Spironolactone 25 mg Tablet, Film Coated, 90-count
Other active recalls for Spironolactone (different manufacturers) — 1 · tap to view
🆔 Identity & classification
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🏷️ RxNorm drug class
This medicine belongs to the Aldosterone Antagonist class.
Where does this data come from?
🏭 Manufacturer & labeler
Where does this data come from?
🩺 Clinical
Spironolactone is used to treat certain patients with hyperaldosteronism (the body produces too much aldosterone, a naturally occurring hormone); low potassium levels; heart failure; and in patients with edema (fluid retention) caused by various conditions, including liver, or kidney disease. It is also used alone or with other medications to treat high blood pressure. Spironolactone is in a class of medications called aldosterone receptor antagonists. It causes the kidneys to eliminate unneeded water and sodium from the body into the urine but reduces the loss of potassium from the body. High...
Read the full MedlinePlus article ↗- Spironolactone has a few different uses depending on your situation. Most commonly, it's prescribed to treat moderate-to-severe heart failure, high blood pressure, or fluid buildup...
- What exactly is spironolactone used for?
- Yes, it actually matters quite a bit. Food can nearly double the amount of spironolactone your body absorbs. That doesn't mean you must always take it with food — but you should pi...
- Does it matter if I take it with food or not?
Patient education
Supplement & herbal interactions
Some supplements/herbs that may interact with Spironolactone — tap one for details:
Spironolactone may be associated with lower levels of 7 nutrients — worth a chat with your pharmacist, not a cause for alarm.
Where does this data come from?
Ask a licensed pharmacist directly — free, answered by our team.
💊 What it looks like
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🧪 Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.
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UNII O7TSZ97GEP
A mineral compound that serves as a filler and binding agent in tablets and capsules. It adds bulk to the medicine and helps hold ingredients together during manufacturing.
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UNII EX438O2MRT
Ferric oxide yellow is a naturally occurring iron compound used as a colorant in medications. It gives tablets, capsules, and other forms a yellow or golden hue for identification and appearance.
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UNII 3NXW29V3WO
Hypromellose is a plant-based thickener made from cellulose. It's used in medicines as a binder to hold ingredients together, a coating for tablets, and a thickener for liquids.
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UNII EWQ57Q8I5X
Lactose monohydrate is a natural sugar derived from milk. It serves as a filler and binder in tablets and capsules, helping create the proper size, texture, and consistency of the medicine.
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UNII 70097M6I30
Magnesium stearate is a salt made from magnesium and stearic acid, a fatty substance. It's used in tablets and capsules as a lubricant and glidant to help ingredients flow smoothly during manufacturing and prevent sticking.
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UNII AV092KU4JH
A natural oil extracted from peppermint plants. It's used as a flavoring agent to mask bitter tastes and add a refreshing mint flavor to medicines, making them easier to take.
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UNII B697894SGQ
Polyethylene glycol 400 is a clear, thick liquid made from petroleum-derived polymers. It acts as a solvent and humectant in medicines, helping dissolve active ingredients and retain moisture in the formulation.
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UNII K0KQV10C35
Povidone K25 is a synthetic polymer made from vinyl pyrrolidone. It acts as a binder to hold tablet ingredients together and as a disintegrant to help the tablet break apart in the stomach for better absorption.
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UNII ETJ7Z6XBU4
Silicon dioxide is a naturally occurring mineral used as a glidant and anti-caking agent. It helps powder ingredients flow smoothly and prevents clumping during manufacturing and storage.
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UNII O8232NY3SJ
A plant-based carbohydrate derived from corn kernels. It acts as a filler to add bulk, a binder to hold ingredients together, and a disintegrant to help the tablet break apart in your stomach for absorption.
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UNII 7SEV7J4R1U
A powder made from a naturally occurring mineral. In medicines, talc works as a glidant and anti-caking agent, helping tablets and capsules flow smoothly during manufacturing and preventing clumping.
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UNII 15FIX9V2JP
Titanium dioxide is a bright white mineral powder commonly used as a colorant and opacifying agent. It makes pills and tablets white or lighter in color and helps make coatings non-transparent.
12 inactive ingredients listed in the exact product block matched to this NDC.
Where does this data come from?
ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.Inactive ingredient FAQ
Are inactive ingredients the same for every manufacturer?
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💲 Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per each | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · Q2 2026 | $0.1319 | $11.87 / 90 tablets |
Where does this data come from?
🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Spironolactone 25 mg 00378-2146-01 | Mylan | 100 tablets | $0.043 | AB | Availability likely | — |
| spironolactone 25 mg 00904-6927-61 | Major | 100 tablets | $0.043 | AB | Availability likely | — |
| spironolactone 25 mg 31722-0094-01 | Camber | 100 tablets | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 51079-0103-20 | Mylan | 1 tablet | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 53489-0143-01 | Sun | 100 tablets | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 53746-0511-01 | Amneal | 100 tablets | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 59651-0426-01 | Aurobindo | 100 tablets | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 60687-0465-01 | American | 100 tablets | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 64980-0706-01 | Rising | 100 tablets | $0.043 | AB | Availability likely | — |
| spironolactone 25 mg 68382-0660-01 | Zydus | 100 tablets | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 69584-0852-10 | Oxford | 100 tablets | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 72603-0134-01 | NorthStar | 100 tablets | $0.043 | AB | Availability likely | — |
| Spironolactone 25 mg 16729-0225-01 | Accord | 100 tablets | $0.045 | AB | Availability likely | — |
| Spironolactone 25 mg 59746-0216-01 | Jubilant | 100 tablets | $0.052 | AB | FDA listed | — |
| Aldactone 25 mg 00025-1001-31 | Pfizer | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 00615-8451-05 | NCS | 15 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 42708-0101-30 | QPharma, | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 42708-0126-30 | QPharma, | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 43063-0832-01 | PD-Rx | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 48433-0087-20 | Safecor | 1 tablet | — | AB | FDA listed | — |
| Spironolactone 25 mg 50090-0136-00 | A-S | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 50090-3747-00 | A-S | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 50090-6369-00 | A-S | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 50090-6908-00 | A-S | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 50090-6909-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 50090-7797-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| spironolactone 25 mg 55154-3556-00 | Cardinal | 10 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 55154-5517-00 | Cardinal | 1 tablet | — | AB | FDA listed | — |
| Spironolactone 25 mg 63187-0841-03 | Proficient | 3 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 63629-1061-01 | Bryant | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 63629-1062-01 | Bryant | 500 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 63629-1064-01 | Bryant | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 63629-1830-01 | Bryant | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 63629-2437-01 | Bryant | 500 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 63629-8539-01 | Bryant | 1000 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 65162-0511-03 | Amneal | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 67046-0744-03 | Coupler | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 67544-0310-30 | Aphena | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 68071-2989-03 | NuCare | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 68071-3375-01 | NuCare | 120 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 68071-3967-03 | NuCare | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 68071-3969-01 | NuCare | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 68788-8545-03 | Preferred | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 70518-3625-00 | REMEDYREPACK | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 70518-4350-00 | REMEDYREPACK | 100 tablets | — | AB | FDA listed | — |
| spironolactone 25 mg 70518-4470-00 | REMEDYREPACK | 1 tablet | — | AB | FDA listed | — |
| spironolactone 25 mg 70771-1027-00 | Zydus | 1000 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71205-0146-30 | Proficient | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71205-0772-30 | Proficient | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71335-0053-01 | Bryant | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71335-2205-01 | Bryant | 500 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71335-2217-01 | Bryant | 1000 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71335-2301-01 | Bryant | 1000 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71335-2366-01 | Bryant | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71335-2846-01 | Bryant | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71610-0102-60 | Aphena | 90 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71610-0742-30 | Aphena | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 71610-0970-30 | Aphena | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 72162-1624-01 | Bryant | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 72162-1693-05 | Bryant | 500 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 72162-2150-05 | Bryant | 500 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 72189-0497-90 | Direct_Rx | 90 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 72789-0290-30 | PD-Rx | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mgthis 76420-0062-90 | Asclemed | 90 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 76420-0556-01 | Asclemed | 100 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 76420-0925-00 | Asclemed | 1000 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 82804-0255-30 | Proficient | 30 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 82804-0975-00 | Proficient | 100 tablets | — | AB | FDA listed | — |
| spironolactone 25 mg 51655-0636-26 | Northwind | 90 tablets | — | AB | FDA listed | — |
| Spironolactone 25 mg 67296-2319-09 | Redpharm | 90 tablets | — | AB | FDA listed | — |
Where does this data come from?
