螺內酯

用途

• As a diuretic in CHF (when furosemide and ACE inhibitors alone do not control fluid accumulation)
• As a diuretic in CHF (when serum potassium is low)
• For adjunctive treatment of hypertension
• For adjunctive treatment of hypertension (Step 3 drug)
• For adjunctive treatment of primary hyperaldosteronism
• Congestive heart failure, ascites, hyperaldosteronism
• As a diuretic in CHF (when furosemide and ACE inhibitors alone do not control fluid accumulation)
• As a diuretic in CHF (with other diuretics when hypokalemia is an issue)
• As a diuretic in CHF (to allow further reduction of furosemide dose)
• For treating ascites (using fixed dose combination with hydrochlorothiazide)
• For treating ascites (caused by right-sided heart failure)

給藥方式

可能的副作用

• Facial dermatitis (notably reported in Maine Coon cats)
• Hyperkalemia
• Hyponatremia
• Dehydration
• Increased BUN and mild acidosis (in patients with renal impairment)
• Gastrointestinal distress (vomiting, anorexia)
• CNS effects (lethargy, ataxia)
• Endocrine changes (anti-androgenic effects, e.g., gynecomastia in humans, feminization of male fetuses)
• Hyponatraemia
• Hyperkalaemia
• Reversible prostatic atrophy (in entire male dogs)
• Severe ulcerative facial dermatitis (in Maine Coon cats)
• Hepatotoxicity (reported in humans)

注意事項與禁忌

• Hyperkalemia
• Addison's disease (hypoadrenocorticism)
• Anuria
• Acute renal failure
• Significant renal impairment
• Hypoadrenocorticism
• Hyperkalaemia
• Hyponatraemia
• Concurrent use with NSAIDs in animals with renal insufficiency
• Pregnancy
• Lactation
• Animals intended for breeding
• > **Hepatic & Renal Caution:** Use cautiously in patients with hepatic disease (though often used to treat ascites). Use in patients with renal impairment may lead to hyperkalemia. > **Reproductive Safety:** FDA Category D for pregnancy. Spironolactone and its active metabolites cross the placenta and can cause feminization of male fetuses. Canrenone (active metabolite) is excreted in breast milk; use with caution in nursing animals.

藥物相互作用

• Digoxin: Spironolactone may increase the half-life of digoxin; enhanced monitoring of digoxin serum levels is warranted. May also cause falsely elevated digoxin values if using a radioimmune assay (RIA).
• Mitotane: Spironolactone may mute the effects of mitotane if given concurrently; monitor carefully.
• Neuromuscular blockers, non-depolarizing: Possible increase in neuromuscular blockade effects.
• Potassium-sparing diuretics (e.g., triamterene): Increased risk of hyperkalemia.
• Potassium supplements: Increased risk of hyperkalemia.
• Salicylates (e.g., Aspirin): Spironolactone's diuretic effects may be decreased if administered concomitantly.
• Thiazide diuretics: Potentiates diuretic effects
• Loop diuretics: Potentiates diuretic effects
• ACE inhibitors: Increased risk of hyperkalaemia (though generally safe to use concurrently in practice; monitor potassium)
• NSAIDs: Increased risk of hyperkalaemia and nephrotoxicity

常見問題