Description of the medicine: Spironolactone (Spironolactonum)
Spironolactone (Spironolactonum). g-Lactone-3- (3-oxo-7 a-thioacetyl-17 b-hydroxy-4-androsten-17 a yl-) propionic acid.
Synonyms: Aldactone, Veroshpiron, Aldactone A, Spironolactone, Verospiron.
Spironolactone is a potassium-sparing diuretic that differs in its mechanism of action from triamteren and amiloride. The diuretic effect exerted by spironolactone is associated with antagonism with respect to the hormone of the adrenal cortex - aldosterone (See Adrenal cortex preparations and their synthetic analogues.).
Aldosterone is a mineralocorticosteroid; he is involved in regulating the concentration of electrolytes in the body; promotes the reverse absorption of sodium ions in the renal tubules, reduces the excretion of sodium in the urine, enhances the excretion of potassium ions. As a mineralocarticosteroid, aldosterone is significantly more active than deoxycorticosterone: in its ability to delay the release of sodium, it is 25 times higher than deoxycorticosterone and 300 times more active than cortisol (hydrocortisone).
Spironolactone is a competitive antagonist of aldosterone in relation to the effect on the distal nephrons; the drug increases the excretion of sodium, but reduces the excretion of potassium and urea, and reduces the titratable acidity of urine. Natriuretic action leads to increased diuresis. Due to the increased release of sodium ions, spironolactone may have a hypotensive effect, but this effect is not constant.
Spirolactone is used as a diuretic for edema associated with cardiac disorders, ascites due to cirrhosis of the liver, nephrotic syndrome and edema of other origin. The diuretic effect of spironolactone is moderate and usually manifests itself on the 2nd - 5th day of treatment.
To accelerate and enhance the diuretic effect, other diuretics (derivatives of benzothiadiazine, furosemide, ethacrylic acid, etc.) are simultaneously prescribed (in usual doses), while the release of sodium is significantly increased, and the excretion of potassium is delayed. With insufficient diuretic effect, glucocorticosteroids can be additionally prescribed. With nephrotic syndrome, glucocorticosteroids are first given, and if necessary, additional spironolactone.
Spironolactone is especially indicated for hypokalemia syndrome caused by other diuretics and hypersensitivity to digitalis preparations due to hypokalemia.
There is evidence of the use of spironolactone (veroshpiron) in infectious-allergic bronchial asthma. The drug is especially indicated for patients with asthma complicated by heart failure.
Spironolactone was also used for paroxysmal myoplegia. The effect is possibly associated with a delay in the excretion of potassium ions from the body.
It is also proposed to use spironolactone in the treatment of parkinsonism.