⏳ Availability & generic status
This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.
Where does this data come from?
📊 Medicare Part D spend CMS · PART D · 2026 (Q1)
📦 Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Status |
|---|---|---|---|
| 76420-0062-30 | 30 TABLET, FILM COATED in 1 BOTTLE (76420-062-30) | 2020-02-11 | Active |
| 76420-0062-01 | 100 TABLET, FILM COATED in 1 BOTTLE (76420-062-01) | 2023-10-03 | Active |
| 76420-0062-60 | 60 TABLET, FILM COATED in 1 BOTTLE (76420-062-60) | 2023-10-03 | Active |
| 76420-0062-90 You're viewing this | 90 TABLET, FILM COATED in 1 BOTTLE (76420-062-90) | 2023-10-03 | Active |
You're viewing one of 4 pack sizes for this product.
Pack size FAQ
What quantity is in NDC 76420-0062-90?
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🧭 About this NDC listing & data coverage
What data is (and isn’t) available for this NDC — tap to expand
| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | ✓ Available |
| NADAC pharmacy acquisition price (CMS) | — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey. |
| Orange Book / therapeutic-equivalence data | ✓ Available |
| HCPCS J-code billing crosswalk | — Not published for this NDC Most self-administered / retail products have no J-code — that is normal. |
| Medicaid utilization (CMS SDUD) | — Not published for this NDC CMS reports utilization only for NDCs with Medicaid claims above its privacy threshold. |
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📄 Full prescribing information FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Spironolactone is an aldosterone antagonist indicated for: The treatment of NYHA Class III–IV heart failure and reduced ejection fraction to increase survival, manage edema, and to reduce the need for hospitalization for heart failure ( 1.1 ) Use as an add-on therapy for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions ( 1.2 ) The management of edema in adult patients who are cirrhotic when edema is not responsive to fluid and sodium restrictions and in the setting of nephrotic syndrome when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics produce an inadequate response ( 1.3 ).
Treatment of primary hyperaldosternism for: ( 1.4 ) Short-term preoperative treatment Long-term maintenance for patients with discrete aldosterone-producing adrenal adenomas who are not candidates for surgery and patients with bilateral micro or macronodular adrenal hyperplasia
1.1Heart Failure Spironolactone tablets are indicated for treatment of NYHA Class III–IV heart failure and reduced ejection fraction to increase survival, manage edema, and reduce the need for hospitalization for heart failure. Spironolactone tablets are usually administered in conjunction with other heart failure therapies.
1.2Hypertension Spironolactone tablets are indicated as add-on therapy for the treatment of hypertension, to lower blood pressure in patients who are not adequately controlled on other agents. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes.
Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than one drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).
Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly.
Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.
Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy.
1.3 Edema Associated with Hepatic Cirrhosis or Nephrotic Syndrome…
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION Heart Failure: Initiate treatment at 25 mg once daily ( 2.2 ). Hypertension: Initiate treatment at 25 to 100 mg daily in either single or divided doses ( 2.3 ). Edema: Initiate therapy in a hospital setting and titrate slowly.
The recommended initial daily dose is 100 mg in single or divided doses ( 2.4 ). Primary hyperaldosteronism: Initiate treatment at 100 to 400 mg in preparation for surgery. In patients unsuitable for surgery use the lowest effective dosage determined for the individual patient ( 2.5 ).
2.1General Considerations Spironolactone tablets can be taken with or without food, but should be taken consistently with respect to food [see Clinical Pharmacology (12.3) ] .
2.2Treatment of Heart Failure In patients with serum potassium ≤5.0 mEq/L and eGFR >50 mL/min/1.73 m 2 , initiate treatment at 25 mg once daily. Patients who tolerate 25 mg once daily may have their dosage increased to 50 mg once daily as clinically indicated. Patients who develop hyperkalemia on 25 mg once daily may have their dosage reduced to 25 mg every other day [see Warnings and Precautions (5.1) ] .
