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  • Zuzu. . .what do you know about Spironolactone?

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    Old 11-13-2003, 06:08 AM   #1
    spirlhelix
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    Zuzu. . .what do you know about Spironolactone?

    Hi, Zuzu!

    I was hoping you might help me with some information about Spironolactone. I have tried a couple of dozen different blood pressure meds, and I have bad reactions to some. Beta blockers and ACE inhibitors are two classes that would be good for me (I have just been diagnosed with severe heart failure), but I am not able to use.

    A few weeks ago, my internist started me on Spironolactone, knowing it was good for heart failure. For the first time in three years, I'm getting normal blood pressure readings (were averaging 200/125, now 125/80). I have had a fever for three years, and it's gone now! From being a dreadful insomniac and wakening from the few hours sleep I did get feeling like I've been shoved off a train, now I'm sleeping better than I have for years. My heart rate was always over 100, but now my heart rate is down in the sixties and seventies.

    This seems like a good medication for me. What can you tell me about it? Aldosterone antagonist. . .does that mean my HTN might be secondary to a condition that is causing high aldosterone? I wonder why they didn't try it sooner?

    Any thoughts appreciated!

    Hugs,

    Pam

     
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    Old 11-13-2003, 10:29 PM   #2
    zuzu8
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    Hi Pam- Wow...your BP is down, you're sleeping like a baby (well, almost!), your heart rate is nearing that of an athlete!
    I presume, given your history, you've been through a battery of tests and diagnoses ad infinitum. If you had primary hyperaldosteronism (excessive production of aldosterone by the adrenal gland) it would be difficult to believe that this would have been missed. It's something to discuss with your physician(s) but your hypertension is more likely to be primary. Did you have long-standing (difficult to control) hypertension before being diagnosed with CHF?


    SPIRONOLACTONE is rarely the first line of therapy for hypertension due to studies that show a high toxicity in lab rats, plus the fact that there are other drugs available that have fewer side effects. However, they give spironolactone to patients who cannot be treated adequately with other agents (that seems to be you) or for whom other agents are considered inappropriate....(again, you?)


    When it comes to congestive heart failure it's a good drug for treating edema and sodium retention when again, you are only partially responsive to, or are intolerant of, other drugs.

    Seems to me that w/ this drug you're killing 16 birds with 20 stones (!) in that it's really doing wonders for your BP and heart rate, plus your CHF, taking a load off your kidneys, and on top of it, you feel better!

    PS.By the way, while on this drug, did your doctor warn you to avoid potassium supplements and foods containing high levels of potassium including salt substitutes? (To avoid hyperkalemia ...excess serum potassium).

    zuzu xxx

    Last edited by zuzu8; 11-13-2003 at 10:33 PM. Reason: edited for typos

     
    Old 11-14-2003, 04:36 AM   #3
    spirlhelix
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    Quote:
    Originally Posted by zuzu8
    Hi Pam- Wow...your BP is down, you're sleeping like a baby (well, almost!), your heart rate is nearing that of an athlete!
    I presume, given your history, you've been through a battery of tests and diagnoses ad infinitum. If you had primary hyperaldosteronism (excessive production of aldosterone by the adrenal gland) it would be difficult to believe that this would have been missed. It's something to discuss with your physician(s) but your hypertension is more likely to be primary. Did you have long-standing (difficult to control) hypertension before being diagnosed with CHF?


    I had HTN on and off for three years before the CHF diagnosis. It seems kind of sad to me that now I have a medication that works. . .I already have irreparable damage to my heart. I'm Stage D, end stage. Yeah, I have had tests out the wazoo, but I have not had a workup by an endocrinologist. I did have a positive test for plasma free metanephrines, but the 24-hour urine was negative. I understand false negatives on the 24-hour test are astonishingly high. I was kind of wanting to get your thoughts about it in case I ought to be nudging my internist or nephrologist in this direction. I asked him if the resolution of a three-year fever (the same length of time I've been treated, with little success, for hypertension) could indicate anything about the etiology of the HTN, and he said it did suggest an occult tumor causing increased aldosterone.

