Aldactone (spironolactone) vs. Lasix (furosemide)

• Aldactone (spironolactone) and Lasix (furosemide) are types of diuretics used to remove excess fluid from the body in congestive heart failure, cirrhosis of the liver, and kidney disease.
• Aldactone also is used to counteract the effects of excessive adrenal aldosterone production (hyperaldosteronism).
• Side effects of Aldactone and that are similar include diarrhea, rash, and nausea.
• Side effects of Aldactone that are different from include headache cramps, drowsiness, vomiting, impotence, irregular menstrual periods, irregular hair growth, and enlargement of the male breasts (gynecomastia) (this side effect usually reverses upon discontinuation of Aldactone).
• Side effects of that are different from Aldactone include low blood pressure (hypotension), dehydration, electrolyte depletion (for example, sodium, potassium), yellowing skin and eyes (jaundice), ringing in the ears (tinnitus), sensitivity to light (photophobia), pancreatitis, abdominal pain, dizziness, and increased blood sugar and uric acid levels.

Aldactone (spironolactone) is a diuretic that removes excess fluid from the body in congestive heart failure, cirrhosis of the liver, and kidney disease. It also can be used in combination with other drugs to treat high blood pressure, and diuretic-induced low potassium (hypokalemia). Aldactone also is used to counteract the effects of excessive adrenal aldosterone production (hyperaldosteronism) that can occur from a tumor in the adrenal gland or enlarged adrenal glands (hyperplasia of the adrenal glands).

Lasix (furosemide) is a potent diuretic (water pill) used to eliminate water and salt from the body used to treat excess accumulation of fluid or swelling of the body (edema) caused by cirrhosis, chronic kidney failure, heart failure, and nephrotic syndrome. In the kidneys, salt, water, and other small molecules normally are filtered out of the blood and into the tubules of the kidney. Most of the sodium, chloride and water filtered out of the blood are reabsorbed into the blood before the filtered fluid becomes urine and is eliminated from the body. Lasix blocks the absorption of sodium, chloride, and water from the filtered fluid in the kidney tubules, causing a profound increase in the output of urine (diuresis).

Aldactone

Common side effects of Aldactone include:

• Headache
• Diarrhea
• Cramps
• Drowsiness
• Rash
• Nausea
• Vomiting
• Impotence
• Irregular menstrual periods
• Irregular hair growth

Enlargement of the male breasts (gynecomastia) may also occur and is related to dose and duration of therapy. It usually reverses upon discontinuation of Aldactone.

Possible serious side effects of Aldactone include:

• Liver dysfunction
• Kidney failure
• Anaphylaxis
• Abnormal heart rhythm
• Low platelets
• Low white blood cells
• Toxic epidermal necrolysis
• Vasculitis
• Risk of tumors in animal studies

Fluid and electrolytes imbalance (for example, low sodium, low magnesium, and high potassium) may occur, so patients should be monitored carefully.

Lasix

Common side effects of furosemide are:

• low blood pressure,
• dehydration and
• electrolyte depletion (for example, sodium, potassium).

Other important side effects include:

• jaundice,
• ringing in the ears (tinnitus),
• sensitivity to light (photophobia),
• rash,
• pancreatitis,
• nausea,
• diarrhea,
• abdominal pain, and
• dizziness.

Increased blood sugar and uric acid levels also may occur.

Aldactone

• Aldactone may be taken with or without food. The dosage range is 25-400 mg daily in single or divided doses.
• The initial dose for treating edema in adults is 100 mg daily as a single dose or divided doses. The dose may be adjusted after 5 days based on response. The recommended dose range is 25 to 200 mg daily. The initial dose should be continued for at least 5 days before increasing the dose. If there is no adequate response after 5 days, a second diuretic may be added.
• The dose for treating high blood pressure (hypertension) is 50 to 100 mg daily in single or divided doses.
• The dose for treating hypokalemia is 25 to 100 mg daily.

Lasix

• The usual starting oral dose for treatment of edema in adults is 20-80 mg as a single dose. The same dose or an increased dose may be administered 6-8 hours later. Doses may be increased 20-40 mg every 6-8 hours until the desired effect occurs. The effective dose may be administered once or twice daily. Some patients may require 600 mg daily.
• The starting oral dose for children is 2 mg/kg. The starting dose may be increased by 1-2 mg/kg every 6 hours until the desired effect is achieved. Doses greater than 6 mg/kg are not recommended.
• The recommended dose for treating hypertension is 40 mg twice daily. The dose of other blood pressure medications should be reduced by half when furosemide is added.

Aldactone

• Aldactone 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, Aldactone 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.
• Aldactone can cause elevation of blood digoxin (Lanoxin) to toxic levels, requiring adjustment of the digoxin dosage.

Lasix

Administration of furosemide with aminoglycoside antibiotics (for example, gentamicin) or ethacrynic acid (Edecrin, another diuretic) may cause hearing damage.

Furosemide competes with aspirin for elimination in the urine by the kidneys. Concomitant use of furosemide and aspirin may, therefore, lead to high blood levels of aspirin and aspirin toxicity. Furosemide also may reduce excretion of lithium (Eskalith, Lithobid) by the kidneys, causing increased blood levels of lithium and possible side effects from lithium. Sucralfate (Carafate) reduces the action of furosemide by binding furosemide in the intestine and preventing its absorption into the body. Ingestion of furosemide and sucralfate should be separated by two hours.

When combined with other antihypertensive drugs there is an increased risk of low blood pressure or reduced kidney function.

Nonsteroidal anti-inflammatory drugs (for example., ibuprofen, indomethacin [Indocin, Indocin-SR]) may interfere with the blood pressure reducing effect of furosemide.

Aldactone

• There are no adequate studies in pregnant women. Aldactone may be harmful if used for treating gestational hypertension (high blood pressure during pregnancy).
• An active metabolite of Aldactone is secreted in breast milk. To avoid adverse effects in the newborn, mothers should avoid breastfeeding while taking Aldactone.

Lasix

• Furosemide is secreted in breast milk. Nursing mothers should avoid breastfeeding while taking furosemide.