Cardiorenal Med. 2013 Apr;3(1):1-6. doi: 10.1159/000346447. Epub 2013 Jan 30.
Daily doses of spironolactone higher than 25 mg are rarely used in heart failure (HF) patients, presumably due to the concern for hyperkalemia. However, in advanced HF, doses ≥50 mg have been found to be necessary to produce natriuresis. The aim of the present study was to examine the safety of natriuretic doses of spironolactone (50-200 mg) on serum potassium concentration in New York Heart Association (NYHA) class III/IV HF patients over several weeks.
18 patients with advanced HF received 50-200 mg of spironolactone in addition to standard treatment. Serum electrolytes, BUN and serum creatinine were assessed at baseline, during increased doses of spironolactone and at the 1-month follow-up.
During a total of 738 patient-weeks, there was no significant increase in mean serum potassium (4.0 vs. 4.2 mEq/l) or serum creatinine (1.3 vs. 1.4 mg/dl). However, in 3 patients, spironolactone treatment was stopped due to a mean increase in serum creatinine (1.9 vs. 2.6 mg/dl) and in one of them, an increase in serum potassium (4.4 vs. 5.2 mEq/l) was noted.
Increased doses of spironolactone are generally safe during outpatient follow-up in selected patients with advanced HF, who are receiving treatment with ACE inhibitors, beta-blockers, and loop diuretics.
心力衰竭（HF）患者很少使用高于 25 毫克的螺内酯日剂量，大概是因为担心高钾血症。然而，在晚期 HF 中，发现需要≥50 毫克的剂量才能产生利钠作用。本研究的目的是在数周内检查大剂量螺内酯（50-200 毫克）对纽约心脏协会（NYHA）III/IV 级 HF 患者血清钾浓度的安全性。
18 名晚期 HF 患者在标准治疗的基础上加用 50-200 毫克螺内酯。在基线、增加螺内酯剂量期间和 1 个月随访时评估血清电解质、BUN 和血清肌酐。
在总共 738 个患者周期间，平均血清钾（4.0 与 4.2 mEq/l）或血清肌酐（1.3 与 1.4 mg/dl）无显著增加。然而，在 3 名患者中，由于血清肌酐平均增加（1.9 与 2.6 mg/dl）和其中 1 名患者的血清钾增加（4.4 与 5.2 mEq/l），停止了螺内酯治疗。
在接受 ACE 抑制剂、β受体阻滞剂和袢利尿剂治疗的选择晚期 HF 患者门诊随访期间，增加螺内酯剂量通常是安全的。
