SPIRONOLACTONE MERCK 75 mg Spironolactone tablets scored to 50 mg. Action
Diuretic (drug increasing renal filtration) hyperkaliémiant (originally of an increase in the rate of potassium in the blood). One speaks also of potassium-sparing diuretic amending the exchanges between the sodium and potassium to the level of a specific area of the kidney: the distal convoluted tubule. Its action is by effect antialdostérone.
Aldosterone is part of the hormone called minéralocorticostéroïdes. It is secreted in the cortex (i.e. peripheral part) of the adrenal glands (glands on the kidneys) and allow the kidneys to reabsorb sodium, and eliminate the potassium. These two metals play a leading role in the regulation of blood pressure of the body.

The primary role of aldosterone is its action on the nephron (unit of functioning of the kidney). At the level of the nephron, there is an area called distal tubule where aldosterone is making out (first urine produced by the nephron) primitive urine sodium to the blood. In contrast, aldosterone allows the passage of potassium in the urine. The sodium in the blood will cause water retention, as a result the increase in blood volume, hence the increase in blood pressure.

Important loss of water (this is the case for example of diarrhea or vomiting repeatedly), the body increases the production of aldosterone to preserve its sodium. The adrenal glands secrete then most importantly aldosterone.
Conversely, when there is a too large amount of sodium in the body where, adrenal manufacture less aldosterone, causing a leak of sodium in the urine.
The regulation of this system involves substances together under the term of Renin angiotensin system.

Indications
• Elevation of blood pressure
• Cardiac and liver edema: retention of water and salt which origin is renal or secondary to nephrotic syndrome (set of symptoms that accompany the Glomerulonephritis, or kidney disease characterized by an impairment of the glomeruli).
• Primary hyperaldosteronism. Hyperaldosteronism (excessive secretion of aldosterone) results in hypokalemia (drop in blood potassium levels). This hyperaldosteronism is either primary (benign tumor of the adrenal gland), is secondary to the decrease in blood volume in the body.
• In the case of myasthenia gravis, spironolactone is used in adjuvant therapy

Dosage
Tablets, in adults and in the case of edema: 50 to 100 mg, and up to 300 mg per day at the beginning of treatment, adapted then.
In the case of cyclic idiopathic edema: 50 to 100 mg daily in maintenance treatment
In the presence of high blood pressure: 50 to 100 mg daily (associated with other antihypertensives)
In the presence of a hyperaldosteronism: up to 300 mg per day, and in the child 2 mg / kg / day.

Contraindications
• Hyperkalemia (increased potassium levels, greater than 5.5 mmol / l)
• Severe kidney failure in acute phase
• At the terminal stage of liver failure, spironolactone should not be used
• Some patients have a known hypersensitivity or allergy to this molecule.

Drug interactions
Contraindicated:
• Potassium, outside a hypokalemic episode
• Other diuretics hyperkaliémiants (increasing potassium levels in the blood)
Deprecated:
• Converting enzyme inhibitors
• Lithium
Monitor:
• Nonsteroidal drugs (not containing cortisone)
• Metformin
• Iodinated contrast products used to pass certain radiological examinations (scanner, radio with preparation, etc.)
• Diuretics hypokaliémiants, that is at the origin of a decrease in the rate of potassium in the blood

Adverse effects
• A (mammary volume increase) Gynecomastia usually reversible with discontinuation of treatment
• Impotence in men
• Disorders of the rules
• Gastrointestinal disorders
• Drowsiness
• Skin rash
• Headaches
• Risk of hyperkalemia (too much elevation of potassium in the blood) in patients with cirrhosis when natrémie (rate of sodium in the blood) is less than 130 mmol per litre

Pregnancy and breastfeeding
The administration of this molecule is discouraged during pregnancy and breastfeeding.