{"id":60999,"date":"2024-02-28T07:19:36","date_gmt":"2024-02-28T07:19:36","guid":{"rendered":"https:\/\/medsname.com\/aldactone\/"},"modified":"2026-05-01T10:49:16","modified_gmt":"2026-05-01T10:49:16","slug":"aldactone","status":"publish","type":"product","link":"https:\/\/medsbase.com\/ro\/product\/aldactone\/","title":{"rendered":"Aldactone"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:18px 22px;margin:0 0 24px 0;border-radius:4px;\">\n<h3 class=\"wp-block-heading\" style=\"margin:0 0 8px 0;font-size:16px;font-weight:700;\">\u26a1 R\u0103spuns rapid \u2014 Ce este Aldactone?<\/h3>\n<p style=\"margin:0;\"><strong>Aldactone<\/strong> este un <strong>Comprimat de spironolacton\u0103 25 \/ 50 \/ 100 mg<\/strong> de la RPG Life Sciences \u2014 un <strong>antagonist al receptorului de mineralocorticoizi (antagonist al aldosteronului)<\/strong> care ac\u021bioneaz\u0103 asupra <strong>receptorul mineralocorticoid (MR) din celulele principale ale tubului colector cortical<\/strong>. Spironolacton\u0103 a fost introdus\u0103 de G.D. Searle \u00een 1959 \u2014 conceput\u0103 ca un steroid sintetic pentru a antagoniza efectul aldosteronului la nivelul tubului distal asupra re\u021binerii de sodiu \u0219i excre\u021biei de potasiu. Primul antagonist al MR; r\u0103m\u00e2ne agentul de referin\u021b\u0103 \u00een ciuda disponibilit\u0103\u021bii eplerenonei, mai selectiv\u0103. Timp de \u00eenjum\u0103t\u0103\u021bire 1,4 ore (substan\u021ba matern\u0103); 16-24 ore (metaboli\u021bii activi canrenon\u0103 \u0219i 7-\u03b1-tiometilspirolacton\u0103); debut 24-48 ore (necesit\u0103 timp pentru ca antagonismul receptorilor s\u0103 se manifeste la nivel tisular); efect maxim 2-3 zile; durat\u0103 2-3 zile dup\u0103 \u00eentrerupere. Indica\u021bie principal\u0103: <strong>insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie redus\u0103 (IC-FER), hiperaldosteronism primar, hipertensiune rezistent\u0103, ascit\u0103 cirotic\u0103, tratament adjunctiv pentru hirsutism \u0219i PCOS<\/strong>. Dozaj tipic: <strong>Hipertensiune rezistent\u0103<\/strong> (TA necontrolat\u0103 pe ACEi\/ARB + CCB + tiazidic\u0103): 25-50 mg o dat\u0103 pe zi \u2014 dovezi PATHWAY-2. Spironolacton\u0103 \u00eentrece bisoprololul \u0219i doxazosina ca al patrulea agent \u00een HTA rezistent\u0103. <strong>Nu este un antihipertensiv de prim\u0103 inten\u021bie.<\/strong> <strong>Hiperaldosteronism primar (Conn):<\/strong> 50-400 mg\/zi p\u00e2n\u0103 la normalizarea potasiului \u0219i TA, apoi \u00eentre\u021binere 25-100 mg. Contraindica\u021bii cheie: consulta\u021bi lista complet\u0103 de mai jos. Monitoriza\u021bi electroli\u021bii, creatinina \u0219i glicemia. <strong>Nu combina\u021bi cu litiu<\/strong> (diureticele tiazidice\/de ans\u0103 pot precipita toxicitatea litiului). <strong>Utilizarea \u00een sarcin\u0103 este specific\u0103 cazului<\/strong> (consulta\u021bi nota despre sarcin\u0103). Pentru majoritatea pacien\u021bilor hipertensivi, diureticele func\u021bioneaz\u0103 cel mai bine ca <strong>al doilea sau al treilea agent<\/strong> \u2014 de obicei combinat cu un BRA, inhibitor ACE sau blocant al canalelor de calciu, mai degrab\u0103 dec\u00e2t utilizat singur.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f8fb;border:1px solid #d8e3eb;padding:12px 16px;margin:16px 0;border-radius:4px;font-size:14px;\">\n<strong>Ce beneficii ofer\u0103 MedsBase:<\/strong> Produc\u0103tor certificat WHO-GMP \u00b7 Ambalaj discret \u00b7 Livrare la nivel mondial \u00b7 Peste 1.400 de recenzii verificate <a href=\"https:\/\/medsbase.com\/ro\/reviews\/\">ale clien\u021bilor<\/a>\n<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 Fiecare comand\u0103 este acoperit\u0103 de politica noastr\u0103 de <a href=\"https:\/\/medsbase.com\/ro\/medsbase-re-shipment-assurance-policy\/\"><strong>Politica noastr\u0103 de Reexpediere Garantat\u0103<\/strong><\/a> \u2014 dac\u0103 coletul dumneavoastr\u0103 nu sose\u0219te \u00een 20 de zile lucr\u0103toare, \u00eel relivr\u0103m.