{"id":59339,"date":"2024-02-28T05:53:18","date_gmt":"2024-02-28T05:53:18","guid":{"rendered":"https:\/\/medsname.com\/silectone\/"},"modified":"2026-05-01T10:49:15","modified_gmt":"2026-05-01T10:49:15","slug":"silectone","status":"publish","type":"product","link":"https:\/\/medsbase.com\/el\/silectone\/","title":{"rendered":"Silectone"},"content":{"rendered":"

<\/p>\n

\n

⚡ Quick Answer — What is Silectone?<\/h3>\n

Silectone<\/strong> \u03b5\u03af\u03bd\u03b1\u03b9 25 \/ 50 mg spironolactone tablet<\/strong> \u03b1\u03c0\u03cc \u03c4\u03b7 Sun Pharma \u2014 \u03ad\u03bd\u03b1 mineralocorticoid receptor antagonist (aldosterone antagonist)<\/strong> \u03c0\u03bf\u03c5 \u03b4\u03c1\u03b1 \u03c3\u03c4\u03bf\u03bd mineralocorticoid receptor (MR) in the principal cells of the cortical collecting duct<\/strong>. Spironolactone was introduced by G.D. Searle in 1959 — designed as a synthetic steroid to antagonise aldosterone’s distal-tubule effect on sodium retention and potassium excretion. The first MR antagonist; remains the reference agent despite the availability of the more selective eplerenone. Half-life 1.4 hours (parent); 16-24 hours (active metabolites canrenone and 7-\u03b1-thiomethylspirolactone); onset 24-48 hours (needs time for receptor antagonism to manifest at the tissue level); peak effect 2-3 days; duration 2-3 days after discontinuation. Primary indication: heart failure with reduced ejection fraction (HF-REF), primary aldosteronism, resistant hypertension, cirrhotic ascites, adjunct treatment for hirsutism and PCOS<\/strong>. \u03a4\u03c5\u03c0\u03b9\u03ba\u03ae \u03b4\u03bf\u03c3\u03bf\u03bb\u03bf\u03b3\u03af\u03b1: \u0391\u03bd\u03b8\u03b5\u03ba\u03c4\u03b9\u03ba\u03ae \u03c5\u03c0\u03ad\u03c1\u03c4\u03b1\u03c3\u03b7<\/strong> (BP not controlled on ACEi\/ARB + CCB + thiazide): 25-50 mg once daily — PATHWAY-2 evidence. Spironolactone beats bisoprolol and doxazosin as the fourth agent in resistant HTN. \u0394\u03b5\u03bd \u03b5\u03af\u03bd\u03b1\u03b9 \u03c0\u03c1\u03ce\u03c4\u03b7\u03c2 \u03b3\u03c1\u03b1\u03bc\u03bc\u03ae\u03c2 \u03b1\u03bd\u03c4\u03b9\u03c5\u03c0\u03b5\u03c1\u03c4\u03b1\u03c3\u03b9\u03ba\u03cc.<\/strong> Primary aldosteronism (Conn’s):<\/strong> 50-400 mg\/day until potassium and BP normalise, then maintenance 25-100 mg. Key contraindications: see full list below. Monitor electrolytes, creatinine, and glucose. \u039c\u03b7\u03bd \u03c3\u03c5\u03bd\u03b4\u03c5\u03ac\u03b6\u03b5\u03c4\u03b5 \u03bc\u03b5 \u03bb\u03af\u03b8\u03b9\u03bf<\/strong> (\u03c4\u03b1 \u03b8\u03b5\u03b9\u03b1\u03b6\u03af\u03b4\u03b9\u03b1\/\u03b4\u03b9\u03bf\u03c5\u03c1\u03b7\u03c4\u03b9\u03ba\u03ac \u03b2\u03c1\u03cc\u03c7\u03bf\u03c5 \u03bc\u03c0\u03bf\u03c1\u03bf\u03cd\u03bd \u03bd\u03b1 \u03c0\u03c1\u03bf\u03ba\u03b1\u03bb\u03ad\u03c3\u03bf\u03c5\u03bd \u03c4\u03bf\u03be\u03b9\u03ba\u03cc\u03c4\u03b7\u03c4\u03b1 \u03bb\u03b9\u03b8\u03af\u03bf\u03c5). \u0397 \u03c7\u03c1\u03ae\u03c3\u03b7 \u03ba\u03b1\u03c4\u03ac \u03c4\u03b7\u03bd \u03b5\u03b3\u03ba\u03c5\u03bc\u03bf\u03c3\u03cd\u03bd\u03b7 \u03b5\u03be\u03b5\u03c4\u03ac\u03b6\u03b5\u03c4\u03b1\u03b9 \u03b1\u03bd\u03ac \u03c0\u03b5\u03c1\u03af\u03c0\u03c4\u03c9\u03c3\u03b7<\/strong> (\u03b2\u03bb. \u03c3\u03b7\u03bc\u03b5\u03af\u03c9\u03c3\u03b7 \u03b5\u03b3\u03ba\u03c5\u03bc\u03bf\u03c3\u03cd\u03bd\u03b7\u03c2). \u0393\u03b9\u03b1 \u03c4\u03bf\u03c5\u03c2 \u03c0\u03b5\u03c1\u03b9\u03c3\u03c3\u03cc\u03c4\u03b5\u03c1\u03bf\u03c5\u03c2 \u03c5\u03c0\u03b5\u03c1\u03c4\u03b1\u03c3\u03b9\u03ba\u03bf\u03cd\u03c2 \u03b1\u03c3\u03b8\u03b5\u03bd\u03b5\u03af\u03c2, \u03c4\u03b1 \u03b4\u03b9\u03bf\u03c5\u03c1\u03b7\u03c4\u03b9\u03ba\u03ac \u03bb\u03b5\u03b9\u03c4\u03bf\u03c5\u03c1\u03b3\u03bf\u03cd\u03bd \u03ba\u03b1\u03bb\u03cd\u03c4\u03b5\u03c1\u03b1 \u03c9\u03c2 \u03c4\u03bf \u03b4\u03b5\u03cd\u03c4\u03b5\u03c1\u03bf \u03ae \u03c4\u03c1\u03af\u03c4\u03bf \u03c6\u03ac\u03c1\u03bc\u03b1\u03ba\u03bf<\/strong> \u2014 \u03c3\u03c5\u03bd\u03ae\u03b8\u03c9\u03c2 \u03c3\u03c5\u03bd\u03b4\u03c5\u03ac\u03b6\u03bf\u03bd\u03c4\u03b1\u03b9 \u03bc\u03b5 ARB, \u03b1\u03bd\u03b1\u03c3\u03c4\u03bf\u03bb\u03ad\u03b1 ACE \u03ae \u03b1\u03bd\u03b1\u03c3\u03c4\u03bf\u03bb\u03ad\u03b1 \u03b4\u03b9\u03b1\u03cd\u03bb\u03c9\u03bd \u03b1\u03c3\u03b2\u03b5\u03c3\u03c4\u03af\u03bf\u03c5 \u03c0\u03b1\u03c1\u03ac \u03bd\u03b1 \u03c7\u03c1\u03b7\u03c3\u03b9\u03bc\u03bf\u03c0\u03bf\u03b9\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03bc\u03cc\u03bd\u03b1.<\/p>\n<\/div>\n

