Tolerability of spironolactone in patients with chronic heart failure – a cautionary message

Authors


Dr Miles D. Witham, Clinical Lecturer in Ageing & Health, Section of Ageing and Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Tel: + 44(0) 1382 632436
Fax: + 44(0) 1382 660675
E-mail: m.witham@dundee.ac.uk

Abstract

Aim

To assess how well heart failure patients tolerate spironolactone in routine clinical practice.

Design

Retrospective analysis of 226 patients attending a specialist heart failure clinic.

Results

One hundred and thirty of 226 (57.5%) patients tried spironolactone at least once. Forty-four of 130 (33.8%) discontinued spironolactone due to side-effects after a mean of 11.1 months; 59/141 (41.8%) trials of spironolactone resulted in at least one side-effect; therapy was stopped in 30/141 (21.3%) trials due to raised potassium or creatinine. Significant risk factors for raised potassium/creatinine were age and baseline potassium level.

Conclusions

Potentially serious side-effects are common despite appropriate use of spironolactone.

Ancillary