In patients with an eGFR between 30 and 50 mL/min/1.73 m 2 , consider initiating therapy at 25 mg every other day because of the risk of hyperkalemia [see Use in Specific Populations (8.6) ].
2.3Treatment of Essential Hypertension The recommended initial daily dose is 25 to 100 mg of spironolactone tablets administered in either single or divided doses is recommended. Dosage can be titrated at two-week intervals. Doses greater than 100 mg/day generally do not provide additional reductions in blood pressure.
2.4Treatment of Edema In patients with cirrhosis, initiate therapy in a hospital setting and titrate slowly [see Use in Specific Populations (8.7) ] . The recommended initial daily dosage is 100 mg of spironolactone tablets administered in either single or divided doses, but may range from 25 to 200 mg daily. When given as the sole agent for diuresis, administer for at least five days before increasing dose to obtain desired effect.
2.5Treatment of Primary Hyperaldosteronism Administer spironolactone tablets in doses of 100 to 400 mg daily in preparation for surgery. For patients who are considered unsuitable for surgery, spironolactone tablets can be used as long-term maintenance therapy at the lowest effective dosage determined for the individual patient.
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Spironolactone tablets USP 25 mg are light yellow to yellow colored, round, biconvex, film coated tablets with inscription “AD” on one side and plain on the other side having faint odour of peppermint. Spironolactone tablets USP 50 mg are light orange to orange colored, oval, biconvex, film coated tablets with inscription “AE” on one side and breakline on the other side having faint odour of peppermint. Tablets: 25 mg, and 50 mg ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS Spironolactone tablets are contraindicated in the patients with: Hyperkalemia Addison's disease Concomitant use of eplerenone Spironolactone tablets are contraindicated in patients with ( 4 ): Hyperkalemia Addison's disease Concomitant use of eplerenone
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Hyperkalemia: Monitor serum potassium within one week of initiation and regularly thereafter ( 5.1 ). Hypotension and Worsening Renal Function: Monitor volume status and renal function periodically ( 5.2 ). Electrolyte and Metabolic Abnormalities: Monitor serum electrolytes, uric acid and blood glucose periodically ( 5.3 ). Gynecomastia: Spironolactone can cause gynecomastia ( 5.4 ).
5.1Hyperkalemia Spironolactone can cause hyperkalemia. This risk is increased by impaired renal function or concomitant potassium supplementation, potassium-containing salt substitutes or drugs that increase potassium, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers [see Drug Interactions (7.1) ] . Monitor serum potassium within 1 week of initiation or titration of spironolactone and regularly thereafter.
More frequent monitoring may be needed when spironolactone is given with other drugs that cause hyperkalemia or in patients with impaired renal function. If hyperkalemia occurs, decrease the dose or discontinue spironolactone and treat hyperkalemia.
5.2Hypotension and Worsening Renal Function Excessive diuresis may cause symptomatic dehydration, hypotension and worsening renal function, particularly in salt-depleted patients or those taking angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Worsening of renal function can also occur with concomitant use of nephrotoxic drugs (e.g., aminoglycosides, cisplatin, and NSAIDs). Monitor volume status and renal function periodically.
5.3Electrolyte and Metabolic Abnormalities In addition to causing hyperkalemia, spironolactone can cause hyponatremia, hypomagnesemia, hypocalcemia, hypochloremic alkalosis, and hyperglycemia. Asymptomatic hyperuricemia can occur and rarely gout is precipitated. Monitor serum electrolytes, uric acid and blood glucose periodically.
5.4Gynecomastia Spironolactone can cause gynecomastia. In The Randomized Spironolactone Evaluation Study, patients with heart failure treated with a mean dose of 26 mg of spironolactone once daily, about 9% of the male subjects developed gynecomastia. The risk of gynecomastia increases in a dose-dependent manner with an onset that varies widely from 1 to 2 months to over a year. Gynecomastia is usually reversible.
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following clinically significant adverse reactions are described elsewhere in the labeling: Hyperkalemia [see Warnings and Precautions (5.1) ] Hypotension and Worsening Renal Function [see Warnings and Precautions (5.2) ] Electrolyte and Metabolic Abnormalities [see Warnings and Precautions (5.3) ] Gynecomastia [see Warnings and Precautions (5.4 ] Impaired neurological function/ coma in patients with hepatic impairment, cirrhosis and ascites [see Use in Specific Populations (8.7) ] The following adverse reactions associated with the use of spironolactone were identified in clinical trials or postmarketing reports.
