 3081532]</ref><ref name="pmid3934201">Melby JC (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3934201 Idiopathic edema. A clinical conundrum.] ''Hosp Pract (Off Ed)'' 20 (12):68E-68G, 68J, 68M passim. PMID: [http://pubmed.gov/3934201 3934201]</ref>
 
=====Myocardial infarction=====
 
* Dosing information
 
:* 25 mg/day <ref name="pmid12732605">Hayashi M, Tsutamoto T, Wada A, Tsutsui T, Ishii C, Ohno K et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12732605 Immediate administration of mineralocorticoid receptor antagonist spironolactone prevents post-infarct left ventricular remodeling associated with suppression of a marker of myocardial collagen synthesis in patients with first anterior acute myocardial infarction.] ''Circulation'' 107 (20):2559-65. [http://dx.doi.org/10.1161/01.CIR.0000068340.96506.0F DOI:10.1161/01.CIR.0000068340.96506.0F] PMID: [http://pubmed.gov/12732605 12732605]</ref>
 
=====Prophylaxis of osteopenia;  - Polycystic ovary syndrome=====
 
* Dosing information
 
:* 100 mg PO qd <ref name="pmid10199763">Moghetti P, Castello R, Zamberlan N, Rossini M, Gatti D, Negri C et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10199763 Spironolactone, but not flutamide, administration prevents bone loss in hyperandrogenic women treated with gonadotropin-releasing hormone agonist.] ''J Clin Endocrinol Metab'' 84 (4):1250-4. [http://dx.doi.org/10.1210/jcem.84.4.5606 DOI:10.1210/jcem.84.4.5606] PMID: [http://pubmed.gov/10199763 10199763]</ref>
}}
}}

Revision as of 19:55, 11 April 2014

Spironolactone/Hydrochlorothiazide
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sheng Shi, M.D. [2]

Disclaimer

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Black Box Warning

WARNING
See full prescribing information for complete Boxed Warning.
WARNING

Spironolactone, an ingredient of ALDACTAZIDE, has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions). ALDACTAZIDE should be used only in those conditions described under Indications and Usage. Unnecessary use of this drug should be avoided.

Fixed-dose combination drugs are not indicated for initial therapy of edema or hypertension. Edema or hypertension requires therapy titrated to the individual patient. If the fixed combination represents the dosage so determined, its use may be more convenient in patient management. The treatment of hypertension and edema is not static but must be reevaluated as conditions in each patient warrant.

Overview

Spironolactone/Hydrochlorothiazide is {{{aOrAn}}} Aldosterone antagonist that is FDA approved for the {{{indicationType}}} of Edematous conditions of congestive heart failure, cirrhosis of the liver accompanied by edema and/or ascites, nephrotic syndrome, essential hypertension. There is a Black Box Warning for this drug as shown here. Common adverse reactions include gynecomastia, diarrhea, nausea and vomiting, neurologic: Somnolence,reproductive: disorder of menstruation, impotence.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

congestive heart failure, hepatic cirrhosis, or nephrotic syndrome
  • Dosing Information (Optimal dosage should be established by individual titration of the components)
  • 25-200 mg/day depending on the response to the initial titration
  • usually maintaining dosage: 100 mg/day
Essential hypertension
  • Dosing Information
  • 50-100 mg/day (depending on the results of titration of the individual ingredients)

Off-Label Use and Dosage (Adult)

Non–Guideline-Supported Use

Acne vulgaris
  • Dosing information
  • 50-200 mg PO
  • optimal dosage: 150-200 mg PO [1][2][3]
Ascites of patients in cirrhosis of liver
  • Dosing information
  • 100-400 mg/day (300-600 mg/day satisfies 50%-90% patients)
  • recommended initial dosage: 100-200 mg PO qd
  • 225 mg/day [4]
Proteinuria in Chronic renal failure
  • Dosing information
Proteinuria in diabetic nephropathy
  • Dosing information
Hirsutism
  • Dosing information
  • spironolactone plus cyproterone/ethinyl estradiol or flutamide alone were both significantly effective for the treatment of women with moderate to severe hirsutism in a prospective, randomized, clinical trial [7]
Idiopathic edema
  • Dosing information
  • spironolactone 50-200 mg every morning or hydrochlorothiazide 25 mg every morning [8][9]
Myocardial infarction
  • Dosing information
Prophylaxis of osteopenia; - Polycystic ovary syndrome
  • Dosing information

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding Spironolactone/Hydrochlorothiazide FDA-Labeled Indications and Dosage (Pediatric) in the drug label.

Off-Label Use and Dosage (Pediatric)

Contraindications

There is limited information regarding Spironolactone/Hydrochlorothiazide Contraindications in the drug label.

Warnings

WARNING
See full prescribing information for complete Boxed Warning.
WARNING

Spironolactone, an ingredient of ALDACTAZIDE, has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions). ALDACTAZIDE should be used only in those conditions described under Indications and Usage. Unnecessary use of this drug should be avoided.

Fixed-dose combination drugs are not indicated for initial therapy of edema or hypertension. Edema or hypertension requires therapy titrated to the individual patient. If the fixed combination represents the dosage so determined, its use may be more convenient in patient management. The treatment of hypertension and edema is not static but must be reevaluated as conditions in each patient warrant.

There is limited information regarding Spironolactone/Hydrochlorothiazide Warnings' in the drug label.

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Spironolactone/Hydrochlorothiazide Clinical Trials Experience in the drug label.

