Tolerability of spironolactone in patients with chronic heart failure -- a cautionary message.
OBJECTIVE
To assess how well heart failure patients tolerate spironolactone in routine clinical practice.


METHODS
Retrospective analysis of 226 patients attending a specialist heart failure clinic.


RESULTS
One hundred and thirty of 226 (57.5%) patients tried spironolactone at least once. Forty-four of 130 (33.8%) discontinued spironolactone due to side-effects after a mean of 11.1 months; 59/141 (41.8%) trials of spironolactone resulted in at least one side-effect; therapy was stopped in 30/141 (21.3%) trials due to raised potassium or creatinine. Significant risk factors for raised potassium/creatinine were age and baseline potassium level.


CONCLUSIONS
Potentially serious side-effects are common despite appropriate use of spironolactone.
Witham
Miles D
MD
Section of Ageing and Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. m.witham@dundee.ac.uk
Gillespie
Neil D
ND
Struthers
Allan D
AD
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D003404:Creatinine / Q000378:metabolism; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects*
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D003404:Creatinine