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Spironolactone

Also indexed as: Aldactone®

Combination drug: Aldactazide®

Spironolactone is a potassium-sparing diuretic. Diuretics cause water loss and are used to treat a variety of conditions, including high blood pressure, heart failure, and diseases of the kidneys and liver. Spironolactone is available as a single agent and in a combination drug product.

Interactions with Dietary Supplements

Folic acid
One study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics.1 Homocysteine, a toxic amino acid byproduct, has been associated with atherosclerosis. Folic acid is also an important cause of elevated homocysteine levels. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.

Magnesium
Preliminary research in animals suggests that amiloride, a drug similar to spironolactone, may inhibit the urinary excretion of magnesium.2 It is unknown if this same effect would occur in humans or with spironolactone. Persons taking more than 300 mg of magnesium per day and spironolactone should consult with a doctor as this combination may lead to potentially dangerous increases in the level of magnesium in the body. The combination of spironolactone and hydrochlorothiazide would likely eliminate this problem, as hydrochlorothiazide may deplete magnesium.

Potassium
As a potassium-sparing diuretic, spironolactone reduces urinary loss of potassium, which can lead to elevated potassium levels.3 People taking spironolactone should avoid potassium supplements, potassium-containing salt substitutes (Morton Salt Substitute®, No Salt®, Lite Salt®, and others), and even high-potassium foods (primarily fruit). Doctors should monitor potassium blood levels in patients taking spironolactone to prevent problems associated with elevated potassium levels.

Sodium
Diuretics, including spironolactone, cause increased loss of sodium in the urine. By removing sodium from the body, diuretics also cause water to leave the body. This reduction of body water is the purpose of taking diuretics. Therefore, there is usually no reason to replace lost sodium, although strict limitation of salt intake in combination with the actions of diuretics can sometimes cause excessive sodium depletion. On the other hand, people who restrict sodium intake and in the process reduce blood pressure may need to have their dose of diuretics lowered. People taking spironolactone should talk with their prescribing doctor before severely restricting salt.

Interactions with Herbs

Diuretic herbs
Herbs that have a diuretic effect should be avoided when taking diuretic medications, as they may increase the effect of these drugs and lead to possible cardiovascular side effects. These herbs include dandelion, uva ursi, juniper, buchu, cleavers, horsetail, and gravel root.4

Interactions with Foods and Other Compounds

Food
Food can increase absorption of spironolactone.5 Spironolactone should be taken at the same time and always with food or always without food, every day for best results. People with questions about spironolactone and food should ask their prescribing doctor or pharmacist.

Summary of Interactions for Spironolactone

Depletion or interference None known
Adverse interaction Buchu
Cleavers
Dandelion
Gravel root
Horsetail
Juniper
Magnesium*
Potassium
Uva ursi
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability None known
Other (see text) Sodium

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J 1999;92:866–70.

2. Devane J, Ryan MP. The effects of amiloride and triamterene on urinary magnesium excretion in conscious saline-loaded rats. Br J Pharmacol 1981;72:285–9.

3. Ramsay LE, Hettiarachchi J, Fraser R, Morton JJ. Amiloride, spironolactone, and potassium chloride in thiazide-treated hypertensive patients. Clin Pharmacol Ther 1980;27:533–43.

4. Brinker F. Herb Contraindications and Drug Interactions. Sandy, OR: Eclectic Institute, 1997, 102–3.

5. Threlkeld DS, ed. Diuretics and Cardiovasculars, Potassium-Sparing Diuretics, Spironolactone. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jul 1993, 138h–8j.