Spironolactone has been used clinically in the following conditions:
1. Primary hyperaldosteronism. Used as an aid in preparing patients with adrenal cortical tumors for surgery.
2. Hypokalemia. Used in patients with low serum K+ resulting from diuretic therapy with other agents. Its use should be restricted to patients who are unable to supplement their dietary K+ intake or adequately restrict their salt intake or who cannot tolerate orally available KCl preparations.
3. Hypertension and congestive heart failure. Although spironolactone may be useful in combination with thiazides, the latter remain the drugs of first choice. Fixed-dose combinations of spironolactone and a particular thiazide (e.g., Aldactazide) generally offer no therapeutic advantage over either component given separately and tend to restrict the ability of the clinician to determine the optimal dosage of each drug for a particular patient.
4. Cirrhosis and nephrotic syndrome. Spironolactone is a mild diuretic and may be useful in treating the edema that occurs in these two clinical conditions, that is, when excessive K+ loss is to be avoided.
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