Because these reactions were reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency, reliably, or to establish a causal relationship to drug exposure. Digestive: Gastric bleeding, ulceration, gastritis, diarrhea and cramping, nausea, vomiting. Reproductive: Decreased libido, inability to achieve or maintain erection, irregular menses or amenorrhea, postmenopausal bleeding, breast and nipple pain.
Hematologic: Leukopenia (including agranulocytosis), thrombocytopenia. Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous eruptions, anaphylactic reactions, vasculitis. Metabolism: Hyperkalemia, electrolyte disturbances [see Warnings and Precautions (5.1 , 5.3) ] , hyponatremia, hypovolemia.
Musculoskeletal : Leg cramps. Nervous system/psychiatric: Lethargy, mental confusion, ataxia, dizziness, headache, drowsiness. Liver/biliary: A very few cases of mixed cholestatic/hepatocellular toxicity, with one reported fatality, have been reported with spironolactone administration.
Renal: Renal dysfunction (including renal failure). Skin: Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), alopecia, pruritis. The most common adverse reaction with spironolactone treatment is gynecomastia ( 5.4 , 6 ).
To report SUSPECTED ADVERSE REACTIONS, contact Accord Healthcare, Inc. at 1866-941-7875 or www.accordhealthcare.us or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch .
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS Agents increasing serum potassium: Concomitant administration can lead to hyperkalemia ( 5.1 , 7.1 ). Lithium: Increased risk of lithium toxicity ( 7.2 ). NSAIDs: May reduce the diuretic, natriuretic and antihypertensive effect of spironolactone ( 7.3 ).
Digoxin: spironolactone can interfere with radioimmunologic assays of digoxin exposure ( 7.4 ). Cholestyramine: Hyperkalemic metabolic acidosis has been reported with concomitant use ( 7.5 ). Acetylsalicylic Acid (ASA): ASA may reduce the efficacy of spironolactone ( 7.6 ).
7.1Drugs and Supplements Increasing Serum Potassium Concomitant administration of spironolactone with potassium supplementation or drugs that can increase potassium may lead to severe hyperkalemia. In general, discontinue potassium supplementation in heart failure patients who start spironolactone [see Warnings and Precautions (5.1) and Clinical Pharmacology (12.3) ] . Check serum potassium levels when ACE inhibitor or ARB therapy is altered in patients receiving spironolactone.
Examples of drugs that can increase potassium include: ACE inhibitors angiotensin receptor blockers non-steroidal anti-inflammatory drugs (NSAIDs) heparin and low molecular weight heparin trimethoprim
7.2Lithium Like other diuretics, spironolactone reduces the renal clearance of lithium, thus increasing the risk of lithium toxicity. Monitor lithium levels periodically when spironolactone is coadministered [see Clinical Pharmacology (12.3) ] .
7.3Nonsteroidal anti-inflammatory drugs (NSAIDs) In some patients, the administration of an NSAID can reduce the diuretic, natriuretic, and antihypertensive effect of diuretics. Therefore, when spironolactone and NSAIDs are used concomitantly, monitor closely to determine if the desired effect of the diuretic is obtained [see Clinical Pharmacology (12.3) ] .
7.4Digoxin Spironolactone and its metabolites interfere with radioimmunoassays for digoxin and increase the apparent exposure to digoxin. It is unknown to what extent, if any, spironolactone may increase actual digoxin exposure. In patients taking concomitant digoxin, use an assay that does not interact with spironolactone.
7.5Cholestyramine Hyperkalemic metabolic acidosis has been reported in patients given spironolactone concurrently with cholestyramine.
7.6Acetylsalicylic Acid Acetylsalicylic acid may reduce the efficacy of spironolactone. Therefore, when spironolactone and acetylsalicylic acid are used concomitantly, spironolactone tablets may need to be titrated to higher maintenance dose and the patient should be observed closely to determine if the desired effect is obtained [see Clinical Pharmacology (12.3) ] .
