Potassium-sparing diuretics and aldosterone antagonists

Notes:

1. Routine co-prescribing of potassium sparing diuretics in combination with thiazide or loop diuretics should be reserved as second line when the patient is stabilised, except in patients where hypokalaemia has been demonstrated or in patients not taking an ACE inhibitor who are at risk from hypokalaemia e.g. those with severe CHD and arrhythmias and those taking digoxin.
2. In severe heart failure, spironolactone added to other treatments in a low dose (e.g. 25mg daily) can reduce mortality and morbidity. Careful monitoring for hyperkalaemia and hypovolaemia is required especially for people taking other diuretics and / or ACE inhibitors.
3. Spironolactone is also included for specific indications e.g. ascites, nephrotic syndrome, primary hyperaldosteronism, hypertension.
4. Eplerenone has outcome data for LVF post MI, but is much more expensive than spironolactone and there is no comparative data for this indication.