\n\u0391\u03c5\u03c4\u03cc \u03c0\u03bf\u03c5 \u03bb\u03b1\u03bc\u03b2\u03ac\u03bd\u03b5\u03c4\u03b5 \u03bc\u03b5 \u03c4\u03b7\u03bd MedsBase:<\/strong> \u03a0\u03b9\u03c3\u03c4\u03bf\u03c0\u03bf\u03b9\u03b7\u03bc\u03ad\u03bd\u03bf\u03c2 \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03c4\u03ae\u03c2 WHO-GMP \u00b7 \u0394\u03b9\u03b1\u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ae \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1 \u00b7 \u03a0\u03b1\u03b3\u03ba\u03cc\u03c3\u03bc\u03b9\u03b1 \u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae \u00b7 1,400+ \u03b5\u03c0\u03b1\u03bb\u03b7\u03b8\u03b5\u03c5\u03bc\u03ad\u03bd\u03b5\u03c2 \u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ad\u03c2 \u03c0\u03b5\u03bb\u03b1\u03c4\u03ce\u03bd<\/a>\n<\/div>\n

\ud83d\udce6 \u039a\u03ac\u03b8\u03b5 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03bb\u03af\u03b1 \u03ba\u03b1\u03bb\u03cd\u03c0\u03c4\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd \u03a0\u03bf\u03bb\u03b9\u03c4\u03b9\u03ba\u03ae \u0395\u03b3\u03b3\u03cd\u03b7\u03c3\u03b7\u03c2 \u0395\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae\u03c2<\/strong><\/a> \u2014 \u03b5\u03ac\u03bd \u03c4\u03bf \u03b4\u03ad\u03bc\u03b1 \u03c3\u03b1\u03c2 \u03b4\u03b5\u03bd \u03c6\u03c4\u03ac\u03c3\u03b5\u03b9 \u03b5\u03bd\u03c4\u03cc\u03c2 20 \u03b5\u03c1\u03b3\u03ac\u03c3\u03b9\u03bc\u03c9\u03bd \u03b7\u03bc\u03b5\u03c1\u03ce\u03bd, \u03c4\u03bf \u03b5\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03ad\u03bb\u03bb\u03bf\u03c5\u03bc\u03b5.<\/p>\n

