Drug breakdown: Spironolactone
Abstract
In this column, Sharon Rees aims to refresh knowledge and interest in some of the commonly used drugs in a series of tweets. This month she is talking about #spironolactone
Dr Sharon Rees @reesprescribe
Day 1: In the early 1950s, after aldosterone was extracted and purified, there followed an investigation re the action and development of antagonists. An oral agent #spironolactone was approved by the FDA in 1960 and by the UK in the early 60s.
Dr Sharon Rees @reesprescribe
(cont) It took until 1987 to clone the mineralocorticoid receptor (MR), via which aldosterone/spironolactone act. By this time, the dose-dependent limitations for use in oedema were known, as poor MR selectivity leads to many sexual adverse drug reactions (ADRs), such as voice pitch change, breast pain and gynaecomastia.
Dr Sharon Rees @reesprescribe
Day 2: Indications for #spironolactone include moderate-severe heart failure (main UK use), oedema associated with ascites, nephrotic syndrome and CHF. Unlicensed uses include resistant hypertension (adjunct). Antiandrogen properties make it suitable for acne and hirsutism.
Dr Sharon Rees @reesprescribe
(cont) #spironolactone was revived after the RALES study (1999) showed a 30% reduction in heart failure in any type of mortality and this drug is now key to the management pathway for heart failure.
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