    Quote:
    Originally Posted by zuzu8
    SPIRONOLACTONE is rarely the first line of therapy for hypertension due to studies that show a high toxicity in lab rats, plus the fact that there are other drugs available that have fewer side effects. However, they give spironolactone to patients who cannot be treated adequately with other agents (that seems to be you) or for whom other agents are considered inappropriate....(again, you?)

    Yeah, I guess I'm in those categories.

    Quote:
    Originally Posted by zuzu8
    When it comes to congestive heart failure it's a good drug for treating edema and sodium retention when again, you are only partially responsive to, or are intolerant of, other drugs.

    Lucky me, I don't have any edema that I know of. I'm an odd bird with Class 1 heart failure, Stage D. No symptoms, severely damaged heart, don't tolerate standard treatments for heart failure (except this one). I know some of those other diuretics wear off, though, and I really hope this one does not, because clearly it works for me when others have not and I'd hate to face losing the effect.

    Quote:
    Originally Posted by zuzu8
    Seems to me that w/ this drug you're killing 16 birds with 20 stones (!) in that it's really doing wonders for your BP and heart rate, plus your CHF, taking a load off your kidneys, and on top of it, you feel better!

    PS.By the way, while on this drug, did your doctor warn you to avoid potassium supplements and foods containing high levels of potassium including salt substitutes? (To avoid hyperkalemia ...excess serum potassium).

    Yes, he did, and he has been watching my serum potassium, which usually tends to be on the low side (at one point it was 2.5, and that was before I started diuretics!). It's coming right up on Spironolactone.

    Thanks for the information on Spironolactone, zuzu! I hope it stays a winner for me.



    Hugs,

    Pam

    Last edited by spirlhelix; 11-14-2003 at 05:06 AM.

     
    Old 11-14-2003, 05:49 AM   #4
    zip2play
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    Pam,

    I'm glad you found a drug that is so effective, but I'm kind of surprised that it is because its benefits usually accrue from relief of edema, of which you seem to have little.
    It is extremely anti-androgenic and is almost NEVER prescribed for men except for cirrhotic(sp?) edema. Does it make you feel particularly "feminine?"

    In any case I'm sure the plasma volume reducing ability of the diuretic drug has removed a LOT of stress from your weak heart.
    Good continued luck with it!

    (I've been thinking about that fever. Is it possible that your CHF was ultimately caused by some kind of lingering heart infection, an undetected myositis which can be viral or bacterial?)
    Did you get on any transplant lists yet?

    Last edited by zip2play; 11-14-2003 at 06:01 AM.

     
    Old 11-14-2003, 02:24 PM   #5
    zuzu8
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    Pam- Given that your doctor suggested the possibility of an occult tumor, perhaps a workup with an endocrinologist would be a good idea to rule out secondary aldosteronism. A tumor could indeed increase production of aldosterone by the cortex of the adrenal glands.These tumors (benign) as you know can cause high blood pressure and disorders with fluid retention and/or edema such as heart failure and cirrhosis of the liver with fluid in the abdomen (kidney syndrome). This syndrome is believed to be caused by excessive secretion of the enzyme renin, secondary to constriction of the blood vessels in the kidney. It also occurs as a symptom of other kidney disorders. I know little more than this but it seems like you've covered a lot of territory and perhaps an endocrine evaluation could turn over yet another (but hopefully helpful) stone.

    Are all your doctors talking to and working with each other? Mainly your cardio and didn't you say you had a nephrologist?

    zuzu xx

     
    Old 11-14-2003, 02:31 PM   #6
    spirlhelix
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    Quote:
    Originally Posted by zip2play
    Pam,

    I'm glad you found a drug that is so effective, but I'm kind of surprised that it is because its benefits usually accrue from relief of edema, of which you seem to have little.
    It is extremely anti-androgenic and is almost NEVER prescribed for men except for cirrhotic(sp?) edema. Does it make you feel particularly "feminine?"

