Spironolactone and Hydrochlorothiazide

Spironolactone and hydrochlorothiazide is a prescription medication used to treat high blood pressure and fluid retention caused by various conditions. Spironolactone and hydrochlorothiazide is a single product containing 2 medications: spironolactone and hydrochlorothiazide. Spironolactone belongs to a group of drugs called diuretics ("water pills"). Specifically, it is a "potassium-sparing" diuretic known as an "aldosterone antagonist". By blocking aldosterone, spironolactone helps the body get rid of excess fluid  by increasing the amount of salt and water the kidneys remove from the blood, while still keeping potassium in the body. Hydrochlorothiazide belongs to a group of drugs called thiazide diuretics, which work by stopping reabsorption of salt into your body. This prevents fluid from building up in the body.

This medication comes in tablet form. It is typically given once daily with or without food.

Common side effects include nausea, vomiting, and headache.

Spironolactone and hydrochlorothiazide can cause dizziness and weakness. Do not drive or operate heavy machinery until you know how this medication affects you. 

Spironolactone and hydrochlorothiazide is a prescription medication used to treat high blood pressure and fluid retention caused by various conditions.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 

Spironolactone and Hydrochlorothiazide may be found in some form under the following brand names:

• Aldactazide

Serious side effects have been reported with spironolactone and hydrochlorothiazide. See the "Spironolactone and hydrochlorothiazide Precautions" section. 

Common side effects of spironolactone and hydrochlorothiazide include the following:

• weakness
• low blood pressure
• stomach issues such as diarrhea, vomiting, cramping, constipation, nausea
• an eating disorder associated with low weight (anorexia) 
• inflammation of a saliva gland (sialoadenitis)
• muscle spasm
• dizziness
• feeling like your surroundings are spinning (vertigo)
• headache
• skin reactions involving redness and itching
• short term blurred vision
• predominance of yellow in vision (xanthopsia)

This is not a complete list of spironolactone and hydrochlorothiazide side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• ACE inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace)
• angiotensin receptor II blockers such as azilsartan (Edarbi), candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis, Twynsta), and valsartan (Diovan)
• medicines that block a substance in the body called aldosterone such as eplerenone (Inspra) and spironolactone (Aldactone)
• heparin (Hemochron, Hep-Lock)
• nonsteroidal anti-inflammatory medications such as ibuprofen (Motrin, Nuprin) or naproxen (Aleve) and salicylates
• corticosteroids such as prednisone, hydrocortisone (Cortef), and dexamethasone (Decadron, Dexone, Hexadrol)
• lithium (Eskalith, Lithobid)
• potassium products including potassium chloride (K-Dur, Klor-Con, Micro-K), potassium citrate (Urocit-K, Polycitra-K), potassium gluconate, potassium phosphate (Neutra-Phos-K, K-Phos)
• salt substitutes that contain potassium
• alcohol
• a group of pain medicines called narcotics such as oxycodone (Roxicodone, Oxycontin, Oxecta)
• barbiturates such as amobarbital (Amytal), butalbital (Fioricet, Fiorinal), phenobarbital (Luminal) and others
• digoxin (Digox, Lanoxin)
• substances that raise blood pressure (pressor amines) such as norepinephrine (Levophed)
• medicines that relax skeletal muscles such as cyclobenzaprine (Flexeril) and carisoprodol (Soma)
• cholestyramine (Questran)

This is not a complete list of spironolactone and hydrochlorothiazide drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with spironolactone and hydrochlorothiazide or its ingredients including the following:

• a condition in which close objects appear clearly, but far ones don't (myopia) or a buildup of pressure in the eye that can cause blindness (glaucoma). Tell your healthcare provider right away if you experience ​visual changes or eye pain.
• allergic reactions. Tell your healthcare provider about any symptoms of allergic reactions, which include the following:
  • ​chest pain
  • swelling of the face, eyes, lips, tongue, arms, or legs
  • difficulty breathing or swallowing
  • rash
• imbalances in the levels of salts and fluids in your body (electrolyte and fluid imbalance). Tell your healthcare provider right away if you have some or all of the following symptoms:
  • dry mouth
  • thirst
  • weakness
  • drowsiness
  • restlessness
  • muscle pains or cramps
  • low blood pressure
  • low output of urine
  • fast heart rate
  • nausea
  • vomiting
• liver, pancreas, and kidney damage
• lowered white blood cell count (agranulocytosis/leukopenia) increasing the risk of infections
• low red blood cell count (aplastic or hemolytic anemia)
• low amount of platelets in the blood which causes bleeding into the tissues, bruising, and slow blood clotting after injury (thrombocytopenia)

Do not take spironolactone and hydrochlorothiazide if you:

• are allergic to spironolactone and hydrochlorothiazide or any of its ingredients, thiazides, or other sulfonamide-derived drugs
• have kidneys that cannot produce urine (anuria)
• have kidney problems (significant impairment of renal excretory function)
• have high levels of potassium or calcium in the blood
• have Addison's disease
• have acute or severe liver failure

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of spironolactone and hydrochlorothiazide, salt substitutes containing potassium should be avoided. 

Before taking spironolactone and hydrochlorothiazide, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to spironolactone and hydrochlorothiazide or any of its ingredients, thiazides, or other sulfonamide-derived drugs
• have kidneys that cannot produce urine (anuria)
• have kidney problems (significant impairment of renal excretory function)
• have high levels of potassium or calcium in the blood
• have Addison's disease
• have acute or severe liver failure
• have diabetes
• you are pregnant or plan to become pregnant
• you are breastfeeding or plan to breastfeed

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Spironolactone and hydrochlorothiazide falls into category C.  In animal studies, pregnant animals were given spironolactone and hydrochlorothiazide, and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child. 

Tell your doctor is you are breastfeeding or plan to breastfeed. 

Spironolactone and hydrochlorothiazide has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from spironolactone and hydrochlorothiazide, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered. 

• Take spironolactone and hydrochlorothiazide exactly as prescribed. 
• Spironolactone and hydrochlorothiazide comes in a tablet form and is usually taken by mouth once daily with or without food. 

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. 

The dose your doctor recommends may be based on the following:

• your blood pressure
• previous medications used and the doses tried
• how you respond to this medication

The usual dose range of spironolactone and hydrochlorothiazide to treat high blood pressure and fluid retention is 50mg to 100 mg each of spironolactone and hydrochlorothiazide given once daily or in divided doses. 

If you take too much spironolactone and hydrochlorothiazide, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away. 

• Store below 77°F (25°C).
• Keep this and all medications out of the reach of children. 

WARNING

Spironolactone, an ingredient of spironolactone and hydrochlorothiazide, has been shown to be a tumorigen in chronic toxicity studies in rats. Spironolactone and hydrochlorothiazide should be used only in those conditions indicated. Unnecessary use of this drug should be avoided.

Fixed-dose combination drugs are not indicated for initial therapy of edema or hypertension. Edema or hypertension requires therapy titrated to the individual patient. If the fixed combination represents the dosage so determined, its use may be more convenient in patient management. The treatment of hypertension and edema is not static but must be reevaluated as conditions in each patient warrant.