Tolerability of spironolactone in patients with chronic heart failure - a cautionary message

Aim To assess how well heart failure patients tolerate spironolactone in routine clinical practice. Design Retrospective analysis of 226 patients attending a specialist heart failure clinic. Results One hundred and thirty of 226 (57.5%) patients tried spironolactone at least once. Forty-four of 130 (33.8%) discontinued spironolactone due to side-effects after a mean of 11.1 months; 59/141 (41.8%) trials of spironolactone resulted in at least one side-effect; therapy was stopped in 30/141 (21.3%) trials due to raised potassium or creatinine. Significant risk factors for raised potassium/creatinine were age and baseline potassium level. Conclusions Potentially serious side-effects are common despite appropriate use of spironolactone.