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Spironolactone. Anybody on it?

Mullardman

Mullardman

Moderately extreme...
Being gently pressured by a' Heart Failure Nurse' to start on this stuff, for Heart Failure. Thing is the main benefits seem to be limiting Oedema ( swelling, mostly of ankles), which I don't have..and breathlessness, which I also don't have.

So the question becomes why? At least at this stage. I have enough drugs to deal with and the side effects of Spironolactone are hardly attractive.

I mentioned this to a GP a couple of weeks ago and he agreed with me..

Also I don't really want to change anything before second knee replacement op, as I coped well with the last one 14 weeks ago.

Anybody else have experience?
 
Mullardman said:
Being gently pressured by a' Heart Failure Nurse' to start on this stuff, for Heart Failure. Thing is the main benefits seem to be limiting Oedema ( swelling, mostly of ankles), which I don't have..and breathlessness, which I also don't have.

So the question becomes why? At least at this stage. I have enough drugs to deal with and the side effects of Spironolactone are hardly attractive.

I mentioned this to a GP a couple of weeks ago and he agreed with me..

Also I don't really want to change anything before second knee replacement op, as I coped well with the last one 14 weeks ago.

Anybody else have experience?
Click to expand...
Mull, if this is nurse initiated she/he will simply be following a protocol. You can I’m sure ask to speak to her consultant colleague about your concerns. That’s entirely reasonable- could just be a simple chat over the phone.
 
We used to use spironolactone a lot with folks, but that was for other reasons than heart failure.

Looking at the BNF listing, I would assume the dose would be low and it would be an adjunct.

I would ask specifically what is hoped to be achieved by using the drug. If they are unable to provide a satisfactory answer and explain it to you in terms that you understand, ask someone else.

see the ‘Moderate to severe heart failure (adjunct)’ bit.

https://bnf.nice.org.uk/drugs/spironolactone/
 
Thanks for that BT. At least the starting dose looks lowish.
The nurse agreed that being pretty much asymptomatic, I'm not in urgent need of more drugs, so we agreed to re-visit the subject later, probably after my second knee op.
 
I’m well past my sell by date, but I would encourage you to take advice asap if you have your doubts. Spironolactone will reduce the load on your heart and the less load it has to deal with during major surgery, the better you will be at dealing with the stress of surgery.
Even when I was in practice, the heart failure nurses knew much more than I did about heart failure, so don’t ignore their advice.
The side effects are not a big deal in lower doses.
 
Yep, I am on it (25mg), together with Ramopril (10mg). Seems to be working, in that my BP is almost back (consistently) “in the green” according to my BP meter - having come down from top of the red band! Took the best part of a year though.

I was moved off Amlodipine and Indapamide, coz they made my ankles and gums swell up.

Side effects that I’ve noticed. I need to be within striking distance of a loo (or a shrubbery for organic use) …especially in the mornings. And I do doze off in the afternoons………

OTOH the chest aches are less frequent. :)
 
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Thanks for all comments. I'm considering them all.

For info, I'm on Bisoprolol 2.5mg, Losartan 50mg, Aspirin EC 75 mg, plus a statin.
My BP is consistently below 130/75 and often as low as 115. I have an estimated ejection fraction of 35/40%.
I do not get breathless at rest and whether I get breathless under exertion is a moot point because restricted mobility before and since surgery mean I'm a bit out of condition and thus get 'out-of breath' more easily. Is that 'breathlessness'?
I'm also 73 years old and fitter than many younger men.
It seems to me that the issue with the Spironolactone is whether it has some beneficial effect beyond reducing BP and Oedema, because I have no problem with either.
 
In patients with compensated heart failure with reduced ejection fraction who continue to have symptoms (seems like you). The addition of spironolactone is associated with ~ 30% decrease in mortality after 2 years.

NICE guidelines 2018
2022 AHA/ACC/HFSA Guideline for
the Management of Heart Failure
 
Apologies, I was just relating back to
Mullardman said:
I'm a bit out of condition and thus get 'out-of breath' more easily. Is that 'breathlessness'?
Click to expand...
You are saying you are unfit which I read as cardiovascularly unfit rather muscular insufficiency, but that was my interpretation over a forum from 17000km away. No offense meant.
Without breathlessness, the evidence is less compelling
Keith
 
ktish said:
Apologies, I was just relating back to

You are saying you are unfit which I read as cardiovascularly unfit rather muscular insufficiency, but that was my interpretation over a forum from 17000km away. No offense meant.
Without breathlessness, the evidence is less compelling
Keith
Click to expand...
When I read your post, I too realised that the OP stated he was symptom free. Despite this, if it does not cause an unacceptable reduction in blood pressure, I would have thought survival rate would be improved.
 
Sometimes medication is more an art than a science and from my years as a pharmacist (now retired) I would have a positive disposition towards Spironolactone and its beneficial effects.

It’s one of those drugs that went out of fashion as potassium became less of an issue with diuretics and a case perhaps of baby and bath water.

More in heaven and earth than is dreamt of in your philosophy springs to mind with certain drugs, this being one of them.

.sjb
 
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