Shocking Side Effects Of Spironolactone [New & Proper Guidelines]

Spironolactone was first approved by the FDA in 1960, almost 63 years back. It’s still a popular medication, with millions of prescriptions being written every year.

This drug can lead to a number of side effects, including fatigue, nausea, and stomach cramps. One of the main reasons is spironolactone reduces the amount of water in your body. It also interferes with the process of testosterone production.

Spironolactone can also cause severe side effects such as kidney failure, difficulty breathing, stool in the blood, and so on.

This article will give you a full comprehensive idea and proper guidelines for preventing mild and severe side effects of prednisone.

What Does Spironolactone Do

Spironolactone alone belongs to two different medical classes. The first is a diuretic, which increases the body’s excretion and causes you to expend more water.

Second, it is an antiandrogen – a medication that lowers the effects of androgens like testosterone in the body.

Spironolactone As Diuretic

Spironolactone is a diuretic (the drug that increases the amount of urine) that works by decreasing the amount of salt and water in your body. It is used to treat high levels of aldosterone in the blood, which can cause high blood pressure or make your heart beat faster.

Spironolactone As Anti-androgen

Spironolactone also works by interfering with the process of testosterone synthesis. The molecule is a competitive inhibitor of aldosterone, a hormone that is responsible for increasing blood pressure and sodium retention in the body.

It does act as a moderate anti-androgen meaning it will not block male sex hormones from being produced. However, it does interfere with the production of testosterone.

Research [1] proved that It could also reduce the amount of testosterone in your body.

How Does it Help

Spironolactone is a medication that has been used for over 63 years to treat diseases a wide range of diseases like

  • High blood pressure (Hypertension)
  • Heart failure
  • Kidney disease
  • Liver disease
  • Edema (Swelling)
  • Breathing Problems
  • Low Potassium Level
  • Having too much aldosterone in the body (Hyperaldosteronism)
  • Acne in women
  • Polycystic ovary syndrome in Female
  • Ascites
  • Resistant hypertension
  • Secondary hyperaldosteronism

Spironolactone can also be used to prevent or slow the progression of heart failure caused by a reduction in blood flow to the heart muscle. It prevents the remodeling of heart muscles as a compensatory response to the failure of the heart.  It’s a synthetic, water-soluble steroid that blocks the effects of aldosterone. Aldosterone is a hormone that helps regulate sodium balance in the body.

15 Cautions and Precautions For Spironolactone

  1. Potassium levels and renal function must be monitored regularly in patients taking spironolactone. More frequent monitoring is required if Spironolactone is given with other drugs.
  2. This medication should not be taken with Eplerenone (Inspra®). It may cause serious side effects if taken together.
  3. Try to avoid Potassium riched food while taking Spironolactone.
  4. Research [2] showed that Spironolactone could decrease testosterone in healthy men by up to 60% within one hour. Talk to your doctor about that.
  5. If you have liver or kidney disease, your doctor may not recommend Spironolactone; ask your doctor about that.
  6. You may also experience electrolyte imbalances (low sodium, magnesium, and calcium levels, hypochloremic alkalosis) and increased uric acid and blood sugar levels.
  7. Studies show that taking Spironolactone increases the risk of developing Gynecomastia [3] and hyperkalemia. Consult your doctor if you are at risk of developing these diseases.
  8. Patients with low or no salt levels and those taking other blood pressure medications (eg, ARB, ACE inhibitor) may experience a worsening kidney function from Spironolactone.
  9. You should not take two doses of Spironolactone at a time; if you just missed one and it is almost time for the next dose, skip the missed one.
  10. The use of spironolactone during pregnancy is not recommended due to the fact that studies [4] in animals suggest the drug feminizes male fetuses. Consult your doctor about this issue.
  11. If you are pregnant. If you are planning to become pregnant during the dose and breastfeeding, consult your doctor before taking Spironolactone.
  12. Some patients can have an allergic reaction to the ingredients of Spironolactone; ask for the list of ingredients from your doctor.
  13. Consult your doctor about your current health situation, drugs you are taking, supplements and vitamins you are taking, and how your lifestyle. Let your doctor know if you take too much caffeine or alcohol regularly.
  14. Alcohol with Spironolactone can cause mild side effects like dizziness, light-headedness, etc. Too much consumption can cause severe damage.
  15. Avoid driving and running other machinery for the first few days after taking Spironolactone to check if it affects you badly.

When Does Spironolactone Side Effects Start?

Spironolactone side effects may occur within a few days to months and even years after. There is no guarantee of experiencing side effects.

The majority of patients do not experience any severe symptoms after taking it. And patients who experience side effects from Spironolactone, most of them are mild symptoms.

In very rare cases, patients can experience severe symptoms from Spironolactone. It depends on a few things. Such as:

  • Your dosage (High/low)
  • Your DNA
  • Your lifestyle
  • Your food habit
  • Drugs you are taking
  • Therapy or surgery you took
  • Supplements or vitamins you are taking
  • Your Kidney Status
  • Status Of Your Liver
  • Your overall health situation

KEY NOTE: If you are already started taking Spironolactone and still did not experienced any side effects, just don’t panic. And if you are not started taking it yet, follow full instruction of your doctor. Panicking about side effects can worsen the situation.


