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HEART FAILURE
The exciting new finding that spironolactone (Aldactone) is beneficial for heart failure will change prescribing habits.
Researchers saw such significant improvement that they stopped the study early. The New England Journal of Medicine released the article over a month before it was scheduled to be published.
Adding spironolactone to the usual therapy for severe CHF improves symptoms.. .and reduces mortality and hospitalization by 30%.
Spironolactone was approved 40 years ago.. .but it's a weak diuretic and isn't used much. Most CHF patients get an ACE inhibitor.. .plus a icop diuretic such as furosemide.
But combining spironolactone and ACE inhibitors makes sense... they have additive effects to block aldosterone.
ACE inhibitors reduce the PRODUCTION of aldosterone... spironolactone blocks its EFFECTS by blocking aldosterone receptors.
Aidosterone plays an important role in the progression of CHF. It not only causes sodium retention.. . it also causes rnyocardial and vascular fibrosis.
Give 25 mg/day of spironolactone to patients with Class III or IV heart failure.. .along with a loop diuretic, ACE inhibitor, etc.
This low dose of spironolactone doesn't have much of a diuretic effect.. .use it for its cardioprotective effect.
Monitor serum potassium and renal function. . .both spiroriolactone and ACE inhibitors can block the renal excretion of potassium.
Don't give spironola.ctone if serum creatinine is > 2.5 mg/dL... too much risk of hyperkalemia.
About 10% of men on spironolactone develop gynecornastia... because of its androgen-blocking effects.
In the future, you'll see more SELECTIVE aldosterone receptor antagonists that don't block androgeri receptors. Searle is now testing one called eplerenone. . . for CHF and hypertension.'50801
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