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Pregnancy: Based on animal data, spironolactone may affect sex differentiation of the male during embryogenesis ( 8.1 )
8.1Pregnancy Risk Summary Based on mechanism of action and findings in animal studies, spironolactone may affect sex differentiation of the male during embryogenesis (see Data ) . Rat embryofetal studies report feminization of male fetuses and endocrine dysfunction in females exposed to spironolactone in utero. Limited available data from published case reports and case series did not demonstrate an association of major malformations or other adverse pregnancy outcomes with spironolactone .
There are risks to the mother and fetus associated with heart failure, cirrhosis and poorly controlled hypertension during pregnancy (see Clinical Considerations ) . Because of the potential risk to the male fetus due to anti-androgenic properties of spironolactone and animal data, avoid spironolactone in pregnant women or advise a pregnant woman of the potential risk to a male fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.
All pregnancies have a background risk of birth defect, loss or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Clinical Considerations Disease-Associated Maternal and/or Embryo/Fetal Risk Pregnant women with congestive heart failure are at increased risk for preterm birth.
Stroke volume and heart rate increase during pregnancy, increasing cardiac output, especially during the first trimester. Clinical classification of heart disease may worsen with pregnancy and lead to maternal death. Closely monitor pregnant patients for destabilization of their heart failure.
Pregnant women with symptomatic cirrhosis generally have poor outcomes including hepatic failure, variceal hemorrhage, preterm delivery, fetal growth restriction and maternal death. Outcomes are worse with coexisting esophageal varices. Pregnant women with cirrhosis of the liver should be carefully monitored and managed accordingly.
Hypertension in pregnancy increases the maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage). Hypertension increases the fetal risk for intrauterine growth restriction and intrauterine death. Data Animal Data Teratology studies with spironolactone have been carried out in mice and rabbits at doses of up to 20 mg/kg/day.
On a body surface area basis, this dose in the mouse is substantially below the maximum recommended human dose and, in the rabbit, approximates the maximum recommended human dose. No teratogenic or other embryotoxic effects were observed in mice, but the 20 mg/kg dose caused an increased rate of resorption and a lower number of live fetuses in rabbits. Because of its antiandrogenic activity and the requirement of testosterone for male morphogenesis, spironolactone may have the potential for adversely affecting sex differentiation of the male during embryogenesis.
When administered to rats at 200 mg/kg/day between gestation days 13 and 21 (late embryogenesis and fetal development), feminization of male fetuses was observed. Offspring exposed during late pregnancy to 50 and 100 mg/kg/day doses of spironolactone exhibited changes in the reproductive tract including dose-dependent decreases in weights of the ventral prostate and seminal vesicle in males, ovaries and uteri that were enlarged in females, and other indications of endocrine dysfunction, that persisted into adulthood. spironolactone has known endocrine effects in animals including progestational and antiandrogenic effects.
8.2Lactation Risk Summary Spironolactone is not present in breastmilk; however, limited data from a lactating woman at 17 days postpartum reports the presence o…
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary Based on mechanism of action and findings in animal studies, spironolactone may affect sex differentiation of the male during embryogenesis (see Data ) . Rat embryofetal studies report feminization of male fetuses and endocrine dysfunction in females exposed to spironolactone in utero. Limited available data from published case reports and case series did not demonstrate an association of major malformations or other adverse pregnancy outcomes with spironolactone .
There are risks to the mother and fetus associated with heart failure, cirrhosis and poorly controlled hypertension during pregnancy (see Clinical Considerations ) . Because of the potential risk to the male fetus due to anti-androgenic properties of spironolactone and animal data, avoid spironolactone in pregnant women or advise a pregnant woman of the potential risk to a male fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.
All pregnancies have a background risk of birth defect, loss or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Clinical Considerations Disease-Associated Maternal and/or Embryo/Fetal Risk Pregnant women with congestive heart failure are at increased risk for preterm birth.
Stroke volume and heart rate increase during pregnancy, increasing cardiac output, especially during the first trimester. Clinical classification of heart disease may worsen with pregnancy and lead to maternal death. Closely monitor pregnant patients for destabilization of their heart failure.
