Indications & Dose: CONGESTIVE HEART FAILURE Severe Combination therapy PO Adult 12.5-25mg/day, may increase 50mg/day after 8 wk with ACEI & loop diuretic with/without cardiac glycoside (NYHA class III/IV) | DIAGNOSIS OF PRIMARY ALDOSTERONISM PO Adult Long test: 400mg/day for 3-4 wk short test: 400mg/day for 4 days, MD 100-400mg/day in 1-2 divided doses until surgical correction | DIURETIC-INDUCED HYPOKALEMIA PO Adult 25-100mg/day | EDEMA PO Adult 100mg/day as single or divided doses Child 3.3mg/kg/day as single or divided doses | HYPERTENSION PO Adult 25-50mg/day Child 1mg/kg/day as single or divided doses, max 3.3mg/kg/day

Precautions: Cirrhosis, HF, elderly, hepatic/renal impairment, fluid & electrolyte imbalances, DM

ADR: Serious: agranulocytosis, gynecomastia, hyperkalemia, hepatocellular toxicity, renal failure, hyponatremia, vasculitis, increases BUN, Others: eosinophilia, amenorrhea, postmenopausal bleeding, ataxia, confusion, drowsiness, fatigue, anorexia, GI ulceration, xerostomia, drug fever, hirsutism

DDI: Serious Amantadine causes myoclonic jerks, ACEIs causes severe hyperkalemia, Carbenoxolone efficacy is reduced, Digoxin increases drug level, NSAIDs increases GI adverse effects, Colestyramine leads to hyperchloremic metabolic acidosis, Tacrolimus leads to hyperkalemia, Thiazides leads to hyponatremia, Losartan/Candesartan/Telmisartan life-threatening hyperkalemia, Dextropropoxyphene results in gynecomastia & rash, Lithium toxicity increases

Diet: With food

Monitor: Vital signs, electrolyte levels, renal function test, body weight, CBC