    In any case I'm sure the plasma volume reducing ability of the diuretic drug has removed a LOT of stress from your weak heart.
    Good continued luck with it!

    (I've been thinking about that fever. Is it possible that your CHF was ultimately caused by some kind of lingering heart infection, an undetected myositis which can be viral or bacterial?)
    Did you get on any transplant lists yet?
    Hi, Zip!

    In the workup for fever, I've been checked for an array of infections in the blood--all were negative.

    I'm mulling over how this med helps. Before, I was having trouble sleeping without waking with a jolt and thudding heart. After that, I could not get back to sleep and was very wide awake. Those are symptoms of pheochromocytoma, which is rare but causes imbalances of hormones like aldosterone. I was probably _very_ awake for about twenty hours a day. I also had a fever for three years and uncontrollable blood pressure with a high heart rate (100 and over).

    I was doing no regular excercise, but I sure became a well-muscled specimen! My thighs, quads, calves and biceps are all pretty buff for someone who is not terribly active. In the summer when I was wearing cutoffs constantly, this was more noticable. My voice seems to have gotten lower in the past few years, but I feel it's usually in a normal/low range for a woman. I feel a little funny now and then when it slips to a baritone, but I assure you I think it's still pretty! It's all in what you do with it. Smile. I found myself getting kind of more argumentative and adamant than usual over the summer. I also felt I had plenty of energy to do whatever I wanted, which I don't think is usual for me. I think I might have had some excess aldosterone, but I have never been to see an endocrinologist. So if the drug works by neutralizing aldosterone, perhaps that explains something about why it has worked for me.

    I don't feel that these things are quite as noticable now, but I've been on spironolactone for only about a month and maybe I'm imagining it. Perhaps this is along the line of what you were asking about feeling especially "feminine" on spironolactone?

    I am also on Imdur and Diovan, but nothing else has affected my fever or sleeping patterns like Spironolactone.

    Let me know if I understood you correctly on the "feminizing" features of spironolactone.

    Hugs,

    Pam

     
    Old 11-14-2003, 03:25 PM   #7
    lazaruss
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    Quote:
    Originally Posted by zuzu8
    Hi Pam- Wow...your BP is down, you're sleeping like a baby (well, almost!), your heart rate is nearing that of an athlete!
    I presume, given your history, you've been through a battery of tests and diagnoses ad infinitum. If you had primary hyperaldosteronism (excessive production of aldosterone by the adrenal gland) it would be difficult to believe that this would have been missed. It's something to discuss with your physician(s) but your hypertension is more likely to be primary. Did you have long-standing (difficult to control) hypertension before being diagnosed with CHF?


    SPIRONOLACTONE is rarely the first line of therapy for hypertension due to studies that show a high toxicity in lab rats, plus the fact that there are other drugs available that have fewer side effects. However, they give spironolactone to patients who cannot be treated adequately with other agents (that seems to be you) or for whom other agents are considered inappropriate....(again, you?)


    When it comes to congestive heart failure it's a good drug for treating edema and sodium retention when again, you are only partially responsive to, or are intolerant of, other drugs.

    Seems to me that w/ this drug you're killing 16 birds with 20 stones (!) in that it's really doing wonders for your BP and heart rate, plus your CHF, taking a load off your kidneys, and on top of it, you feel better!

    PS.By the way, while on this drug, did your doctor warn you to avoid potassium supplements and foods containing high levels of potassium including salt substitutes? (To avoid hyperkalemia ...excess serum potassium).

    zuzu xxx
    zuzu8, spironolactone is a firstline drug for congestive heart failure based on the results of the RALES study. there are other more selective aldosterone antagonists in development currently with fewer side-effects eg eplerenone

     
    Old 11-14-2003, 04:43 PM   #8
    zuzu8
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    LAZARUSDOC- Thanks for the info! I just googled the RALES study...fascinating.
    Reassuring for Pam too.
    Obviously all patients on this drug need to be monitored frequently for hyperkalemia.
    Also, since Pam is already taking an angiotensin receptor blocker, there's always the possibility of full aldosterone suppression. Although aldosterone inhibition is WANTED, there's obviously a risk for the renal implications of HYPOaldosteronism. But I'm sure PAM's doctor's will be keeping close tabs on her.