Pregnant women with symptomatic cirrhosis generally have poor outcomes including hepatic failure, variceal hemorrhage, preterm delivery, fetal growth restriction and maternal death. Outcomes are worse with coexisting esophageal varices. Pregnant women with cirrhosis of the liver should be carefully monitored and managed accordingly.
Hypertension in pregnancy increases the maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage). Hypertension increases the fetal risk for intrauterine growth restriction and intrauterine death. Data Animal Data Teratology studies with spironolactone have been carried out in mice and rabbits at doses of up to 20 mg/kg/day.
On a body surface area basis, this dose in the mouse is substantially below the maximum recommended human dose and, in the rabbit, approximates the maximum recommended human dose. No teratogenic or other embryotoxic effects were observed in mice, but the 20 mg/kg dose caused an increased rate of resorption and a lower number of live fetuses in rabbits. Because of its antiandrogenic activity and the requirement of testosterone for male morphogenesis, spironolactone may have the potential for adversely affecting sex differentiation of the male during embryogenesis.
When administered to rats at 200 mg/kg/day between gestation days 13 and 21 (late embryogenesis and fetal development), feminization of male fetuses was observed. Offspring exposed during late pregnancy to 50 and 100 mg/kg/day doses of spironolactone exhibited changes in the reproductive tract including dose-dependent decreases in weights of the ventral prostate and seminal vesicle in males, ovaries and uteri that were enlarged in females, and other indications of endocrine dysfunction, that persisted into adulthood. spironolactone has known endocrine effects in animals including progestational and antiandrogenic effects.
🧒 Pediatric Use ▾
8.4Pediatric Use Safety and effectiveness in pediatric patients have not been established.
🧓 Geriatric Use ▾
8.5Geriatric Use Spironolactone is substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, monitor renal function.
🆘 Overdosage ▾
10 OVERDOSAGE The oral LD 50 of spironolactone is greater than 1000 mg/kg in mice, rats, and rabbits. Acute overdosage of spironolactone may be manifested by drowsiness, mental confusion, maculopapular or erythematous rash, nausea, vomiting, dizziness, or diarrhea. Rarely, instances of hyponatremia, hyperkalemia, or hepatic coma may occur in patients with severe liver disease, but these are unlikely due to acute overdosage.
Hyperkalemia may occur, especially in patients with impaired renal function. Treatment: Induce vomiting or evacuate the stomach by lavage. There is no specific antidote.
Treatment is supportive to maintain hydration, electrolyte balance, and vital functions. Patients who have renal impairment may develop hyperkalemia. In such cases, discontinue spironolactone.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Spironolactone and its active metabolites are specific pharmacologic antagonists of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. Spironolactone causes increased amounts of sodium and water to be excreted, while potassium is retained. Spironolactone acts both as a diuretic and as an antihypertensive drug by this mechanism.
It may be given alone or with other diuretic agents that act more proximally in the renal tubule.
12.2Pharmacodynamics Aldosterone antagonist activity: Increased levels of the mineralocorticoid, aldosterone, are present in primary and secondary hyperaldosteronism. Edematous states in which secondary aldosteronism is usually involved include congestive heart failure, hepatic cirrhosis, and nephrotic syndrome. By competing with aldosterone for receptor sites, spironolactone provides effective therapy for the edema and ascites in those conditions.
Spironolactone counteracts secondary aldosteronism induced by the volume depletion and associated sodium loss caused by active diuretic therapy.
12.3Pharmacokinetics Absorption The mean time to reach peak plasma concentration of spironolactone and the active metabolite, canrenone, in healthy volunteers is 2.6 and 4.3 hours, respectively. Effect of food : Food increased the bioavailability of spironolactone (as measured by AUC) by approximately 95.4%. Patients should establish a routine pattern for taking spironolactone with regard to meals [see Dosage and Administration (2.1) ] .
Distribution Spironolactone and its metabolites are more than 90% bound to plasma proteins. Elimination The mean half-life of spironolactone is 1.4 hour.The mean half-life values of its metabolites including canrenone, 7-α-(thiomethyl) spirolactone (TMS), and 6-β-hydroxy-7-α-(thiomethyl) spirolactone (HTMS) are 16.5, 13.8, and 15 hours, respectively. Metabolism : Spironolactone is rapidly and extensively metabolized.