\u0393\u03b9\u03b1\u03c4\u03af \u03bd\u03b1 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03af\u03bb\u03b5\u03c4\u03b5 \u03b1\u03c0\u03cc \u03c4\u03b7 MedsBase<\/h3>\n

\u03a4\u03b1 \u03b3\u03b5\u03bd\u03cc\u03c3\u03b7\u03bc\u03b1 \u03c6\u03ac\u03c1\u03bc\u03b1\u03ba\u03ac \u03bc\u03b1\u03c2 \u03c0\u03c1\u03bf\u03ad\u03c1\u03c7\u03bf\u03bd\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03c4\u03ad\u03c2 \u03c0\u03bf\u03c5 \u03c0\u03b9\u03c3\u03c4\u03bf\u03c0\u03bf\u03b9\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd WHO-GMP \u03ba\u03b1\u03b9 \u03b1\u03c0\u03bf\u03c3\u03c4\u03ad\u03bb\u03bb\u03bf\u03bd\u03c4\u03b1\u03b9 \u03c0\u03b1\u03b3\u03ba\u03bf\u03c3\u03bc\u03af\u03c9\u03c2 \u03c3\u03b5 \u03b4\u03b9\u03b1\u03ba\u03c1\u03b9\u03c4\u03b9\u03ba\u03ae, \u03b1\u03c0\u03bb\u03ae \u03c3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03af\u03b1 \u2014 \u03c7\u03c9\u03c1\u03af\u03c2 \u03cc\u03bd\u03bf\u03bc\u03b1 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03bf\u03c5 \u03c3\u03c4\u03bf \u03b5\u03be\u03c9\u03c4\u03b5\u03c1\u03b9\u03ba\u03cc \u03c4\u03bf\u03c5 \u03b4\u03ad\u03bc\u03b1\u03c4\u03bf\u03c2. \u039f\u03b9 \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ad\u03c2 \u03bc\u03b5 \u03ba\u03ac\u03c1\u03c4\u03b1 \u03b4\u03c1\u03bf\u03bc\u03bf\u03bb\u03bf\u03b3\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9 \u03bc\u03ad\u03c3\u03c9 \u03c1\u03c5\u03b8\u03bc\u03b9\u03c3\u03bc\u03ad\u03bd\u03bf\u03c5 \u03b5\u03c0\u03b5\u03be\u03b5\u03c1\u03b3\u03b1\u03c3\u03c4\u03ae (\u03bf\u03b9 \u03c0\u03b5\u03c1\u03b9\u03b3\u03c1\u03b1\u03c6\u03ad\u03c2 \u03b5\u03ba\u03ba\u03b1\u03b8\u03ac\u03c1\u03b9\u03c3\u03b7\u03c2 \u03c0\u03b5\u03c1\u03b9\u03bb\u03b1\u03bc\u03b2\u03ac\u03bd\u03bf\u03c5\u03bd \u03c1\u03c5\u03b8\u03bc\u03b9\u03c3\u03bc\u03ad\u03bd\u03bf \u03b5\u03c0\u03b5\u03be\u03b5\u03c1\u03b3\u03b1\u03c3\u03c4\u03ae \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ce\u03bd \u03bc\u03b5 \u03ba\u03ac\u03c1\u03c4\u03b1 \u2014 \u03c0\u03bf\u03c4\u03ad \u201cMedsBase\u201d \u03ae \u03bf\u03c0\u03bf\u03b9\u03bf\u03b4\u03ae\u03c0\u03bf\u03c4\u03b5 \u03cc\u03bd\u03bf\u03bc\u03b1 \u03c6\u03b1\u03c1\u03bc\u03ac\u03ba\u03bf\u03c5). \u0393\u03af\u03bd\u03bf\u03bd\u03c4\u03b1\u03b9 \u03b4\u03b5\u03ba\u03c4\u03ad\u03c2 \u03ba\u03b1\u03b9 \u03c0\u03bb\u03b7\u03c1\u03c9\u03bc\u03ad\u03c2 \u03bc\u03b5 \u03ba\u03c1\u03c5\u03c0\u03c4\u03bf\u03bd\u03bf\u03bc\u03af\u03c3\u03bc\u03b1\u03c4\u03b1 \u03ba\u03b1\u03b9 \u03c4\u03c1\u03b1\u03c0\u03b5\u03b6\u03b9\u03ba\u03ae \u03bc\u03b5\u03c4\u03b1\u03c6\u03bf\u03c1\u03ac SEPA. \u039a\u03ac\u03b8\u03b5 \u03c0\u03b1\u03c1\u03b1\u03b3\u03b3\u03b5\u03bb\u03af\u03b1 \u03ba\u03b1\u03bb\u03cd\u03c0\u03c4\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd \u03a0\u03bf\u03bb\u03b9\u03c4\u03b9\u03ba\u03ae \u0395\u03c0\u03b1\u03bd\u03b1\u03c0\u03bf\u03c3\u03c4\u03bf\u03bb\u03ae\u03c2 \u0395\u03be\u03b1\u03c3\u03c6\u03b1\u03bb\u03af\u03c3\u03b5\u03ce\u03c2 \u03bc\u03b1\u03c2.<\/p>\n

