Mechanism of action

Spironolactone is an aldosterone antagonist which acts in the cortical collecting duct.

Indications

Indications
  • ascites: patients with cirrhosis develop a secondary hyperaldosteronism. Relatively large doses such as 100 or 200mg are often used
  • hypertension: used in some patients as a NICE 'step 4' treatment
  • heart failure (see RALES study below)
  • nephrotic syndrome
  • Conn's syndrome

Adverse effects

Adverse effects
  • hyperkalaemia
  • gynaecomastia: less common with eplerenone