Common use
Aldactone (spironolactone) is a potassium-sparing diuretic and aldosterone antagonist. By blocking aldosterone’s effects in the kidneys and other tissues, it helps remove excess sodium and water without depleting potassium. Clinically, it is used to reduce morbidity and mortality in heart failure with reduced ejection fraction, to treat resistant hypertension, and to manage edema associated with cirrhosis and nephrotic syndrome. It is also used to diagnose and treat primary hyperaldosteronism (Conn’s syndrome).
Off-label, spironolactone is frequently prescribed for hormonal acne, hirsutism, and symptoms related to polycystic ovary syndrome due to its anti-androgen properties. Some gender-affirming care protocols include spironolactone to reduce androgen effects. All uses should be supervised by a clinician, with periodic monitoring of kidney function and electrolytes to mitigate risks like hyperkalemia.
Dosage and direction
Dosing is individualized based on the condition, kidney function, and response. For heart failure, clinicians often start at 12.5–25 mg once daily and titrate to 25–50 mg daily if tolerated, guided by potassium and creatinine. In resistant hypertension, typical doses range from 25–50 mg once daily, occasionally up to 100 mg/day in divided doses. For edema due to cirrhosis or nephrotic syndrome, 25–200 mg/day may be used, often combined with a loop diuretic, with careful sodium restriction and monitoring.
For primary hyperaldosteronism, dosing varies widely (often 100–400 mg/day) depending on whether it is used diagnostically, preoperatively, or as long-term therapy when surgery is not an option. Off-label for acne or hirsutism, clinicians commonly start at 25–50 mg/day and titrate to 100–200 mg/day based on response and tolerability. Because spironolactone can raise potassium, baseline and follow-up labs are essential, especially after initiation and dose increases.
Take Aldactone at the same time each day with food to minimize stomach upset. If a diuretic effect disrupts sleep, morning dosing is often preferred. Do not adjust your dose or add potassium supplements or salt substitutes containing potassium without medical advice.
Precautions
Aldactone can increase serum potassium and affect kidney function. Before starting and periodically during therapy, your clinician will check electrolytes and renal function. Hyperkalemia risk is higher in older adults, those with chronic kidney disease, diabetes, or when used with ACE inhibitors, ARBs, aliskiren, or potassium supplements. Report symptoms like muscle weakness, palpitations, or profound fatigue promptly.
Spironolactone has anti-androgen effects that may cause menstrual irregularities, breast tenderness, or decreased libido. Dizziness or low blood pressure can occur, particularly when combined with other antihypertensives, after alcohol, or during dehydration. In patients with advanced liver disease, cautious titration and close monitoring are vital to avoid electrolyte shifts that may precipitate encephalopathy.
The product carries a tumorigenicity warning based on high-dose animal data; use only for approved or well-justified indications. Discuss pregnancy plans: spironolactone is generally avoided during pregnancy due to potential effects on a male fetus. In breastfeeding, limited data suggest low risk, but individualized risk–benefit discussions are advised.
Contraindications
Do not use Aldactone if you have hyperkalemia, anuria, acute renal insufficiency, Addison’s disease, or a known hypersensitivity to spironolactone. Avoid combining with other potassium-sparing diuretics (such as amiloride or triamterene). Use with extreme caution—or avoid—in severe kidney impairment unless guided by a specialist. Spironolactone is typically avoided in pregnancy for non–life-threatening indications. Always review your full medication list and medical history with your clinician before starting.
Possible side effects
Common side effects include increased urination, dizziness, low blood pressure, gastrointestinal upset (nausea, diarrhea), headache, and fatigue. Due to anti-androgen activity, some people experience breast tenderness, gynecomastia (in men), menstrual irregularities, or changes in libido. Acne patients may notice increased urination and initial breast tenderness that often settles with time and dose adjustment.
Serious adverse effects include hyperkalemia, hyponatremia, kidney dysfunction, and rare hypersensitivity reactions (rash, angioedema). Signs of dangerous potassium elevation include muscle weakness, tingling, flaccid paralysis, or heart rhythm changes (palpitations, syncope). Seek urgent care if you develop severe lightheadedness, fainting, chest pain, or signs of an allergic reaction. Periodic lab monitoring helps detect problems early so dosing can be adjusted or therapy discontinued.
Drug interactions
Drugs that raise potassium or reduce kidney perfusion increase the risk of hyperkalemia with Aldactone. Notable interactions include ACE inhibitors (such as lisinopril), ARBs (such as losartan), aliskiren, potassium supplements, potassium-containing salt substitutes, trimethoprim (including TMP-SMX), and heparin/low–molecular weight heparins. Nonsteroidal anti-inflammatory drugs (NSAIDs) can blunt diuretic effect and worsen kidney function when combined.
Spironolactone can increase digoxin levels; monitor for toxicity if used together. Diuretics may increase lithium levels and toxicity risk; avoid or monitor closely. Alcohol and other blood pressure–lowering agents may enhance hypotensive effects. While hepatic metabolism occurs, cytochrome-mediated interactions are generally less prominent than with many other drugs; nonetheless, always provide your pharmacist and clinician with a complete medication and supplement list, including herbal products like licorice (which can counteract aldosterone blockade) and high-dose DHEA or testosterone products (which may affect androgen-related outcomes).
Missed dose
If you miss a dose, take it as soon as you remember unless it is close to your next scheduled dose. If it is near your next dose, skip the missed dose and resume your regular schedule. Do not double up to “catch up.” If you miss doses frequently, set reminders and discuss adherence strategies with your clinician.
Overdose
Overdose may cause drowsiness, dizziness, nausea, vomiting, diarrhea, dehydration, low blood pressure, and dangerous electrolyte disturbances—especially hyperkalemia—which can trigger life-threatening arrhythmias. Seek emergency care immediately or contact Poison Control at 1-800-222-1222 in the U.S. Management typically includes cardiac monitoring, serial electrolytes, IV fluids, and targeted therapies to correct potassium and sodium abnormalities. Bring the medication bottle or a list of doses taken to assist clinicians.
Storage
Store Aldactone at room temperature (68–77°F or 20–25°C) in a dry place, away from excess heat and light. Keep tablets in their original container with the lid tightly closed and out of reach of children and pets. Do not store in the bathroom. Dispose of unused or expired medication through a take-back program; do not flush unless instructed.
U.S. Sale and Prescription Policy
In the United States, Aldactone (spironolactone) is a prescription-only medicine. It is not legal or safe to buy Aldactone without a prescription, and websites offering “no-Rx” sales often dispense counterfeit or substandard drugs and bypass critical safety checks like kidney function and potassium monitoring. The responsible path is to obtain a clinician’s evaluation—often achievable conveniently through telehealth—and fill the prescription at a licensed pharmacy (local or mail order).
If you are seeking a streamlined experience without an in-person office visit, many reputable health systems and telemedicine services provide same- or next-day online consultations. After a licensed clinician confirms that Aldactone is appropriate, they will issue a prescription that can be sent electronically to your pharmacy. Ask about generics (spironolactone), price matching, discount programs, or manufacturer and nonprofit assistance options. Bottom line: while queries about how to “buy Aldactone without prescription” are common, U.S. law requires a valid prescription; legitimate providers can make the process fast, legal, and safe with proper monitoring to protect your heart, kidneys, and electrolytes.