What Is Silectone?<\/h2>\n

Silectone is an oral 25 \/ 50 mg spironolactone tablet from Sun Pharma, supplied in 30-180 tablets. Spironolactone was introduced by G.D. Searle in 1959 — designed as a synthetic steroid to antagonise aldosterone’s distal-tubule effect on sodium retention and potassium excretion. The first MR antagonist; remains the reference agent despite the availability of the more selective eplerenone.<\/p>\n

How Spironolactone Works<\/h2>\n

Spironolactone inhibits the mineralocorticoid receptor (MR) in the principal cells of the cortical collecting duct<\/strong>. \u039f\u03b9 \u03b5\u03c0\u03b1\u03ba\u03cc\u03bb\u03bf\u03c5\u03b8\u03b5\u03c2 \u03b5\u03c0\u03b9\u03c0\u03c4\u03ce\u03c3\u03b5\u03b9\u03c2:<\/p>\n

    \n
  • Blocks aldosterone at the mineralocorticoid receptor<\/strong> in principal cells of the cortical collecting duct<\/li>\n
  • Reduced sodium reabsorption, reduced potassium secretion<\/strong> \u2014 \u03ae\u03c0\u03b9\u03b1 \u03bd\u03b1\u03c4\u03c1\u03b9\u03bf\u03cd\u03c1\u03b7\u03c3\u03b7 \u03bc\u03b5 \u03b4\u03b9\u03b1\u03c4\u03ae\u03c1\u03b7\u03c3\u03b7 \u03ba\u03b1\u03bb\u03af\u03bf\u03c5 (\u03ba\u03b1\u03bb\u03b9\u03bf\u03c6\u03c5\u03b3\u03ae)<\/li>\n
  • Anti-fibrotic and anti-remodelling effect in myocardium<\/strong> — aldosterone drives cardiac fibrosis independent of its salt-retaining effect; blocking the receptor reduces fibrosis. This is the main mechanism of the HF-REF mortality benefit (RALES).<\/li>\n
  • Anti-androgen activity<\/strong> — cross-reactivity with androgen and progesterone receptors produces gynaecomastia and menstrual irregularity as class side effects; same activity gives its off-label role in hirsutism and PCOS.<\/li>\n
  • Delayed onset\/offset<\/strong> (24-72 hours each direction) — receptor pharmacology plus long-acting active metabolites (canrenone)<\/li>\n
  • Effective at resistant hypertension<\/strong> (PATHWAY-2) — acts on the subpopulation of hypertensives with covert aldosterone excess<\/li>\n<\/ul>\n

    \u0395\u03b3\u03ba\u03b5\u03ba\u03c1\u03b9\u03bc\u03ad\u03bd\u03b5\u03c2 \u03ba\u03b1\u03b9 \u0392\u03b1\u03c3\u03b9\u03c3\u03bc\u03ad\u03bd\u03b5\u03c2 \u03c3\u03b5 \u0391\u03c0\u03bf\u03b4\u03b5\u03af\u03be\u03b5\u03b9\u03c2 \u03a7\u03c1\u03ae\u03c3\u03b5\u03b9\u03c2<\/h2>\n
      \n
    • Heart failure with reduced ejection fraction (HF-REF), primary aldosteronism, resistant hypertension, cirrhotic ascites, adjunct treatment for hirsutism and PCOS<\/strong> \u2014 \u03ba\u03cd\u03c1\u03b9\u03b1 \u03b5\u03bd\u03b4\u03b5\u03af\u03be\u03b5\u03b9<\/li>\n
    • Heart failure with reduced ejection fraction (EF ≤35%)<\/strong> — RALES evidence, 25-50 mg daily<\/li>\n
    • Primary aldosteronism (Conn’s syndrome)<\/strong> — definitive medical therapy for bilateral adrenal hyperplasia; bridging therapy for unilateral adenoma pre-surgery<\/li>\n
    • \u0391\u03bd\u03b8\u03b5\u03ba\u03c4\u03b9\u03ba\u03ae \u03c5\u03c0\u03ad\u03c1\u03c4\u03b1\u03c3\u03b7<\/strong> — PATHWAY-2 evidence; fourth-line agent after ACEi\/ARB + CCB + thiazide<\/li>\n
    • Cirrhotic ascites<\/strong> — first-line diuretic in cirrhosis (loop diuretics added if response inadequate)<\/li>\n
    • Hirsutism, PCOS-related acne, female-pattern hair loss<\/strong> — off-label anti-androgen therapy<\/li>\n
    • Post-MI with LV dysfunction<\/strong> — eplerenone is preferred (EPHESUS trial specific)<\/li>\n<\/ul>\n

