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20-September-2008 09:55:50 - Spironolactone Spironolactone Systematic IUPAC name 7α-Acetylthio-3-oxo-17α-pregn-4-ene-21,17-carbolactone Identifiers CAS number 52-01-7 ATC code C03DA01 PubChem 5833 DrugBank APRD01234 Chemical data Formula C24H32O4S Mol. mass 416.574 g/mol SMILES eMolecules PubChem Synonyms Aldactone Spirotone Spirolactone Pharmacokinetic data Bioavailability ? Metabolism Hepatic Half life 10 minutes Excretion Urine, bile Therapeutic considerations Pregnancy cat. B3AU CUS Legal status POMUK Routes Oral Spironolactone marketed under the trade names Aldactone, Novo-Spiroton, Spiractin, Spirotone, Verospiron or Berlactone is a diuretic and is used as an antiandrogen. It is a synthetic 17-lactone drug which is a renal competitive aldosterone antagonist in a class of pharmaceuticals called potassium-sparing diuretics, used primarily to treat heart failure, ascites in patients with liver disease, low-renin hypertension, hypokalemia, and Conn's syndrome as well as high blood pressure. On its own, spironolactone is only a weak diuretic, but it can be combined with other diuretics. About one person in one hundred with hypertension has elevated levels of aldosterone; in these persons the antihypertensive effect of spironolactone may exceed that of complex combined regimens of other antihypertensives. Due to its anti-androgen effect, it can also be used to treat hirsutism, and is a common component in hormone therapy for male-to-female transsexual and transgendered people. It is also used for treating hair loss and acne in women and can be used as a topical medication for treatment of male baldness. Contents 1 Mechanism of action 2 Pharmacokinetics 3 Mortality and morbidity benefit in severe heart failure 4 Adverse effects and interactions 4.1 Carcinogenicity 5 Other potential benefits 6 See also 7 References 8 External links Mechanism of action Spironolactone inhibits the effect of aldosterone by competing for intracellular aldosterone receptors in the distal tubule cells it actually works on aldosterone receptors in the collecting duct. This increases the excretion of water and sodium, while decreasing the excretion of potassium. Spironolactone has a fairly slow onset of action, taking several days to develop and similarly the effect diminishes slowly. Spironolactone has anti-androgen activity by binding to the androgen receptor and preventing it interacting with dihydrotestosterone.1 Pharmacokinetics Spironolactone is fairly rapidly absorbed from the gastrointestinal tract. It is also rapidly metabolised and bound in plasma proteins. Many of its metabolites are also active and one of them, canrenone as potassium canrenoate, is used parenterally when rapid effect is needed. Spironolactone's half-life is 85 minutes, but canrenone's half-life is 10 to 35 hours, depending on the dose. The main elimination route is in the urine and some also in the bile. Mortality and morbidity benefit in severe heart failure Spironolactone was shown to have a significant mortality and morbidity benefit in the Randomized Aldactone Evaluation Study RALES, which studied people with severe congestive heart failure New York Heart Association functional class III or IV.2 Patients in the study arm of the trial those receiving spironolactone had a relative risk of death when compared to the placebo group equal to 0.70 or a 30% relative risk reduction. Patients in the study arm also had fewer symptoms of CHF and were hospitalized less frequently. The mechanism of this effect is also mediated by inhibiting aldosterone, which in conjunction with heart failure leads to myocardial fibrosis, sodium retention, and vascular dysfunction. Adverse effects and interactions Spironolactone is associated with an increased risk of bleeding from the stomach and duodenum, but a causal relationship between the two has not been established.3 Because it also affects androgen receptors and other steroid receptors, it can cause gynecomastia, menstrual irregularities and testicular atrophy. Other side effects include ataxia, erectile dysfunction, drowsiness and rashes. A carcinogenic effect has been demonstrated in rats. Spironolactone has been shown to be immunosuppressive in the treatment of sarcoidosis.4 Spironolactone often increases serum potassium levels and can cause hyperkalemia, a potentially serious condition. Therefore, it is recommended that people using this drug avoid potassium supplements and salt substitutes containing potassium. 5 Doctors usually recommend periodic screening of serum potassium levels and some patients may be advised to limit dietary consumption of potassium. Research has also shown that spironolactone can interfere with the effectiveness of antidepressant treatment. The drug is actually among its other receptor interactions a mineralocorticoid MR antagonist, and has been found to reduce the effectiveness of antidepressant drugs in the treatment of major depression, presumably by interfering with normalization of the hypothalamic-pituitary-adrenal axis in patients receiving antidepressant therapy. 