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Tolerability of spironolactone in patients with chronic heart failure -- a cautionary message
Miles D Witham1, Neil D Gillespie, Allan D Struthers
1Section of Ageing and Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. m.witham@dundee.ac.uk
Aim:
To assess how well heart failure patients tolerate spironolactone in routine clinical practice.
Design:
Retrospective analysis of 226 patients attending a specialist heart failure clinic.
Results:
One hundred and thirty of 226 (57.5%) patients tried spironolactone at least once. Forty-four of 130 (33.8%) discontinued spironolactone due to side-effects after a mean of 11.1 months; 59/141 (41.8%) trials of spironolactone resulted in at least one side-effect; therapy was stopped in 30/141 (21.3%) trials due to raised potassium or creatinine. Significant risk factors for raised potassium/creatinine were age and baseline potassium level.
Conclusions:
Potentially serious side-effects are common despite appropriate use of spironolactone.
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