      \u039a\u03c5\u03c1\u03af\u03b1\u03c1\u03c7\u03b5\u03c2 \u03ba\u03bb\u03b9\u03bd\u03b9\u03ba\u03ad\u03c2 \u03b4\u03bf\u03ba\u03b9\u03bc\u03ad\u03c2:<\/strong> RALES (1999)<\/strong> — landmark trial of spironolactone 25-50 mg in severe HF-REF; 30% reduction in all-cause mortality. Established aldosterone antagonism as standard HF-REF therapy. EPHESUS<\/strong> \u03ba\u03b1\u03b9 EMPHASIS-HF<\/strong> extended to eplerenone. PATHWAY-2 (2015)<\/strong> — spironolactone 25-50 mg was the most effective fourth agent for resistant hypertension vs bisoprolol or doxazosin. TOPCAT<\/strong> — modest benefit in HF with preserved ejection fraction (HF-PEF); signal stronger in Americas arm than Russia arm (controversial).<\/p>\n

      Silectone Dosage<\/h2>\n

      Heart dose:<\/strong> \u0391\u03bd\u03b8\u03b5\u03ba\u03c4\u03b9\u03ba\u03ae \u03c5\u03c0\u03ad\u03c1\u03c4\u03b1\u03c3\u03b7<\/strong> (BP not controlled on ACEi\/ARB + CCB + thiazide): 25-50 mg once daily — PATHWAY-2 evidence. Spironolactone beats bisoprolol and doxazosin as the fourth agent in resistant HTN. \u0394\u03b5\u03bd \u03b5\u03af\u03bd\u03b1\u03b9 \u03c0\u03c1\u03ce\u03c4\u03b7\u03c2 \u03b3\u03c1\u03b1\u03bc\u03bc\u03ae\u03c2 \u03b1\u03bd\u03c4\u03b9\u03c5\u03c0\u03b5\u03c1\u03c4\u03b1\u03c3\u03b9\u03ba\u03cc.<\/strong> Primary aldosteronism (Conn’s):<\/strong> 50-400 mg\/day until potassium and BP normalise, then maintenance 25-100 mg.<\/p>\n

      \u0386\u03bb\u03bb\u03b5\u03c2 \u03b5\u03bd\u03b4\u03b5\u03af\u03be\u03b5\u03b9\u03c2:<\/strong> Heart failure with reduced ejection fraction (EF ≤35%):<\/strong> 12.5-25 mg once daily; target 25-50 mg if tolerated (RALES trial). Cirrhotic ascites:<\/strong> 50-400 mg\/day, usually with furosemide 20-160 mg (1:2.5 ratio); target 0.5 kg\/day weight loss. Hirsutism \/ PCOS \/ acne (female patients):<\/strong> 50-200 mg\/day — suppresses androgen-driven hair growth and acne over 3-6 months (off-label but well-established).<\/p>\n

