Medication Description: Spironolactone (Spironolactonum)
SPIRONOLACTON (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, differing in its mechanism of action from triamterene and amiloride. The diuretic effect exerted by spironolactone is associated with antagonism with respect to the adrenal hormone - aldosterone (See Preparations of the adrenal cortex and their synthetic analogues.).
Aldosterone is a mineralocorticosteroid; he is involved in regulating the concentration of electrolytes in the body; promotes the reabsorption 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: it is 25 times more abundant than deoxycorticosterone in its ability to delay the release of sodium and 300 times more active than cortisol (hydrocortisone).
Spironolactone is a competitive aldosterone antagonist with respect to the effect on distal nephrons; the drug increases the excretion of sodium, but reduces the excretion of potassium and urea, lowers the titratable acidity of urine. Natriuretic effect causes increased diuresis. Due to the increased excretion of sodium ions, spironolactone may have a hypotensive effect, but this effect is not constant.
Spiroolactone is used as a diuretic for edema associated with impaired cardiac activity, for ascites due to cirrhosis of the liver, for nephrotic syndrome and for edema of other origin. The diuretic effect of spironolactone is moderately pronounced and usually manifests itself on the 2nd - 5th day of treatment.
To accelerate and enhance the diuretic effect, other diuretics (benzothiadiazine derivatives, furosemide, ethacrynic acid, etc.) are simultaneously prescribed (in usual doses), while sodium excretion is significantly enhanced, and potassium elimination is delayed. In case of insufficient diuretic effect, glucocorticosteroids may be additionally prescribed. When nephrotic syndrome first give glucocorticosteroids, and if necessary, additionally spironolactone.
Spironolactone is especially indicated in the syndrome of hypokalemia caused by other diuretics, and in case of hypersensitivity to digitalis preparations caused by hypokalemia.
There is evidence of the use of spironolactone (veroshpiron) in infectious-allergic bronchial asthma. The drug is especially indicated for patients with bronchial asthma complicated by right heart failure.
Spironolactone was also used in paroxysmal myoplegia. The effect may be due to the delayed release of potassium ions from the body.
It is also proposed to use spironolactone in the complex therapy of parkinsonism.