Notes for: Pot-Sparing Diuretics&Aldosterone AntagLast edited [09/08/2013 15:18:23]1. Routine co-prescribing of potassium-sparing diuretics in combination with thiazide or loop diuretics should be AVOIDED except in patients where hypokalaemia has been demonstrated or in patients not taking an ACE inhibitor who are at risk from hypokalaemia, eg those with severe CHD and arrhythmias and those taking digoxin.
2. Spironolactone is used in severe CHF at a low dose of 12.5 - 25 mg daily as adjunct therapy. A dose of 50 mg daily may be advised by a specialist if heart failure deteriorates and hyperkalaemia is not a problem. Close monitoring of renal function and potassium is recommended (eg weekly) in early phases of treatment. See NICE Clinical Guideline on Heart Failure
3. Spironolactone is also included for specific indications eg ascites, nephrotic syndrome, primary hyperaldosteronism.
4. Eplerenone : in addition to standard optimal therapy, to reduce the risk of cardiovascular mortality and morbidity in adult patients with NYHA class II or worse (chronic) heart failure and left ventricular systolic dysfunction (LVEF =30%). Treatment should be initiated at a dose of 25 mg once daily and titrated to the target dose of 50 mg once daily preferably within 4 weeks; taking into account the serum potassium level. Patients with moderate renal impairment (CrCl 30-60 ml/min) should be started at 25 mg every other day, and dose should be adjusted based on the potassium level. Serum potassium should be measured before initiating eplerenone therapy, within the first week and at one month after the start of treatment or dose adjustment. Serum potassium should be assessed as needed periodically thereafter.