Metabolites can be divided into two main categories: those in which sulfur of the parent molecule is removed (e.g., canrenone) and those in which the sulfur is retained (e.g., TMS and HTMS). In humans, the potencies of TMS and 7-α-thiospirolactone in reversing the effects of the synthetic mineralocorticoid, fludrocortisone, on urinary electrolyte composition were approximately a third relative to spironolactone. However, since the serum concentrations of these steroids were not determined, their incomplete absorption and/or first-pass metabolism could not be ruled out as a reason for their reduced in vivo activities.
Excretion: The metabolites are excreted primarily in the urine and secondarily in bile. Specific Populations The impact of age, sex, race/ethnicity, and renal impairment on the pharmacokinetics of spironolactone have not been specifically studied. Patients with Hepatic Impairment: The terminal half-life of spironolactone has been reported to be increased in patients with cirrhotic ascites [see Use in Specific Populations (8.7) ] .
Drug Interaction Studies: Drugs and Supplements Increasing Serum Potassium: Concomitant administration of spironolactone with potassium supplementation, salt substitutes containing potassium, a diet rich in potassium, or drugs that can increase potassium, including ACE inhibitors, angiotensin II antagonists, non-steroidal anti-inflammatory drugs (NSAIDs), heparin and low molecular weight heparin, may lead to severe hyperkalemia [see Warnings and Precautions (5.1) and Drug Interactions (7.1) ] . Lithium: Spironolactone reduces the renal clearance of lithium, inducing a high risk of lithium toxicity [see Warnings and Precautions (5.1) and Drug Interactions (7.2) ] .
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): In some patients, the administration of an NSAID can reduce the diuretic, natriuretic, and antihypertensive effect of loop, potassium-sparing, and thiazide diur…
🧬 Mechanism of Action ▾
12.1Mechanism of Action Spironolactone and its active metabolites are specific pharmacologic antagonists of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. Spironolactone causes increased amounts of sodium and water to be excreted, while potassium is retained. Spironolactone acts both as a diuretic and as an antihypertensive drug by this mechanism.
It may be given alone or with other diuretic agents that act more proximally in the renal tubule.
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING Spironolactone tablets USP 25 mg tablets are Light yellow to yellow colored, round, biconvex, film coated tablets with inscription “AD” on one side and plain on the other side having faint odour of peppermint, supplied as: NDC Number Size 76420-062-30 bottle of 30 (repackaged from NDC 16729-225-17) 76420-062-60 bottle of 60 (repackaged from NDC 16729-225-xx) 76420-062-90 bottle of 90 (repackaged from NDC 16729-225-xx) 76420-062-01 bottle of 100 (relabeled from NDC 16729-225-01) Spironolactone tablets USP 50 mg tablets are Light orange to orange colored, oval, biconvex, film coated tablets with inscription “AE” on one side and breakline on the other side having faint odour of peppermint, supplied as: NDC Number Size 76420-063-30 bottle of 30 (repackaged from NDC 16729-226-16) Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature] Protect from light.
Dispense in tight, Light-resistant containers.
📦 Storage and Handling ▾
Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature] Protect from light. Dispense in tight, Light-resistant containers.
📋 Description ▾
11 DESCRIPTION Spironolactone oral tablets USP, for oral administration contain 25 mg, or 50 mg of the aldosterone antagonist spironolactone, 17-hydroxy-7α-mercapto-3-oxo-17α-pregn-4-ene-21-carboxylic acid γ-lactone acetate, which has the following structural formula: Spironolactone is practically insoluble in water, soluble in alcohol, and freely soluble in benzene and in chloroform. Inactive ingredients include lactose monohydrate, dibasic calcium phosphate, povidone, peppermint oil, purified talc, pregelatinised starch, colloidal anhydrous silica, magnesium stearate, hypromellose, polyethylene glycol 400, titanium dioxide and iron oxide yellow.
In addition iron oxide red (50 mg tablets) is included in the film coating of specific strengths. Chemical Structure
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Patients who receive spironolactone tablets should be advised to avoid potassium supplements and foods containing high levels of potassium, including salt substitutes. Relabeled and Repackaged by: Enovachem PHARMACEUTICALS Torrance, CA 90501