Spironolactone
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| Pronunciation | /ˌspaɪroʊnoʊˈlæktoʊn/ SPY-roh-noh-LAK-tone, /ˌspɪəroʊnoʊˈlæktoʊn/ ⓘ SPEER-oh-noh-LAK-tone |
| Trade names | Aldactone, others |
| Other names | SC-9420; NSC-150339; 7α-Acetylthiospirolactone; 7α-Acetylthio-17α-hydroxy-3-oxopregn-4-ene-21-carboxylic acid γ-lactone |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a682627 |
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| Routes of administration | By mouth, topical |
| Drug class | Antimineralocorticoid; Steroidal antiandrogen |
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| Bioavailability | 60–90% |
| Protein binding | Spironolactone: 88% (to albumin and AGP) Canrenone: 99.2% (to albumin) |
| Metabolism | Liver, others: • Deacetylation via CES • S-Oxygenation via FOM • S-Methylation via TMT • Dethioacetylation • Hydroxylation via CYP3A4 • Lactone hydrolysis via PON3 |
| Metabolites | 7α-TS, 7α-TMS, 6β-OH-7α-TMS, canrenone, others (All three active) |
| Elimination half-life | Spironolactone: 1.4 hrs 7α-TMS: 13.8 hours 6β-OH-7α-TMS: 15.0 hrs Canrenone: 16.5 hours |
| Excretion | Urine, bile |
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| ECHA InfoCard | 100.000.122 |
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| Formula | C24H32O4S |
| Molar mass | 416.58 g·mol−1 |
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| Melting point | 134 to 135 °C (273 to 275 °F) |
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Spironolactone, sold under the brand name Aldactone among others, is classed as a diuretic medication. It can be used to treat fluid build-up due to liver disease or kidney disease. It is also used to reduce risk of disease progression, hospitalization and death due to some types of heart failure. Other uses include acne and excessive hair growth in women, low blood potassium that does not improve with supplementation, high blood pressure that is difficult to treat and early puberty in boys. It can also be used to block the effects of testosterone in transgender women and nonbinary people undergoing feminizing hormone replacement therapy. Spironolactone is usually available in tablets, taken by mouth, though topical forms are also available.
Common side effects include electrolyte abnormalities, particularly high blood potassium, nausea, vomiting, headache, rashes, and a decreased desire for sex. In those with liver or kidney problems, extra care should be taken.
If taken during pregnancy, some animal studies suggest that spironolactone may affect the development of sex organs in babies. While this has not occurred in the few human studies available, women who are pregnant or considering pregnancy should discuss spironolactone use with their doctor due to the theoretical risk.
Spironolactone is a steroid that blocks the effects of the hormones aldosterone and, to a lesser degree, testosterone, causing some estrogen-like effects. Spironolactone belongs to a class of medications known as potassium-sparing diuretics.
Spironolactone was discovered in 1957, and was introduced in 1959. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2022, it was the 52nd most commonly prescribed medication in the United States, with more than 12 million prescriptions. Spironolactone has a history of use in the trans community. Its use continues despite the rise of various accessible alternatives such as bicalutamide and cyproterone acetate with more precise action and less side effects.