For adults, the daily dose may be given in divided doses or as single daily dose.
Essential Hypertension: The usual adult dose is 50 mg/day to 100 mg/day, which for difficult or severe cases may be gradually increased at intervals of 2 weeks up to 200 mg/day.
Treatment should be continued for at least 2 weeks to ensure an adequate response to therapy. Dose should be adjusted as necessary.
Congestive Heart Failure: An initial daily dose of 100 mg of spironolactone administered in either single or divided doses is recommended, but may range from 25 mg to 200 mg daily. Maintenance dose should be individually determined.
Severe heart failure in conjunction with standard therapy (NYHA Class III-IV): Based on the Randomized Aldactone Evaluation Study (RALES), treatment in conjunction with standard therapy should be initiated at a dose of spironolactone 25 mg once daily in patients with a serum potassium ≤5.0 mEq/L and serum creatinine ≤2.5 mg/dL. Patients who tolerate 25 mg once daily may have their dose increased to 50 mg once daily as clinically indicated.
Patients who do not tolerate 25 mg once daily may have their dose reduced to 25 mg every other day (see Hyperkalemia in Patients with Severe Heart Failure under Precautions for advice on monitoring serum potassium and serum creatinine).
Cirrhosis: If urinary Na+/K+ ratio is greater than 1.0, the usual adult dose is 100 mg/day. If the ratio is less than 1.0 the usual dose is 200 mg/day to 400 mg/day. Maintenance dose should be individually determined.
Nephrotic Syndrome: The usual adult dose is 100 mg/day-200 mg/day. Spironolactone has not been shown to affect the basic pathological process, and its use is advised only if other therapy is ineffective.
Edema in Children: Initial dosage is 3 mg/kg body weight daily in divided doses. Dosage should be adjusted on the basis of response and tolerance. If necessary, a suspension may be prepared by pulverizing spironolactone tablets with a few drops of glycerin and adding cherry syrup. Such a suspension is stable for 1 month when refrigerated.
Diagnosis and Treatment of Primary Hyperaldosteronism: Spironolactone (Aldactone) may be employed as an initial diagnostic measure to provide presumptive evidence of primary hyperaldosteronism while patients are on normal diets.
Long Test: Daily adult dose of 400 mg for 3 to 4 weeks. Correction of hypokalemia and hypertension provides presumptive evidence for the diagnosis of primary hyperaldosteronism.
Short Test: Daily adult dose of 400 mg for 4 days. If serum potassium increases during Spironolactone (Aldactone) administration, but drops when Spironolactone (Aldactone) is discontinued, a presumptive diagnosis of primary hyperaldosteronism should be considered.
Short-Term Pre-Operative Treatment of Primary Hyperaldosteronism: After the diagnosis of hyperaldosteronism has been established by more definitive testing procedures, spironolactone (Aldactone) may be administered in daily doses of 100 mg to 400 mg in preparation for surgery. For patients who are considered unsuitable candidates for surgery, spironolactone (Aldactone) may be employed for long-term maintenance therapy at the lowest effective dosage determined for the individual patient.
Hypokalemia/Hypomagnesemia: 25 mg to 100 mg daily may be useful in treating diuretic-induced hypokalemia and/or hypomagnesemia when oral potassium and/or magnesium supplements are considered inappropriate.
Management of Hirsutism: The usual dose is 100 mg/day to 200 mg/day, preferably in divided dose.