Management of primary hyperaldosteronism, edematous conditions for patients w/ CHF, cirrhosis of the liver accompanied by edema &/or ascites, nephrotic syndrome, essential HTN, severe heart failure (NYHA class III-IV); treatment/prophylaxis of hypokalemia; in pregnancy when edema is due to pathologic causes.
Long-term therapy for primary hyperaldosteronism 400 mg daily for 3-4 wk. Short-term therapy for primary hyperaldosteronism 400 mg daily for 4 days. In preparation for surgery 100-400 mg daily. Edema in adult (CHF, hepatic cirrhosis or nephrotic syndrome) Initially 100 mg daily as single or divided doses, but may range from 25-200 mg daily, then continue for at least 5 days. Essential HTN Initially 50-100 mg as single or divided doses, then continue for at least 2 wk. Hypokalemia 25-100 mg daily. Severe heart failure (NYHA class III-IV)Patient w/ serum K of ≤5 mEq/L & serum creatinine ≤2.5 mg/dL Initially 25 mg once daily, may increase to 50 mg once daily. Patient who do not tolerate 25 mg once daily may reduce dosage to 25 mg every other day.
K supplementation, excessive K intake. Do not administer concurrently w/ other K-sparing diuretics, or lithium. Concomitant use w/ ACE inhibitors or indomethacin. Patients w/ severe heart failure, impaired hepatic function. Monitor K & creatinine 1 wk after initiation of therapy or increase in dose, mthly for the 1st 3 mth, then quarterly for a year, & then every 6 mth. Observe for evidence of fluid or electrolyte imbalance eg, hypomagnesemia, hyponatremia, hypochloremic alkalosis & hyperkalemia. Discontinue if hyperkalemia is present. Reversible hyperchloremic metabolic acidosis in some patients w/ decompensated hepatic cirrhosis. Dilutional hyponatremia. Transient elevation of BUN in patient w/ preexisting renal impairment. Mild acidosis. Gynecomastia may develop. Avoid K supplements & foods containing high levels of K. Periodic determination of serum electrolytes particularly in elderly & patient w/ renal or hepatic impairment. Pregnancy & lactation. Childn.
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