      \u03a7\u03bf\u03c1\u03ae\u03b3\u03b7\u03c3\u03b7:<\/strong> \u03bc\u03af\u03b1 \u03c6\u03bf\u03c1\u03ac \u03c4\u03b7\u03bd \u03b7\u03bc\u03ad\u03c1\u03b1 (\u03ae \u03b4\u03cd\u03bf \u03c6\u03bf\u03c1\u03ad\u03c2 \u03c4\u03b7\u03bd \u03b7\u03bc\u03ad\u03c1\u03b1 \u03b3\u03b9\u03b1 \u03c5\u03c8\u03b7\u03bb\u03ad\u03c2 \u03b4\u03cc\u03c3\u03b5\u03b9\u03c2 \u03b8\u03b7\u03bb\u03b1\u03ba\u03b9\u03ba\u03ce\u03bd \u03b4\u03b9\u03bf\u03c5\u03c1\u03b7\u03c4\u03b9\u03ba\u03ce\u03bd \u03c3\u03b5 \u03ba\u03b1\u03c1\u03b4\u03b9\u03b1\u03ba\u03ae \u03b1\u03bd\u03b5\u03c0\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1), \u03c4\u03bf \u03c0\u03c1\u03c9\u03af. \u0397 \u03c7\u03bf\u03c1\u03ae\u03b3\u03b7\u03c3\u03b7 \u03c4\u03bf \u03b2\u03c1\u03ac\u03b4\u03c5 \u03c0\u03c1\u03bf\u03ba\u03b1\u03bb\u03b5\u03af \u03bd\u03c5\u03ba\u03c4\u03bf\u03c5\u03c1\u03af\u03b1 \u03ba\u03b1\u03b9 \u03b8\u03b1 \u03c0\u03c1\u03ad\u03c0\u03b5\u03b9 \u03bd\u03b1 \u03b1\u03c0\u03bf\u03c6\u03b5\u03cd\u03b3\u03b5\u03c4\u03b1\u03b9 \u03cc\u03c4\u03b1\u03bd \u03b5\u03af\u03bd\u03b1\u03b9 \u03b4\u03c5\u03bd\u03b1\u03c4\u03cc\u03bd. \u039b\u03ae\u03c8\u03b7 \u03c4\u03b7\u03bd \u03af\u03b4\u03b9\u03b1 \u03ce\u03c1\u03b1 \u03ba\u03ac\u03b8\u03b5 \u03bc\u03ad\u03c1\u03b1. \u0397 \u03c4\u03c1\u03bf\u03c6\u03ae \u03b4\u03b5\u03bd \u03b5\u03c0\u03b7\u03c1\u03b5\u03ac\u03b6\u03b5\u03b9 \u03c3\u03b7\u03bc\u03b1\u03bd\u03c4\u03b9\u03ba\u03ac \u03c4\u03b7\u03bd \u03b1\u03c0\u03bf\u03c1\u03c1\u03cc\u03c6\u03b7\u03c3\u03b7 \u03b3\u03b9\u03b1 \u03ba\u03b1\u03bd\u03ad\u03bd\u03b1 \u03b1\u03c0\u03cc \u03b1\u03c5\u03c4\u03ac \u03c4\u03b1 \u03b4\u03b9\u03bf\u03c5\u03c1\u03b7\u03c4\u03b9\u03ba\u03ac.<\/p>\n

      \u03a0\u03c1\u03cc\u03b3\u03c1\u03b1\u03bc\u03bc\u03b1 \u03c0\u03b1\u03c1\u03b1\u03ba\u03bf\u03bb\u03bf\u03cd\u03b8\u03b7\u03c3\u03b7\u03c2:<\/strong><\/p>\n

