Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: One of the main functions of the kidneys is
to retain salt (sodium chloride) and water in the body. In patients with heart
failure and cirrhosis, increased levels of a hormone produced by the adrenal
glands, called aldosterone, causes salt and fluid to be retained by the kidneys.
(At the same time, it also causes the kidneys to eliminate potassium.) The body
becomes overloaded with salt and water, and this worsens the heart failure.
Spironolactone inhibits the action of aldosterone thereby causing the kidneys to
excrete salt and fluid in the urine while retaining potassium. Therefore,
spironolactone is classified as a potassium-sparing diuretic, a drug that
promotes the output of urine (diuretic) while allowing the kidneys to hold onto
potassium. The FDA approved spironolactone in October 1985.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets 25, 50, and 100 mg
STORAGE: Spironolactone should be stored at room temperature, below
25 C (77 F).
PRESCRIBED FOR: Spironolactone removes excess fluid from the body in
congestive heart failure, cirrhosis of the liver, and kidney disease. It can
also be used in combination with other drugs to treat
elevated blood pressure
and for treating diuretic-induced low potassium (hypokalemia). Spironolactone
also is used to counteract the effects of excessive adrenal aldosterone
production (hyperaldosteronism). Aldosterone overproduction can occur from a
tumor in the adrenal gland or enlarged adrenal glands (hyperplasia of the
adrenal glands).
DOSING: Spironolactone may be taken with or without food. The dosage
range is 25-400 mg daily in single or divided doses.
DRUG INTERACTIONS: Spironolactone can lower blood sodium levels while
raising blood potassium levels. Excessively high blood potassium levels can lead
to potentially life-threatening abnormalities in the
rhythm of the heart.
Therefore, spironolactone usually is not administered with other agents that can
raise blood potassium levels, such as potassium supplements,
angiotensin
converting enzyme (ACE) inhibitors [for example, enalapril
(Vasotec)], indomethacin
(Indocin), or other potassium-sparing diuretics. Spironolactone can cause
elevation of blood digoxin (Lanoxin) to toxic levels, requiring adjustment of
the digoxin dosage.
NURSING MOTHERS: An active metabolite of spironolactone is secreted in
breast-milk. To avoid adverse effects in the newborn, mothers should avoid
breastfeeding while taking spironolactone.
SIDE EFFECTS: Side effects of spironolactone include headache,
diarrhea, cramps, drowsiness, rash, nausea,
vomiting, impotence,
irregular
menstrual periods, and irregular hair growth. Fluid and electrolytes imbalance
(for example, low sodium, low magnesium, and
high potassium) may
occur, so patients should be monitored carefully. Enlargement of the breasts
(gynecomastia) may also occur and is related to dose and duration of therapy. It
usually reverses upon discontinuation of spironolactone.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Hyperkalemia is an abnormally high level of potassium in the blood. Symptoms of hyperkalemia include nausea, fatigue, tingling sensations, or muscle weakness. Hyperkalemia may also cause no symptoms. Slow heartbeat and weak pulse are more serious symptoms. Causes of hyperkalemia include kidney dysfunction, medications, adrenal gland diseases, and potassium shifts. Treatment of hyperkalemia is dependant upon the cause.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
Hyperkalemia is common; it is diagnosed in up to 8% of
hospitalized patients in the U.S. Fortunately, most patients have mild
hyperkalemia (which is usually well tolerated). However, any
condition causing even mild
hyperkalemia should be treated to prevent progression into more severe
hyperkalemia. Extremely high levels of potassium in the blood (severe
hyperkalemia) can lead to cardiac arrest and
death. When not recognized and treated properly, severe hyperkalemia results in
a mortality rate of about 67%.
Technically, hyperkalemia means an abnormally elevated level of potassium in the blood.
The normal potassium level in the blood is 3.5-5.0 milliequivalents per liter
(mEq/L). Potassium levels between 5.1 mEq/L to 6.0 mEq/L reflect mild hyperkalemia.
Potassium levels of 6.1 mEq/L to 7.0 mEq/L are moderate hyperkalemia, and levels
above 7 mEq/L are severe hyperkalemia.
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