    Hey PAM- Hope you don't mind that we're "discussing" you!

    zuzu xxx

     
    Old 11-15-2003, 06:29 AM   #9
    spirlhelix
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    Howcum?

    Hi, zuzu, lazarusdoc and Zip

    No, I don't feel funny about being discussed. I'm interested in learning anything that could help me, really.

    lazarusdoc, I am I just confusing the benefits of one medicine with another? Do you think the Diovan is probably kicking in, or the Imdur? I wonder why they never tried me on spironolactone until my heart was in such bad shape. Nothing else really helped as much as this one has. If I'm right and this one has caused the drop in blood pressure, why don't they use it more often for blood pressure control? Do you think it is likely to lose its effect like some of the other diuretics?

    I just can't believe I had to get Stage D heart failure before they could find something that helps me.

    Thanks for your thoughts,

    Pam

     
    Old 11-15-2003, 06:41 AM   #10
    zip2play
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    Pam,

    Is the spironolcatone really the FIRST diuretic they have ever prescribed??? That's pretty poor overall treatment if it is.

    In the states, usually the first drug tried is (or at least WAS) a simple diuretic for HBP....unfortunately that MAY be in the past with the gargantuan profitablility of the newer drugs compared to the few pennies made from HCTZ.

     
    Old 11-15-2003, 07:01 AM   #11
    spirlhelix
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    Quote:
    Originally Posted by zip2play
    Pam,

    Is the spironolcatone really the FIRST diuretic they have ever prescribed??? That's pretty poor overall treatment if it is.

    In the states, usually the first drug tried is (or at least WAS) a simple diuretic for HBP....unfortunately that MAY be in the past with the gargantuan profitablility of the newer drugs compared to the few pennies made from HCTZ.
    Hi, Zip

    No, it's not the first I've tried, it's just the first to work.

    I've been on hydroclorothyazide, lasix and maxzide. They start me out on them, they have little effect, (say my BP is 180/100, then it might drop to 160/95, for example. Then it slowly rises back again.) then they increase them, then they lose all effect over time.

    That's what I'm wondering about spironolactone--will it lose effect over time?

    Hugs,

    Pam

     
    Old 02-04-2004, 09:03 AM   #12
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    Re: Zuzu. . .what do you know about Spironolactone?

    Pam,
    I just saw where you asked about the Spironolactone and why it is not perscribed more often. My daughter had been on it now for 2 1/2 years, and it has helped her. But it does have some less than desireable side effects. For instance hair growth on women on the face and back. In general it will make your hair thicker in all places it does grow also. On men, it will make men grow breasts and or breast tenderness. If your a woman in her child bearing years, it is very highly reccomended that you do not have children while on this medication. That said, my daughter requires it to keep her PA in check. She takes numerous other meds but if you take away the spironolactone she goes out of control to the point that she is in the hospital ICU taking Nipride. PS I know that you said the aldosterone was checked and the 24 hour urine was negative. You would not know if they ran a renin at the same time would you? If they did not then the aldosterone test is usless. They MUST be run at the same time. It does sound like a case of PA to me ( I am not a doc just a former PA patient and mother of one as well) . You should check into it because the signifigant change in your BP was too much not to take note of. Also, it is highly possible that your BP will continue to rise on the Spironolactone even if it is PA. My daughters did. It depends on the sevarity of the PA or how much that adrenal or tumor is putting out. It may take a combo of meds to get control. We initally were on 5 but after surgery to remove one adrenal we are down to three. Just watch it and take care of yourself. The Nephrologist will be necessary to control the BP but you must find a endo that can determine if it is indeed the PA causing the hypertention. In our experience the nephrology group wants to control the situation, they feel that they can control the situation indefinatly with meds. The endo is the most qualified to decide a course of action though as he/she knows the true effects of the hormone on your body. Good luck, HeatherW

     
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