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Upper gastrointestinal bleeding and spironolactone

    Prescrire International
    |June 9, 2011
    PubMed

    Insights

    Spironolactone use is linked to a doubled risk of upper gastrointestinal bleeding, particularly at higher doses. Healthcare providers should consider this risk, especially in patients with predisposing factors.

    Area of Science:

    • Pharmacology
    • Gastroenterology
    • Clinical Medicine

    Background:

    • Spironolactone, a potassium-sparing diuretic, has known side effects including hyperkalemia and hormonal disturbances.
    • Upper gastrointestinal bleeding (UGIB) is a potential adverse effect associated with spironolactone use.

    Purpose of the Study:

    • To investigate the association between spironolactone and the incidence of upper gastrointestinal bleeding.
    • To evaluate the dose-dependent relationship between spironolactone and UGIB.

    Main Methods:

    • A meta-analysis combining data from one cohort study and two case-control studies.
    • Analysis focused on patients receiving spironolactone compared to controls.

    Main Results:

    • A twofold, dose-dependent increase in upper gastrointestinal bleeding incidence was observed in patients taking spironolactone.
    • The proposed mechanism involves spironolactone's aldosterone antagonist activity potentially delaying gastroduodenal healing.

    Conclusions:

    • Spironolactone should be considered a potential cause of gastrointestinal bleeding, despite it not being a common side effect of aldosterone antagonists.
    • Caution is advised when prescribing spironolactone, especially in patients with existing risk factors for gastrointestinal bleeding.

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