<\/p>\n<h3>De ce s\u0103 comanzi de la MedsBase<\/h3>\n<p>Medicamentele noastre generice sunt procurate de la produc\u0103tori certifica\u021bi WHO-GMP \u0219i expediate la nivel mondial \u00een ambalaje discrete \u0219i simple \u2014 f\u0103r\u0103 denumirea medicamentului pe exteriorul coletului. Pl\u0103\u021bile cu cardul sunt procesate printr-un procesor reglementat (descrierile de pe extrasul de cont includ un procesor de pl\u0103\u021bi cu card reglementat \u2014 niciodat\u0103 \u201cMedsBase\u201d sau numele vreunui medicament). Accept\u0103m \u0219i criptomonede \u0219i transferuri bancare SEPA. Fiecare comand\u0103 este sus\u021binut\u0103 de Politica noastr\u0103 de Asigurare pentru Relivrare.<\/p>\n<h2 class=\"wp-block-heading\">Ce este Aldactone?<\/h2>\n<p>Aldactone este un comprimat oral de spironolacton\u0103 25\/50\/100 mg de la RPG Life Sciences, furnizat \u00een cutii de 30-180 comprimate. Spironolacton\u0103 a fost introdus\u0103 de G.D. Searle \u00een 1959 \u2014 conceput\u0103 ca un steroid sintetic pentru a antagoniza efectul aldosteronului la nivelul tubului distal asupra re\u021binerii de sodiu \u0219i excre\u021biei de potasiu. Primul antagonist al MR; r\u0103m\u00e2ne agentul de referin\u021b\u0103 \u00een ciuda disponibilit\u0103\u021bii eplerenonei, mai selectiv\u0103.<\/p>\n<h2 class=\"wp-block-heading\">Cum func\u021bioneaz\u0103 spironolactona<\/h2>\n<p>Spironolactona inhib\u0103 <strong>receptorul mineralocorticoid (MR) din celulele principale ale tubului colector cortical<\/strong>. Efectele secundare:<\/p>\n<ul>\n<li><strong>Blocheaz\u0103 aldosteronul la receptorul mineralocorticoid<\/strong> \u00een celulele principale ale tubului colector cortical<\/li>\n<li><strong>Reducere a reabsorb\u021biei de sodiu, reducere a secre\u021biei de potasiu<\/strong> \u2014 naturiez\u0103 u\u0219oar\u0103 cu re\u021binere de potasiu (efect de economisire a potasiului)<\/li>\n<li><strong>Efect antifibrotic \u0219i antiremodelare \u00een miocard<\/strong> \u2014 aldosteronul induce fibroz\u0103 cardiac\u0103 independent de efectul s\u0103u de re\u021binere a s\u0103rurilor; blocarea receptorului reduce fibroza. Acesta este principalul mecanism al beneficiului de mortalitate \u00een IC-FER (RALES).<\/li>\n<li><strong>Activitate anti-androgen\u0103<\/strong> \u2014 reac\u021bia \u00eencruci\u0219at\u0103 cu receptorii androgeni \u0219i progesteronici produce ginecomastie \u0219i tulbur\u0103ri menstruale ca efecte adverse de clas\u0103; aceea\u0219i activitate \u00eei confer\u0103 rolul off-label \u00een hirsutism \u0219i PCOS.<\/li>\n<li><strong>Instalare\/\u00eencetare \u00eent\u00e2rziat\u0103<\/strong> (24-72 ore \u00een fiecare direc\u021bie) \u2014 farmacologia receptorilor plus metabolitele active cu ac\u021biune \u00eendelungat\u0103 (canrenon\u0103)<\/li>\n<li><strong>Eficace la hipertensiunea rezistent\u0103<\/strong> (PATHWAY-2) \u2014 ac\u021bioneaz\u0103 asupra subpopula\u021biei de hipertensivi cu exces mascat de aldosteron<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Utiliz\u0103ri aprobate \u0219i bazate pe dovezi<\/h2>\n<ul>\n<li><strong>Insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie redus\u0103 (HF-REF), hiperaldosteronism primar, hipertensiune rezistent\u0103, ascit\u0103 cirotic\u0103, tratament adjunctiv pentru hirsutism \u0219i PCOS<\/strong> \u2014 indica\u021bie principal\u0103<\/li>\n<li><strong>Insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie redus\u0103 (EF \u226435%)<\/strong> \u2014 dovezi RALES, 25-50 mg zilnic<\/li>\n<li><strong>Hiperaldosteronism primar (sindromul Conn)<\/strong> \u2014 terapie medical\u0103 definitiv\u0103 pentru hiperplazia