        \n
      • \u0392\u03b1\u03c3\u03b9\u03ba\u03ae \u03b1\u03be\u03b9\u03bf\u03bb\u03cc\u03b3\u03b7\u03c3\u03b7:<\/strong> \u03bf\u03c5\u03c1\u03af\u03b1, \u03b7\u03bb\u03b5\u03ba\u03c4\u03c1\u03bf\u03bb\u03cd\u03c4\u03b5\u03c2 (\u03b5\u03b9\u03b4\u03b9\u03ba\u03ac \u03ba\u03ac\u03bb\u03b9\u03bf \u03ba\u03b1\u03b9 \u03bd\u03ac\u03c4\u03c1\u03b9\u03bf), \u03ba\u03c1\u03b5\u03b1\u03c4\u03b9\u03bd\u03af\u03bd\u03b7, eGFR, \u03b3\u03bb\u03c5\u03ba\u03cc\u03b6\u03b7, \u03bf\u03c5\u03c1\u03b9\u03ba\u03cc \u03bf\u03be\u03cd \u03bf\u03c1\u03bf\u03cd. \u039f\u03b9\u03ba\u03b9\u03b1\u03ba\u03ae \u03ae \u03ba\u03bb\u03b9\u03bd\u03b9\u03ba\u03ae \u03c0\u03af\u03b5\u03c3\u03b7 \u03ba\u03b1\u03b9 \u03ba\u03b1\u03b8\u03b7\u03bc\u03b5\u03c1\u03b9\u03bd\u03cc \u03b2\u03ac\u03c1\u03bf\u03c2 \u03b3\u03b9\u03b1 \u03b1\u03c3\u03b8\u03b5\u03bd\u03b5\u03af\u03c2 \u03bc\u03b5 \u03ba\u03b1\u03c1\u03b4\u03b9\u03b1\u03ba\u03ae \u03b1\u03bd\u03b5\u03c0\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1.<\/li>\n
      • 1-2 \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b5\u03c2 \u03bc\u03b5\u03c4\u03ac \u03c4\u03b7\u03bd \u03ad\u03bd\u03b1\u03c1\u03be\u03b7 \u03ae \u03b1\u03bb\u03bb\u03b1\u03b3\u03ae \u03b4\u03cc\u03c3\u03b7\u03c2:<\/strong> \u03b5\u03c0\u03b1\u03bd\u03b1\u03bb\u03b1\u03bc\u03b2\u03b1\u03bd\u03cc\u03bc\u03b5\u03bd\u03b7 U&E \u03ba\u03b1\u03b9 \u03ba\u03c1\u03b5\u03b1\u03c4\u03b9\u03bd\u03af\u03bd\u03b7. \u0391\u03bd\u03b1\u03bc\u03ad\u03bd\u03b5\u03c4\u03b1\u03b9 \u03ae\u03c0\u03b9\u03b1 \u03bc\u03b5\u03c4\u03b1\u03b2\u03bf\u03bb\u03ae \u03c4\u03c9\u03bd \u03b7\u03bb\u03b5\u03ba\u03c4\u03c1\u03bf\u03bb\u03c5\u03c4\u03ce\u03bd\u00b7 \u03b4\u03b9\u03b5\u03c1\u03b5\u03cd\u03bd\u03b7\u03c3\u03b7 \u03c3\u03b7\u03bc\u03b1\u03bd\u03c4\u03b9\u03ba\u03ce\u03bd \u03b1\u03bb\u03bb\u03b1\u03b3\u03ce\u03bd.<\/li>\n
      • 4-6 \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b5\u03c2:<\/strong> \u03b1\u03be\u03b9\u03bf\u03bb\u03cc\u03b3\u03b7\u03c3\u03b7 \u03c0\u03af\u03b5\u03c3\u03b7\u03c2 \u03ba\u03b1\u03b9 \u03c0\u03bb\u03ae\u03c1\u03b7\u03c2 \u03bc\u03b5\u03c4\u03b1\u03b2\u03bf\u03bb\u03b9\u03ba\u03cc \u03c0\u03c1\u03bf\u03c6\u03af\u03bb.<\/li>\n
      • \u03a3\u03c5\u03bd\u03b5\u03c7\u03ae\u03c2 \u03c0\u03b1\u03c1\u03b1\u03ba\u03bf\u03bb\u03bf\u03cd\u03b8\u03b7\u03c3\u03b7:<\/strong> \u03b5\u03c4\u03ae\u03c3\u03b9\u03b1 U&E, \u03bf\u03c5\u03c1\u03b9\u03ba\u03cc \u03bf\u03be\u03cd, \u03b3\u03bb\u03c5\u03ba\u03cc\u03b6\u03b7 \u03ba\u03b1\u03b9 \u03bb\u03b9\u03c0\u03b9\u03b4\u03b1\u03af\u03bf \u03c0\u03c1\u03bf\u03c6\u03af\u03bb \u03bc\u03cc\u03bb\u03b9\u03c2 \u03c3\u03c4\u03b1\u03b8\u03b5\u03c1\u03bf\u03c0\u03bf\u03b9\u03b7\u03b8\u03b5\u03af. \u03a0\u03b9\u03bf \u03c3\u03c5\u03c7\u03bd\u03ac \u03c3\u03b5 \u03c7\u03c1\u03cc\u03bd\u03b9\u03b1 \u03bd\u03b5\u03c6\u03c1\u03b9\u03ba\u03ae \u03bd\u03cc\u03c3\u03bf, \u03ba\u03b1\u03c1\u03b4\u03b9\u03b1\u03ba\u03ae \u03b1\u03bd\u03b5\u03c0\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1 \u03ae \u03c3\u03b5 \u03c3\u03c5\u03bd\u03b4\u03c5\u03b1\u03c3\u03bc\u03ad\u03bd\u03b7 \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1.<\/li>\n
      • \u0394\u03b9\u03b1\u03ba\u03bf\u03c0\u03ae \u03ae \u03bc\u03b5\u03af\u03c9\u03c3\u03b7 \u03b4\u03cc\u03c3\u03b7\u03c2 \u03c3\u03b5 \u03c0\u03b5\u03c1\u03af\u03c0\u03c4\u03c9\u03c3\u03b7:<\/strong> sodium <130 with symptoms, potassium >5.5, creatinine rise >30%, new gout, severe dehydration symptoms.<\/li>\n<\/ul>\n

