Unable to load your delegates due to an error Spironolactone (Aldactone) is a potassium-sparing diuretic that was approved many years ago. Perez A, A prudent approach would be to begin with an ACE inhibitor (or an angiotensin-II receptor blocker) and spironolactone in most patients One death over one year in patients with NYHA class III and IV failureOne death over one year in patients with NYHA class I or II failureOne death over two years in patients with NYHA class IV failureOne death over one year in patients with NYHA class III and IV failureOne death over one year in patients with NYHA class I or II failureOne death over two years in patients with NYHA class IV failureHydralazine (Apresoline)/isosorbide dinitrate (Isorem)Patients who are still symptomatic despite maximal dosages of other medicationsHydralazine (Apresoline)/isosorbide dinitrate (Isorem)Patients who are still symptomatic despite maximal dosages of other medicationsSpironolactone is contraindicated in patients with anuria, acute renal insufficiency, significant renal insufficiency or hyperkalemia. Chronic kidney disease (CKD) has been defined as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m2. Most supporting trials have however excluded patients with renal dysfunction resulting in a dearth of data to support use of spironolactone in CKD patients with CHF. Other side effects are rare and include drug fever, drowsiness, lack of coordination, lethargy and gastrointestinal signs and symptoms.Dosages range from 25 to 50 mg per day in patients with heart failure, although much higher dosages are used to treat other disorders. Dr. Luttermoser completed medical training at the Medical College of Ohio, Toledo, and a residency at the Family Practice Residency at Akron City Hospital, Akron, Ohio. of Health and Human Services, Agency for Health Care Policy and Research, 1994; Clinical Practice Guideline no. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. As an aldosterone-blocking agent, spironolactone is postulated to work synergistically with angiotensin-converting enzyme (ACE) inhibitors to provide more thorough blockade of the renin-angiotensin-aldosterone (RAA) system.The RAA system is the complex mechanism by which the kidneys control the cardiovascular system. Arnau JM, This production is only transiently suppressed, thus allowing aldosterone production to “escape” the effects of the ACE inhibitors.Spironolactone is a specialized antagonist of aldosterone. Ordinary physical activity results in fatigue or dyspnea.Patients with cardiac disease resulting in marked limitation of physical activity. Losartan Heart Failure Mortality Meta-analysis Study Group. Nomenclature and criteria for diagnosis. They are comfortable at rest. COVID-19 is an emerging, rapidly evolving situation. Vidal X, Ambrosioni E, Diseases of the heart and blood vessels. More research is necessary to determine the order and combinations of these medications in slowing the progression of this disease. Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. Wiley Zannad F, Archibald DG, Access This ArticleKATHERINE L. MARGO, M.D., is associate professor of family medicine at the University of Pennsylvania School of Medicine, Philadelphia. Boschi S,
94–0612. Current guidelines support the use of spironolactone for more comprehensive suppression of the RAAS in heart failure patients. Abstract. Richard W. Sloan, M.D., R.Ph., coordinator of this series, is chairman and residency program director of the Department of Family Medicine at York (Pa.) Hospital and clinical associate professor in family and community medicine at the Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pa