The Renal Drug Handbook, 3rd Edition

Product Information

Sweetman SC. Martindale: The Complete Drug Reference. 36th ed. Pharmaceutical Press; 2009. Accessed via http://www.knowledge.scot.nhs.uk Prescribers are advised to take into account the prevalence of resistance in various Candida species to fluconazole as alternative antifungal therapy secondary to treatment failure may be required. When transferring from the oral route to the intravenous route or vice versa, there is no need to change the daily dose. Contraindications

Oropharyngeal and oesophageal candidiasis: 200mg to 400mg loading dose on first day followed by 100mg to 200mg daily. Summary of Product Characteristics: Azocan 150mg capsules. FDC International Ltd. Revised June 2016. Patients who tolerate 25mg once daily may have their dose increased to 50mg once daily as clinically indicated. Patients who do not tolerate 25mg once daily may have their dose reduced to 25mg every other day.

Pregnancy

Spironolactone has been reported to interfere with certain digoxin assays. Patients who are receiving spironolactone should have their serum digoxin concentrations measured by means other than serum digoxin concentrations, unless the digoxin assay has been proven not to be affected by spironolactone therapy. The Renal Drug Database is not intended to offer definitive advice or guidance on how drugs should be used in patients with renal impairment, nor is it a comprehensive and complete list of all drugs licensed in the UK.

The BNF is rarely used as a sole information source for managing medicines in renal impairment. Renal Drug Handbook and Renal Drug Database Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press. Accessed on 03 June 2015. Spironolactone has not been shown to be anti-inflammatory, nor to affect the basic pathological process. Its use is only advised if glucocorticoids by themselves are insufficiently effective.Summary of Product Characteristics: Spironolactone Tablets 100mg. Actavis UK Ltd. Revised June 2014. Summary of Product Characteristics: Spironolactone Tablets 25mg. Actavis UK Ltd. Revised June 2014. The Renal Drug Handbook suggests the following dosage guidelines for patients with renal impairment: Pharmaceutical Preformulation and Formulation: a Practical Guide from Candidate Drug Selection to Commercial Dosage Form - 2nd ed. (2009) Advise patients to report any signs or symptoms of unexplained persistent nausea, decreased appetite, fatigue, vomiting, right upper abdominal pain, or jaundice, dark urine or pale faeces. Side Effects

Patients who have previously experienced adverse reactions to quinine including that in tonic water or other beverages should not be prescribed quinine. Pregnancy and Lactation Pregnancy Small studies have shown that doses of 25mg spironolactone three times per week can be used safely in haemodialysis patients although it is unknown whether or not this dose would have any therapeutic benefit. Potassium levels should be monitored closely. Contraindications Long test: 400mg spironolactone is administered daily for three to four weeks. Correction of hypokalaemia and of hypertension provides presumptive evidence for the diagnosis of primary hyperaldosteronism.

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Summary of Product Characteristics: Azocan-P 150mg capsules. FDC International Ltd. Revised March 2020. Other information: Details given here are only relevant to the use of that particular drug in patients with impaired renal function or on renal replacement therapy. For more general information, please refer to the Summary of Product Characteristics for that drug. It is not known whether unmetabolised spironolactone is excreted into breast milk. Canrenone, which is the principle metabolite, is excreted into human milk and has been found with a milk: plasma ratio of 0.72 at 2 hours, and 0.51 at 14.5 hours. These amounts would provide an estimated maximum of 0.2% of the mother's daily dose to the infant, Briggs (2011) consider these amounts to be clinically insignificant. The effects of spironolactone on the nursing infant are unknown. Theoretically, intense diuresis could suppress lactation, however, spironolactone alone is unlikely to produce this effect. Schaefer (2007) concludes spironolactone should be used only for special indications, such as primary hyperaldosteronism, ascites and nephrotic syndrome.