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Medicines Monitoring

Spironolactone monitoring

Published Last updated
Topics: MonitoringSpironolactone
Using this page · Individualise medicines monitoring

This medicines monitoring page has been written using publications and expert opinion. It is designed to save clinician time, but not replace professional responsibility. When using this page you should: ensure an individualised monitoring plan is developed in partnership with the patient and take account of any locally agreed advice and guidance.

Contents

  1. Before starting
    1. Heart failure
  3. After started or dose changed
    1. Heart failure
  5. Ongoing once stable
    1. Heart failure
  7. Abnormal results
    1. Reduce dose
    2. Stop and seek advice
  9. Notes
    1. Advice to patients
  11. Bibliography
  12. Update history

Before starting

Heart failure

  • Baseline
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration ratecontraindicated in severe renal impairment or acute renal insufficiency
    • Electrolytes
    • Serum potassiumcontraindicated if greater than 5.0 mmol/L

After started or dose changed

Heart failure

  • After 1 week; then monthly for first 3 months, then every 3 months for one year
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
    • Electrolytes
  • Before and after each dose change
    • Blood pressure

Ongoing once stable

Heart failure

  • Every 6 months
    • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
    • Electrolytes

Abnormal results

Reduce dose

Reduce the dose and monitor blood biochemistry if any of the following occur:

Potassium

Potassium is greater than 5.5 mmol/L and less than 6 mmol/L

Creatinine

Creatinine is greater than 220 micromol/L and less than 310 micromol/L

Estimated glomerular filtration rate

eGFR is less than 20 to 30mL/min/1.73m2

Stop and seek advice

Stop and seek specialist advice if any of the following occur:

Potassium

Potassium is greater than 6 mmol/L

Creatinine

Creatinine is greater than 310 micromol/L

Estimated glomerular filtration rate

eGFR is less than 20mL/min/1.73m2

Notes

Advice to patients

Advise patients to:

  • Avoid NSAIDs unless prescribed
  • Avoid salt substitutes containing potassium
  • Contact prescriber if diarrhoea, vomiting, or infection with fever and sweating occurs

Bibliography

Update history

  1. Full review and update. Monitoring recommendations for 'Ongoing once stable' in patients with heart failure change to 'Every 6 months' instead of 'Every 3 to 6 months'.
  1. Published