Common  Spironolactone Side Effects

Spironolactone is one of the oldest medicines and is considered safe. But like all other medications, it can cause side effects. Here is the list of some common and less serious side effects of Spironolactone.

Note: These side effects do not require immediate medical attention. But if you experience this for a longer period of time, it is highly recommended that you consult the doctor who prescribed you the medicine.

  • Erection problems
  • Voice deepening
  • A decrease in body hair growth
  • Feeling drowsy
  • Feeling tired
  • Feeling restless
  • Vomiting
  • Dehydration
  • Diarrhea
  • Cramps or stomach pain
  • Breast pain or enlargement in men or women
  • Menstrual irregularities
  • Vaginal bleeding in post-menopausal women (after the end of monthly periods)

What Are The Serious Side Effects Of Spironolactone

There are some side effects that can be quite serious. Please contact your doctor as soon as possible if you experience any of these symptoms:

  • Muscle pain, weakness, or cramps
  • Feelings of numbness, tingling, or pain in the hands or feet
  • Unable to move arms or legs
  • Heartbeat changes
  • Feeling confused
  • Restlessness and sweating.
  • Nausea
  • Feeling extremely tired
  • Dehydration symptoms include dry mouth, thirst, dizziness, unsteadiness, headaches, or other symptoms
  • Bleeding or bruising that is unusual
  • Energy deficiency
  • A lack of appetite
  • Stomach pain in the upper right corner
  • Skin or eye yellowing
  • Symptoms of the flu
  • Rashes
  • Breathing or swallowing difficulties
  • Vomiting Up Blood
  • Stools containing blood
  • A decrease in urination
  • Feeling faint

Short-Term Side Effects

There is not enough valid data found on the immediate side effects of Spironolactone. But patients may experience

  • Stomach upset
  • Nausea
  • Tiredness
  • Dehydration or Feeling thirsty

after taking Spironolactone, this happens in very rare cases. In general, there are very few or no short-term side effects reported from patients. And even if patients experience any severe symptoms, that does not prove Spironolactone is the only reason behind that.

KEY POINT: If you are healthy, taking Spironolactone exactly as instructed by the doctor and also followed all the precautions, you do not need to worry about any short-term side effects.


Long-Term Side Effects

Some patients may need to take this medication for years, especially those who are on treatment for resistant hypertension, Heart failure, Secondary hyperaldosteronism, polycystic ovary syndrome, and some other steroid hormone-related diseases.

If you’re facing one of those problems described above and on spironolactone for a long time, may encounter the following long-term side effects:

  • Electrolyte imbalance
  • Hyperkalaemia or the high rise of potassium in blood flow.
  • Arrhythmia
  • Cardiac Arrest due to hyperkalemia.
  • Hepatic Impairment (Liver Damage)
  • kidney Failure.
  • Gynaecomastia (Enlarged breast in males)
  • A decrease in libido in males (Lack of sex drive)
  • Lethargy
  • Menstrual irregularity in the case of females.

Key Note: To avoid these fatal & life-threatening side effects, please strictly follow the instructions of your physician monitor your serum electrolytes on a regular basis, especially serum potassium levels. Avoid high consumption of potassium-rich foods. Also, check your steroid hormone levels frequently to surpass hormonal disorders.


Spironolactone Side Effects During Pregnancy

The use of Spironolactone during pregnancy is contraindicated. Animal studies have shown an increased incidence of fetal damage [5], though its significance in humans is uncertain.

There are no valid data studies found in humans of Spironolactone during pregnancy. When using Spironolactone during pregnancy, the benefit must be weighed against the risk to the fetus. Discuss with the doctor briefly about that.

Spironolactone Pregnancy Category

Spironolactone is a pregnancy category C drug. This has been categorized by FDA USA. AU TGA categorized it as category B3.

This means: There are no adequate and well-controlled human studies, but potential benefits may support using the drug in pregnant women despite potential risks. Animal reproduction studies have shown negative effects on fetuses.

Spironolactone During Lactation

Do Spironolactone excretes into human milk? Yes. Based on limited data [6], spironolactone is poorly excreted in breastmilk. There were no adverse effects reported in infants whose mothers breastfed during spironolactone therapy.

The use of Spironolactone during breastfeeding appears to be safe according to some authorities.

Spironolactone With Alcohol

In the case of drinking alcohol and taking spironolactone, you might get orthostatic hypotension, which is low blood pressure when you get up after sitting. Dizziness, lightheadedness, and fainting can result from this sudden drop in blood pressure.

When combined with alcohol’s effects on your balance and motor skills, these issues can significantly increase your risk of injury. Be honest about your alcohol consumption with your doctor and discuss the risk factors.

Side Effects Of Spironolactone in Children

In general, Spironolactone is safe in childhood. When children are taking multiple diuretics, potassium concentrations should be carefully monitored. Some of these side effects may occur while your child is taking Spironolactone.

