Spironolactone, Clinical Evidence

Current guidelines recommend the use of diuretics in all patients with heart failure and fluid retention. Diuretics should not be used as monotherapy, and dosage adjustment may be required, depending on the effects desired and the occurrence of any adverse effects. Spironolactone has been shown to improve survival in adults with heart failure. [Pitt: 1999] The exact reason for this remarkable survival benefit is still being investigated. Possibilities include the beneficial effect of spironolactone’s attenuation of aldosterone-induced myocardial fibrosis, or catecholamine release, or both. Recent evidence suggests that angiotensin-converting enzyme inhibitors may potentiate the diuretic effect of spironolactone. [Captopril-Digoxin: 1988]


Helpful Articles

Madriago E, Silberbach M.
Heart failure in infants and children.
Pediatr Rev. 2010;31(1):4-12. PubMed abstract

Kay JD, Colan SD, Graham TP Jr.
Congestive heart failure in pediatric patients.
Am Heart J. 2001;142(5):923-8. PubMed abstract


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Content Last Updated: 11/2014

Page Bibliography

Captopril-Digoxin Multicenter Research Group.
Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. The Captopril-Digoxin Multicenter Research Group.
JAMA. 1988;259(4):539-44. PubMed abstract

Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J.
The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.
N Engl J Med. 1999;341(10):709-17. PubMed abstract