Withdrawal symptoms of spironolactone

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Withdrawal Symptoms of Spironolactone

Introduction to Spironolactone Withdrawal

Spironolactone is a medication commonly used for various conditions, including heart failure, hyperandrogenic skin disorders, and as a mineralocorticoid receptor antagonist. Understanding the withdrawal symptoms associated with spironolactone is crucial for managing patient care effectively.

Spironolactone Withdrawal in Heart Failure Patients

Dilated Cardiomyopathy and Relapse Risk

In patients with dilated cardiomyopathy who have shown improved ejection fraction, withdrawal of spironolactone can lead to significant relapse. A study found that 58% of patients who discontinued spironolactone experienced a relapse, compared to only 13% of those who continued the medication. Relapse was defined by a reduction in ejection fraction, increased left ventricular end-systolic volume index, elevated NT-proBNP levels, or clinical signs of heart failure. Additionally, patients who stopped taking spironolactone reported more symptom aggravation and a halt in improvements in cardiac structure parameters .

Spironolactone Withdrawal in Hyperandrogenic Skin Disorders

Long-Lasting Effects and Relapse

For women with hyperandrogenic skin disorders such as hirsutism, acne, and alopecia, spironolactone has shown to be an effective treatment. After discontinuation, many patients continued to experience the benefits of the treatment for several months. However, a subset of patients did relapse, with symptoms returning on average 17.5 months after stopping the medication. The study highlighted that ovulatory PCOS patients were more likely to experience earlier relapse compared to those with classic PCOS .

Spironolactone and Opiate Withdrawal

Attenuation of Somatic Signs

Spironolactone has also been studied for its effects on opiate withdrawal. It was found to attenuate the somatic signs of withdrawal in rats treated with morphine. This suggests that spironolactone, through its action on mineralocorticoid receptors, can modulate some physical symptoms associated with opiate withdrawal. However, it did not significantly alter other stress-related responses in the brain, such as noradrenaline turnover or hypothalamus-pituitary-adrenocortical axis activity .

Conclusion

Withdrawal from spironolactone can lead to significant relapse in patients with dilated cardiomyopathy and hyperandrogenic skin disorders, although some patients may continue to experience benefits for several months post-discontinuation. Additionally, spironolactone may help mitigate some physical symptoms of opiate withdrawal. These findings underscore the importance of careful management and monitoring when considering the withdrawal of spironolactone in various patient populations.

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Most relevant research papers on this topic

Spironolactone decreases the somatic signs of opiate withdrawal by blocking the mineralocorticoid receptors (MR).

Spironolactone reduces somatic signs of opiate withdrawal by blocking mineralocorticoid receptors, but does not significantly alter the brain stress system response to morphine withdrawal.

Non-RCTAnimal Study

2014·

12citations

·J. Navarro-Zaragoza et al.

Outcomes of Spironolactone Withdrawal in Dilated Cardiomyopathy With Improved Ejection Fraction

Spironolactone withdrawal is unsafe in dilated cardiomyopathy patients with improved ejection fraction, as most will relapse and experience more symptom aggravation.

Observational Study

2021·

8citations

·Yanjia Chen et al.

Long-Lasting Effects of Spironolactone After its Withdrawal in Patients with Hyperandrogenic Skin Disorders.

Spironolactone is an effective and safe treatment for hyperandrogenic skin disorders, showing long-lasting effects even after discontinuation.

Observational Study

2022·

4citations

·C. Sabbadin et al.

Withdrawal symptoms after gabapentin discontinuation.

Discontinuing gabapentin therapy can cause withdrawal symptoms, which resolve completely when reintroducing the medication.

Case Report

2010·

44citations

·Thaddaus R. Hellwig et al.

Haemodynamic effects of treatment and withdrawal of spironolactone in essential hypertension.

Spironolactone (50 mg b.i.d.) in essential hypertension caused minor adjustments in systemic and renal circulation, despite consistent changes in BW, PV, PRA, and PA.

Non-RCT

1979·

6citations

·D. Falch et al.

Spironolactone‐induced hepatitis

Spironolactone, a common drug used for treating androgenetic alopecia, can cause drug-induced hepatitis, with symptoms resolved and liver function improving after withdrawal.

Case Report

2001·

9citations

·K. Thai et al.

Spironolactone-induced hyperchloremic acidosis in cirrhosis.

Spironolactone treatment for sodium and water retention in cirrhotic patients may induce or worsen hyperchloremic metabolic acidosis, despite preventing hypokalemia and rapid diuresis.

1979·

63citations

·P. Gabow et al.

The effects of spironolactone on morphine withdrawal induced memory loss by the object recognition task method in mice

Spironolactone improves memory performance in morphine-dependent mice after withdrawal, suggesting that mineralocorticoid receptors play a role in memory impairment.

Non-RCTAnimal Study

2009·

6citations

·A. Mesripour et al.

Rationale and Study Design of the Withdrawal of Spironolactone for Heart Failure with Improved Left Ventricular Ejection Fraction

Spironolactone withdrawal is safe and may not cause deterioration of left ventricular ejection fraction in patients with heart failure with improved ejection fraction.

RCT

2021·

0citations

·Junho Hyun et al.

S47. ADD-ON SPIRONOLACTONE FOR THE TREATMENT OF SCHIZOPHRENIA (SPIRO TREAT)

Add-on spironolactone treatment may improve cognitive deficits in patients with clinically stable schizophrenia.

RCTRigorous Journal

2018·

0citations

·A. Roeh et al.

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