PMID- 19006114
OWN - NLM
STAT- MEDLINE
DCOM- 20090227
LR  - 20211020
IS  - 0160-9289 (Print)
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Linking)
VI  - 31
IP  - 11
DP  - 2008 Nov
TI  - Safety of spironolactone use in ambulatory heart failure patients.
PG  - 509-13
LID - 10.1002/clc.20284 [doi]
AB  - BACKGROUND: Since the Randomized Aldactone Evaluation Study (RALES), the use of 
      spironolactone is recommended in systolic heart failure (HF) patients that have 
      been in New York Heart Association (NYHA) class III or IV. There is limited 
      information on the use, side effects, and withdrawal rate of spironolactone in 
      routine clinical practice. HYPOTHESIS: Side effects related to spironolactone use 
      are more common than reported in clinical trials. METHODS: Patients who had 
      moderate to severe left ventricular systolic dysfunction (LVSD) under optimized 
      medical therapy were included. We introduced spironolactone in those with serum 
      potassium (K+) < or = 5 meq/L, and serum creatinine (Cr) < or = 2.5 mg/dL. 
      Spironolactone was withdrawn if serum K + > or = 5.5 meq/L, serum Cr increased 
      more than 30%- 50% of the baseline value, and/or if the patient had gynecomastia. 
      RESULTS: We selected 134 patients followed in an HF clinic. In our sample, 56.7% 
      of the patients (76 out of 134) were currently or had formerly been on 
      spironolactone therapy. The rate of spironolactone withdrawal was 25% (19 out of 
      76). Reasons for suspension were hyperkalemia (17.1%), renal function 
      deterioration (14.5%), gynecomastia (5.3% of males), and other reasons (1.3%). 
      CONCLUSION: Spironolactone side effects are common and are mostly related to 
      effects on the angiotensin-aldosterone axis. Our results reinforce the need to 
      closely monitor serum K+ and Cr levels in patients treated with spironolactone, 
      as its side effects are more common than reported in clinical trials.
CI  - Copyright 2008 Wiley Periodicals, Inc.
FAU - Lopes, Ricardo J
AU  - Lopes RJ
AD  - Department of Cardiology, Hospital Sao Joao 4200-319 Porto, Portugal. 
      rjlclopes@hotmail.com
FAU - Lourenco, Ana Patricia
AU  - Lourenco AP
FAU - Mascarenhas, Joana
AU  - Mascarenhas J
FAU - Azevedo, Ana
AU  - Azevedo A
FAU - Bettencourt, Paulo
AU  - Bettencourt P
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Biomarkers)
RN  - 0 (Diuretics)
RN  - 0 (Mineralocorticoid Receptor Antagonists)
RN  - 27O7W4T232 (Spironolactone)
RN  - AYI8EX34EU (Creatinine)
SB  - IM
CIN - Clin Cardiol. 2009 Jun;32(6):347-8. PMID: 19569078
MH  - Aged
MH  - Ambulatory Care
MH  - Biomarkers/blood
MH  - Cohort Studies
MH  - Creatinine/blood
MH  - Disease Progression
MH  - Diuretics/administration & dosage/*adverse effects
MH  - Female
MH  - Heart Failure/blood/*drug therapy
MH  - Humans
MH  - Hyperkalemia/blood/*chemically induced
MH  - Kidney/*pathology
MH  - Male
MH  - Mineralocorticoid Receptor Antagonists/administration & dosage/*adverse effects
MH  - Renin-Angiotensin System/drug effects
MH  - Retrospective Studies
MH  - Spironolactone/administration & dosage/*adverse effects
PMC - PMC6652974
EDAT- 2008/11/14 09:00
MHDA- 2009/02/28 09:00
PMCR- 2008/11/12
CRDT- 2008/11/14 09:00
PHST- 2008/11/14 09:00 [pubmed]
PHST- 2009/02/28 09:00 [medline]
PHST- 2008/11/14 09:00 [entrez]
PHST- 2008/11/12 00:00 [pmc-release]
AID - CLC20284 [pii]
AID - 10.1002/clc.20284 [doi]
PST - ppublish
SO  - Clin Cardiol. 2008 Nov;31(11):509-13. doi: 10.1002/clc.20284.