6 Carcinogenicity Studies of spironolactone and the related compound potassium canrenoate which, like spironolactone, metabolizes to canrenone in rats for one to two year periods show an increase in carcinogenesis in the thyroid gland, testes, liver, breasts, and myelocytic leukocytes. Mammalian cells, depending on the presence of metabolic activation, show mixed results for mutagenicity in vitro.7 In light of this research, Sandoz has recommended that unnecessary use of spironolactone be avoided. Other potential benefits It has been suggested that spironolactone can reduce the risk of Alzheimer's disease. In one study 8, researchers observed a reduction in the risk of Alzheimer's specifically associated with potassium-sparing diuretics. Unpublished findings from other studies, including the Gothenberg Study have suggested that higher potassium levels may be associated with a lower risk of dementia. It is widely reported that most American diets contain more sodium than is necessary and lack the optimal daily intake of potassium. Therefore, spironolactone could theoretically counter the effects of the typical American diet as it tends to promote sodium excretion and potassium retention. However, there is no proof that it is beneficial for persons whose serum potassium and sodium levels are within the normal range. Few if any doctors would recommend using spironolactone in the absence of conditions for which it is normally indicated. See also Baldness treatments References ^ Berardesca, E; Gabba P, Ucci G, Borroni G, Rabbiosi G. 1988. Topical spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands: an autoradiographic study in subjects with acne vulgaris. Int J Tissue React. 10 2: 115-119. PMID 2972662. Retrieved on 2007-03-15. ^ Pitt B, Zannad F, Remme W, Cody R, Castaigne A, Perez A, Palensky J, Wittes J 1999. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 341 10: 709-17. doi:10.1056/NEJM199909023411001. PMID 10471456. ^ Verhamme KMC, Mosis G, Dieleman JP, et al. 2006. Spironolactone and risk of upper gastrointestinal events: population based case-control study. Brit Med J 333 7563: 330-3. doi:10.1136/bmj.38883.479549.2F. PMID 16840442. ^ Wandelt-Freerksen E. 1977. Aldactone in the treatment of sarcoidosis of the lungs. JZ Erkr Atmungsorgane. 1491: 156-9. PMID 607621. Retrieved on 2007-05-02. ^ Advisory Statement pdf. Klinge Chemicals / LoSalt. Retrieved on 2007-03-15. ^ Holsboer, F. The Rationale for Corticotropin-Releasing Hormone Receptor CRH-R Antagonists to Treat Depression and Anxiety. J. Psychiatr. Res. 33, 181-214 1999 ^ Spironolactone RX Monograph html. Sandoz Inc.. Retrieved on 2007-05-02. ^ Antihypertensive Medication Use and Incident Alzheimer Disease http://archneur.ama-assn.org/cgi/content/full/63.5/noc60013v1 External links nih.gov information site Aldactone patient info leaflet v d e Antihypertensives C02 and diuretics C03 Sympatholytic agents Centrally acting/antiadrenergics α2 agonist Clonidine, Guanfacine, Methyldopa imidazoline receptor agonist Moxonidine, Rilmenidine adrenergic uptake inhibitor Rescinnamine, Reserpine Ganglion-blocking/nicotinic antagonist Mecamylamine, Trimethaphan Peripherally acting/antiadrenergics α1 blockers: Prazosin Indoramin Trimazosin Doxazosin Urapidil Guanidine derivatives: Betanidine Guanethidine Guanoxan Debrisoquine Guanoclor Guanazodine Guanoxabenz Vasodilators Diazoxide hydrazinophthalazine Hydralazine, Dihydralazine, Endralazine, Cadralazine Minoxidil Nitroprusside Phentolamine Other antihypertensives serotonin antagonist Ketanserin endothelin receptor antagonist Bosentan, Ambrisentan, Sitaxsentan MAOI Pargyline THI Metirosine Diuretics Low ceiling Thiazides at DCT Bendroflumethiazide Hydroflumethiazide Hydrochlorothiazide Chlorothiazide Polythiazide Trichlormethiazide Cyclopenthiazide Methyclothiazide Cyclothiazide Mebutizide Sulfonamides Quinethazone Clopamide Chlortalidone Mefruside Clofenamide Metolazone Meticrane Xipamide Indapamide Clorexolone Fenquizone Other Mersalyl Theobromine Cicletanine osmotic Mannitol, Urea carbonic anhydrase inhibitor at PT Acetazolamide High ceiling Loop diuretic at AL Bumetanide, Furosemide, Torasemide, Ethacrynic acid Potassium-sparing at CD ESC blockers Amiloride, Triamterene aldosterone antagonists Spironolactone, Eplerenone, Potassium canrenoate, Canrenone v d e Sex hormones and related agents primarily G03, also L02, H01C - human endogenous in CAPS Progestogens: receptor Agonist PROGESTERONE, Dienogest, Desogestrel, Drospirenone, Dydrogesterone, Ethisterone, Etonogestrel, Ethynodiol diacetate, Gestodene, Gestonorone, Levonorgestrel, Lynestrenol, Medroxyprogesterone, Megestrol, Norelgestromin, Norethisterone, Norethynodrel, Norgestimate, Norgestrel, Norgestrienone, Tibolone SPRM Asoprisnil, CDB-4124 Antiprogestogen Mifepristone Androgens: receptor Agonist TESTOSTERONE, Androstanolone, Fluoxymesterone, Mesterolone, Methyltestosterone, see also anabolic steroids Antiandrogen Bicalutamide, Cyproterone, Dienogest, Flutamide, Nilutamide, Spironolactone Estrogens: receptor Agonist ESTRADIOL, ESTRIOL, ESTRONE, Chlorotrianisene, Dienestrol, Diethylstilbestrol, Ethinylestradiol, Fosfestrol, Mestranol, Polyestradiol phosphate SERM Afimoxifene, Arzoxifene, Bazedoxifene, Clomifene, Fulvestrant, Lasofoxifene, Raloxifene, Tamoxifen, Toremifene AI Aminoglutethimide, Anastrozole, Atamestane, Exemestane, Fadrozole, Formestane, Letrozole, Vorozole Antiestrogen Mepitiostane Gonadotropins: FSHR/LHCGR ovulation stim. Clomifene, Urofollitropin Antigonadotropin Danazol, Gestrinone GnRH: receptor Agonist Buserelin, Goserelin, Histrelin, Leuprorelin, Nafarelin, Triptorelin Antagonist Abarelix, Cetrorelix, Ganirelix Retrieved from http://en..org/wiki/Spironolactone Categories: Aldosterone antagonists | Antiandrogens | Lactones | Hair loss Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Hrvatski Magyar Nederlands 日本語 Polski РуÑ?Ñ?кий УкраїнÑ?ька This page was last modified on 5 August 2008, at 05:04
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