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Spironolactone Class * Potassium-sparing diuretic * Aldosterone (mineralocorticoid) receptor antagonist Mechanism of Action Spironolactone blocks aldosterone receptors in the distal convoluted tubule and collecting duct, resulting in: * Increased sodium and water excretion * Reduced potassium excretion (potassium retention) * Reduced cardiac and vascular remodeling in heart failure Indications * Heart failure with reduced ejection fraction (HFrEF) * Resistant hypertension * Primary hyperaldosteronism (Conn syndrome) * Ascites due to liver cirrhosis * Edema associated with heart failure or nephrotic syndrome * Polycystic ovary syndrome (PCOS) for hirsutism * Prevention of hypokalemia Dosage Adults * Heart failure: 12.525 mg once daily, titrated as needed * Ascites: 100400 mg daily * Hypertension: 25100 mg daily Adverse Effects Common * Hyperkalemia * Nausea * Dizziness * Fatigue Endocrine Effects * Gynecomastia * Breast tenderness * Erectile dysfunction * Decreased libido * Menstrual irregularities Contraindications * Hyperkalemia * Severe renal impairment * Addison disease * Hypersensitivity to spironolactone Drug Interactions * ACE inhibitors * ARBs * Potassium supplements * Other potassium-sparing diuretics These combinations increase the risk of hyperkalemia