Postmarketing Experience

There is limited information regarding Spironolactone/Hydrochlorothiazide Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Spironolactone/Hydrochlorothiazide Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Spironolactone/Hydrochlorothiazide in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Spironolactone/Hydrochlorothiazide in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Spironolactone/Hydrochlorothiazide during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Spironolactone/Hydrochlorothiazide in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Spironolactone/Hydrochlorothiazide in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Spironolactone/Hydrochlorothiazide in geriatric settings.

Gender

There is no FDA guidance on the use of Spironolactone/Hydrochlorothiazide with respect to specific gender populations.

Race

There is no FDA guidance on the use of Spironolactone/Hydrochlorothiazide with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Spironolactone/Hydrochlorothiazide in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Spironolactone/Hydrochlorothiazide in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Spironolactone/Hydrochlorothiazide in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Spironolactone/Hydrochlorothiazide in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Spironolactone/Hydrochlorothiazide Administration in the drug label.

Monitoring

There is limited information regarding Spironolactone/Hydrochlorothiazide Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Spironolactone/Hydrochlorothiazide and IV administrations.

Overdosage

There is limited information regarding Spironolactone/Hydrochlorothiazide overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Spironolactone/Hydrochlorothiazide Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Spironolactone/Hydrochlorothiazide Mechanism of Action in the drug label.

Structure

There is limited information regarding Spironolactone/Hydrochlorothiazide Structure in the drug label.

Pharmacodynamics

There is limited information regarding Spironolactone/Hydrochlorothiazide Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Spironolactone/Hydrochlorothiazide Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Spironolactone/Hydrochlorothiazide Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Spironolactone/Hydrochlorothiazide Clinical Studies in the drug label.

How Supplied

There is limited information regarding Spironolactone/Hydrochlorothiazide How Supplied in the drug label.

Storage

There is limited information regarding Spironolactone/Hydrochlorothiazide Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Spironolactone/Hydrochlorothiazide |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Spironolactone/Hydrochlorothiazide |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Spironolactone/Hydrochlorothiazide Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Spironolactone/Hydrochlorothiazide interaction has not been established. Talk to your doctor regarding the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Spironolactone/Hydrochlorothiazide Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Spironolactone/Hydrochlorothiazide Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Vincenzi C, Trevisi P, Farina P, Stinchi C, Tosti A (1993) Facial contact dermatitis due to spironolactone in an anti-acne cream. Contact Dermatitis 29 (5):277-8. PMID: 8112074
  2. ↑ Hatwal A, Bhatt RP, Agrawal JK, Singh G, Bajpai HS (1988) Spironolactone and cimetidine in treatment of acne. Acta Derm Venereol 68 (1):84-7. PMID: 2449021
  3. ↑ Goodfellow A, Alaghband-Zadeh J, Carter G, Cream JJ, Holland S, Scully J et al. (1984) Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol 111 (2):209-14. PMID: 6235834
  4. ↑ Fernández-Esparrach G, Guevara M, Sort P, Pardo A, Jiménez W, Ginès P et al. (1997) Diuretic requirements after therapeutic paracentesis in non-azotemic patients with cirrhosis. A randomized double-blind trial of spironolactone versus placebo. J Hepatol 26 (3):614-20. PMID: 9075669
  5. ↑ Bianchi S, Bigazzi R, Campese VM (2006) Long-term effects of spironolactone on proteinuria and kidney function in patients with chronic kidney disease. Kidney Int 70 (12):2116-23. DOI:10.1038/sj.ki.5001854 PMID: 17035949
  6. ↑ Schjoedt KJ, Rossing K, Juhl TR, Boomsma F, Tarnow L, Rossing P et al. (2006) Beneficial impact of spironolactone on nephrotic range albuminuria in diabetic nephropathy. Kidney Int 70 (3):536-42. DOI:10.1038/sj.ki.5001580 PMID: 16775595
  7. ↑ Karakurt F, Sahin I, Güler S, Demirbas B, Culha C, Serter R et al. (2008) Comparison of the clinical efficacy of flutamide and spironolactone plus ethinyloestradiol/cyproterone acetate in the treatment of hirsutism: a randomised controlled study. Adv Ther 25 (4):321-8. DOI:10.1007/s12325-008-0039-5 PMID: 18389188
  8. ↑ Gaby AR (1986) Idiopathic edema: 'overlooked' causes. Hosp Pract (Off Ed) 21 (2):21. PMID: 3081532
  9. ↑ Melby JC (1985) Idiopathic edema. A clinical conundrum. Hosp Pract (Off Ed) 20 (12):68E-68G, 68J, 68M passim. PMID: 3934201
  10. ↑ Hayashi M, Tsutamoto T, Wada A, Tsutsui T, Ishii C, Ohno K et al. (2003) Immediate administration of mineralocorticoid receptor antagonist spironolactone prevents post-infarct left ventricular remodeling associated with suppression of a marker of myocardial collagen synthesis in patients with first anterior acute myocardial infarction. Circulation 107 (20):2559-65. DOI:10.1161/01.CIR.0000068340.96506.0F PMID: 12732605
  11. ↑ Moghetti P, Castello R, Zamberlan N, Rossini M, Gatti D, Negri C et al. (1999) Spironolactone, but not flutamide, administration prevents bone loss in hyperandrogenic women treated with gonadotropin-releasing hormone agonist. J Clin Endocrinol Metab 84 (4):1250-4. DOI:10.1210/jcem.84.4.5606 PMID: 10199763
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