        \u0394\u03b9\u03b1\u03ba\u03bf\u03c0\u03ae:<\/strong> \u03b4\u03b5\u03bd \u03c5\u03c0\u03ac\u03c1\u03c7\u03b5\u03b9 \u03c3\u03cd\u03bd\u03b4\u03c1\u03bf\u03bc\u03bf \u03c3\u03c4\u03ad\u03c1\u03b7\u03c3\u03b7\u03c2 \u03b1\u03bb\u03bb\u03ac \u03b7 \u03b1\u03c0\u03cc\u03c4\u03bf\u03bc\u03b7 \u03b4\u03b9\u03b1\u03ba\u03bf\u03c0\u03ae \u03bc\u03c0\u03bf\u03c1\u03b5\u03af \u03bd\u03b1 \u03c0\u03c1\u03bf\u03ba\u03b1\u03bb\u03ad\u03c3\u03b5\u03b9 \u03b1\u03bd\u03ac\u03ba\u03b1\u03bc\u03c8\u03b7 \u03cc\u03b3\u03ba\u03bf\u03c5 \u03c3\u03b5 \u03b1\u03c3\u03b8\u03b5\u03bd\u03b5\u03af\u03c2 \u03bc\u03b5 \u03c7\u03c1\u03cc\u03bd\u03b9\u03b1 \u03ba\u03b1\u03c1\u03b4\u03b9\u03b1\u03ba\u03ae \u03b1\u03bd\u03b5\u03c0\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1 \u03c3\u03b5 \u03c7\u03c1\u03cc\u03bd\u03b9\u03b1 \u03c5\u03c8\u03b7\u03bb\u03ae \u03b4\u03cc\u03c3\u03b7 \u03b8\u03b7\u03bb\u03b1\u03ba\u03b9\u03ba\u03ce\u03bd \u03b4\u03b9\u03bf\u03c5\u03c1\u03b7\u03c4\u03b9\u03ba\u03ce\u03bd \u2014 \u03c3\u03c4\u03b1\u03b4\u03b9\u03b1\u03ba\u03ae \u03bc\u03b5\u03af\u03c9\u03c3\u03b7 \u03cc\u03c0\u03bf\u03c5 \u03b5\u03af\u03bd\u03b1\u03b9 \u03b4\u03c5\u03bd\u03b1\u03c4\u03cc\u03bd \u03ba\u03b1\u03b9 \u03c0\u03b1\u03c1\u03b1\u03ba\u03bf\u03bb\u03bf\u03cd\u03b8\u03b7\u03c3\u03b7 \u03b2\u03ac\u03c1\u03bf\u03c5\u03c2.<\/p>\n

          \n
        • Non-selective steroid receptor activity<\/strong> causes gynaecomastia (5-10%), mastalgia, and menstrual irregularity via androgen and progesterone receptor effects. Eplerenone is selective for MR and avoids these; switch if gynaecomastia develops.<\/li>\n
        • Delayed onset:<\/strong> effect takes 2-3 days to manifest and 2-3 days to wear off; dose adjustments should allow this lag.<\/li>\n
        • Hyperkalaemia is the dose-limiting toxicity<\/strong>, particularly when combined with ACEi\/ARB (standard in HF and HTN). Monitor potassium and creatinine at baseline, 1 week, 1 month, and every 3-4 months.<\/li>\n
        • Contraception considerations:<\/strong> spironolactone is teratogenic (feminisation of male fetus) — women on spironolactone for acne\/hirsutism must use reliable contraception.<\/li>\n<\/ul>\n

          \u03a0\u03b1\u03c1\u03b5\u03bd\u03ad\u03c1\u03b3\u03b5\u03b9\u03b5\u03c2<\/h2>\n

          \u03a3\u03c5\u03c7\u03bd\u03ac (>1%):<\/strong><\/p>\n

            \n
          • \u03a5\u03c0\u03b5\u03c1\u03ba\u03b1\u03bb\u03b9\u03b1\u03b9\u03bc\u03af\u03b1<\/strong> — dose-limiting; severe in CKD or with ACEi\/ARB combinations<\/li>\n
          • Gynaecomastia and mastalgia in men<\/strong> (5-10% at 25-50 mg; up to 50% at high doses >150 mg)<\/li>\n
          • Menstrual irregularity in women<\/strong><\/li>\n
          • Erectile dysfunction and reduced libido in some men<\/strong><\/li>\n
          • \u0389\u03c0\u03b9\u03b1 \u03b3\u03b1\u03c3\u03c4\u03c1\u03b5\u03bd\u03c4\u03b5\u03c1\u03b9\u03ba\u03ae \u03b4\u03c5\u03c3\u03c6\u03bf\u03c1\u03af\u03b1<\/strong><\/li>\n
          • Metabolic acidosis<\/strong> (reduced distal H+ secretion) — usually mild<\/li>\n
          • Stevens-Johnson syndrome<\/strong> — rare hypersensitivity reaction<\/li>\n
          • \u0391\u03cd\u03be\u03b7\u03c3\u03b7 \u03ba\u03c1\u03b5\u03b1\u03c4\u03b9\u03bd\u03af\u03bd\u03b7\u03c2<\/strong> — modest rise (10-20%) is expected on initiation; investigate if >30%<\/li>\n<\/ul>\n

            \u03a3\u03c0\u03ac\u03bd\u03b9\u03b1 \u03b1\u03bb\u03bb\u03ac \u03ba\u03bb\u03b9\u03bd\u03b9\u03ba\u03ac \u03c3\u03b7\u03bc\u03b1\u03bd\u03c4\u03b9\u03ba\u03ac:<\/strong><\/p>\n