Spironolactone/​Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Aldactazide

• Thiazide Combos

Combination oral diuretic product; potassium-sparing diuretic (aldosterone antagonist) and thiazide diuretic
For treatment of hypertension or edema (not initial treatment)
Useful for patients with hyperaldosteronism or hypokalemia

Indicated for the treatment of edema associated with cirrhosis of the liver, congestive heart failure, or the nephrotic syndrome.
For the treatment of essential hypertension.
For the treatment of chronic lung disease (CLD).

Hypersensitivity to spironolactone, hydrochlorothiazide, or sulfonamides

Acute renal failure

Acute/severe hepatic failure

Anuria

Hyperkalemia

Addison’s disease or other conditions associated with hyperkalemia

Coadministration with eplerenone

Spironolactone

• Drowsiness
• Lethargy
• Headache
• Stevens-Johnson Syndrome
• Rash
• Urticaria
• Gynecomastia
• Impotence
• Menstrual disorders
• Abdominal cramping
• Diarrhea
• Gastritis
• Nausea/vomiting
• Drug rash with eosinophilia and systemic symptoms (DRESS)
• Toxic epidermal necrolysis

Hydrochlorothiazide

• Anorexia
• Epigastric distress
• Hypotension
• Orthostatic hypotension
• Photosensitivity
• Anaphylaxis
• Anemia
• Confusion
• Erythema multiforme
• Stevens-Johnson syndrome
• Exfoliative dermatitis including toxic epidermal necrolysis
• Hypomagnesemia
• Dizziness
• Headache
• Hyperuricemia

Somnolence and dizziness reported

Caution with hepatic impairment

Spironolactone

• May cause hyperkalemia; risk may be increased in patients with renal insufficiency, diabetes mellitus, or if coadministered with other drugs/diet that raise serum potassium levels
• Gynecomastia reported

Hydrochlorothiazide

• May cause hypokalemia and hyponatremia; risk of hypokalemia may be increased in patients with cirrhosis, brisk diuresis, or if coadministered with other drugs that lower serum potassium
• May cause hypomagnesemia, which can then result in hypokalemia which appears difficult to treat despite potassium repletion
• May alter glucose tolerance and increase risk for hyperglycemia
• May increase serum levels of calcium and uric acid by decreasing urinary excretion; may also increase cholesterol and triglycerides
• Thiazides diuretics may add to or potentiate the action of other antihypertensive drugs
• Sensitivity reactions to thiazides may occur in patients with or without a history of allergy or bronchial asthma
• Sulfonamide derivatives, including thiazides, have been reported to exacerbate or activate systemic lupus erythematosus
• Instruct patients to protect skin from sun and undergo regular skin cancer screening

• Angle-closure glaucoma

Pregnancy Category: C

Lactation: discontinue drug or do not nurse