Consult your child’s doctor if any of these side effects persist or bother your child:

  • Sleepy feeling
  • The feeling of dizziness when getting up from a lying or sitting position
  • A sense of thirst increases
  • Having a dry mouth
  • Having a headache
  • Stomach cramps, upset stomach, or vomiting
  • Diarrhea or loose stools
  • Fatigue or weakness that is unusual
  • Changes in your child’s urination frequency
  • Breast swelling or soreness (both males and females)
  • Changes in menstruation (period)
  • Sexual ability changes

Several side effects are not common, but they may indicate a severe problem. Immediately contact your child’s doctor or go to the emergency department if any of these side effects occur:

  • An irregular heartbeat
  • Breathing problems (signs of allergic reaction)
  • Throw-up, urine, or bowel movements containing blood
  • Pain or cramps in the muscles
  • Feelings of burning, numbness, or tingling
  • Decreased urination
  • Severe rash

Pediatric patients commonly receive Spironolactone as part of their diuretic regimens. The only adverse effect was an increase in potassium levels. After long-term use, hypokalemia became more common than hyperkalemia. [7]

Research is needed to define Spironolactone’s pharmacokinetics and optimal dosing interval and determine its long-term effects.

Spironolactone Withdrawal Symptoms

You should keep in mind that when you stop taking spironolactone, it will quickly stop working to manage your condition. Spironolactone should not be stopped without consulting your doctor first. The sudden discontinuation of this medication will not cause withdrawal symptoms.

Things To Avoid While Taking Spironolactone

The consumption of salt substitutes, such as Lo-Salt, as well as low-sodium salts, should be avoided as they contain a lot of potassium. It is possible to have too high potassium levels if you combine these products with spironolactone.

Try to limit your intake of foods and drinks that contain a lot of potassium, including bananas, avocados, pulses, nuts, and salmon, as these contain a lot of potassium. It is possible to make a low-potassium diet with the help of your doctor or dietitian.

Medicines Interact With Spironolactone

In some cases, some medicines can cause spironolactone to stop working properly or increase the chances of you experiencing side effects from it. It is important that you tell your doctor if you are taking any of the following medications:

  1. Eplerenone
  2. Diuretics
  3. Other medications that increase potassium levels.
  4. Medicines that prevent blood clots, like enoxaparin, and antibiotics, like trimethoprim, are examples
  5. ACE inhibitors
  6. Digoxin
  7. The term non-steroidal anti-inflammatory drugs (NSAIDs) refers to a class of painkillers including diclofenac, ibuprofen, naproxen, aspirin, and others

If you are taking supplements that are high in potassium, such as Sando K tablets or Kay-Cee-L syrup, you should avoid taking them. If you take these with spironolactone, your potassium levels may become too high. It is difficult to find information about the effects of taking other herbal remedies and supplements with spironolactone. The process of testing them is not the same as that of pharmacy and prescription drugs.

How Long Does it Take To Get Spironolactone Out Of Your System?

Spironolactone, as well as its active metabolites, have a half-life of approximately 16 hours for their active metabolites.  It is estimated that it will take about 36 hours for traces of spironolactone to be completely eliminated from your blood as a result of taking spironolactone.

This drug only works when you are taking it. The sudden stop may lead to side effects, it is recommended that you talk to your doctor before you think to stop taking it.

What Reduces The Side Effects of Spironolactone

You should take this medication by mouth, as directed by your doctor. It is recommended to take the medication with food or milk if stomach upset occurs. You should take your dose early in the day (before 6 p.m.) if you want to avoid having to get up during the night to urinate. It is best to take your dose early in the day.

COVID-19 and Spironolactone

Study shows that Spironolactone may improve clinical outcomes in COVID-19. [8]

The use of spironolactone was analyzed and it was found that there was a substantial negative correlation between the use of spironolactone and the progression of COVID-19 disease to the point of admission to the intensive care unit (ICU). Additionally, a significant negative association has been found between spironolactone use and the need for a mechanical ventilator in patients who use spironolactone.

Can You Take COVID-19 Vaccine while taking Spironolactone

There is not enough data that warns about not taking COVID-19 Vaccine while taking Spironolactone. Not enough research has been done yet. There are some medications that may lessen the effect of the vaccine and Spironolactone is not one of them. It is expected to be safe with COVID 19 Vaccines and there is not much data that shows any side effects with Spironolactone.

Talk to your doctor before taking the vaccine, you may need to stop taking some medications for a period of time. Your doctor will set it according to your current physical condition.

Dr. Tauhid Al Araf

Dr. Tauhid Al Araf

Hi, I’m Dr. Tauhid. I’ve completed my MBBS from Shaheed Ziaur Rahman Medical College. After completing my BCS, now working as an Upazilla Health Complex Medical Officer. I'm on a mission to Spread awareness about using and misusing drugs has become so significant nowadays. This is one of my dream projects, hopefully, this gonna help people all around the world.

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