adrenal\u0103 bilateral\u0103; terapie de punte pentru adenomul unilateral prechirurgical<\/li>\n<li><strong>Hipertensiune rezistent\u0103<\/strong> \u2014 dovezi PATHWAY-2; agent de linia a patra dup\u0103 ACEi\/ARB + CCB + tiazidic\u0103<\/li>\n<li><strong>Ascit\u0103 cirotic\u0103<\/strong> \u2014 diuretic de prim\u0103 inten\u021bie \u00een ciroz\u0103 (diureticele de ans\u0103 sunt ad\u0103ugate dac\u0103 r\u0103spunsul este inadecvat)<\/li>\n<li><strong>Hirsutism, acnee asociat\u0103 PCOS, pierderea p\u0103rului la femei \u00een tipar feminin<\/strong> \u2014 terapie anti-androgen\u0103 off-label<\/li>\n<li><strong>Post-IM cu disfunc\u021bie ventricular\u0103 st\u00e2ng\u0103<\/strong> \u2014 eplerenonul este preferat (specific trialului EPHESUS)<\/li>\n<\/ul>\n<p><strong>Dovezile din studiile pivotale:<\/strong> <strong>RALES (1999)<\/strong> \u2014 studiu de referin\u021b\u0103 al spironolactonei 25-50 mg \u00een IC-REF sever\u0103; reducere cu 30% a mortalit\u0103\u021bii din toate cauzele. A stabilit antagonismul aldosteronului ca terapie standard \u00een IC-REF. <strong>EPHESUS<\/strong> \u0219i <strong>EMPHASIS-HF<\/strong> extins la eplerenon. <strong>PATHWAY-2 (2015)<\/strong> \u2014 spironolactona 25-50 mg a fost cel mai eficient al patrulea agent pentru hipertensiunea rezistent\u0103 vs bisoprolol sau doxazosin\u0103. <strong>TOPCAT<\/strong> \u2014 beneficiu modest \u00een insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie p\u0103strat\u0103 (IC-FEP); semnalul este mai puternic \u00een grupul din Americi dec\u00e2t \u00een cel din Rusia (controversat).<\/p>\n<h2 class=\"wp-block-heading\">Doza Aldactone<\/h2>\n<p><strong>Doza pentru inim\u0103:<\/strong> <strong>Hipertensiune rezistent\u0103<\/strong> (TA necontrolat\u0103 pe ACEi\/ARB + CCB + tiazidic\u0103): 25-50 mg o dat\u0103 pe zi \u2014 dovezi PATHWAY-2. Spironolacton\u0103 \u00eentrece bisoprololul \u0219i doxazosina ca al patrulea agent \u00een HTA rezistent\u0103. <strong>Nu este un antihipertensiv de prim\u0103 inten\u021bie.<\/strong> <strong>Hiperaldosteronism primar (Conn):<\/strong> 50-400 mg\/zi p\u00e2n\u0103 c\u00e2nd potasiul \u0219i tensiunea arterial\u0103 se normalizeaz\u0103, apoi \u00eentre\u021binere cu 25-100 mg.<\/p>\n<p><strong>Alte indica\u021bii:<\/strong> <strong>Insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie redus\u0103 (FE \u226435%):<\/strong> 12,5-25 mg o dat\u0103 pe zi; \u021bint\u0103 25-50 mg dac\u0103 este tolerat (studiu RALES). <strong>Ascit\u0103 cirotic\u0103:<\/strong> 50-400 mg\/zi, de obicei cu furosemid\u0103 20-160 mg (raport 1:2,5); \u021bint\u0103 pierdere \u00een greutate de 0,5 kg\/zi. <strong>Hirsutism \/ PCOS \/ acnee (paciente de sex feminin):<\/strong> 50-200 mg\/zi \u2014 reduce cre\u0219terea p\u0103rului \u0219i acneea determinat\u0103 de androgeni \u00een 3-6 luni (\u00een afara indica\u021biilor, dar bine stabilit).<\/p>\n<p><strong>Administrare:<\/strong> o dat\u0103 pe zi (sau de dou\u0103 ori pe zi pentru doze mari de diuretice de ans\u0103 \u00een insuficien\u021b\u0103 cardiac\u0103), diminea\u021ba. Administrarea seara provoac\u0103 nicturie \u0219i ar trebui evitat\u0103 c\u00e2nd este posibil. Lua\u021bi la aceea\u0219i or\u0103 \u00een fiecare zi. Alimenta\u021bia nu afecteaz\u0103 semnificativ absorb\u021bia pentru niciunul dintre aceste diuretice.<\/p>\n<p><strong>Program de monitorizare:<\/strong><\/p>\n<ul>\n<li><strong>Valori ini\u021biale:<\/strong> uree, electroli\u021bi (\u00een special potasiu \u0219i sodiu), creatinin\u0103, eGFR, glucoz\u0103, acid uric seric. Tensiunea arterial\u0103 acas\u0103 sau \u00een clinic\u0103 \u0219i greutatea zilnic\u0103 pentru pacien\u021bii cu insuficien\u021b\u0103 cardiac\u0103.<\/li>\n<li><strong>la 1-2 s\u0103pt\u0103m\u00e2ni dup\u0103 \u00eenceperea sau modificarea dozei:<\/strong> repetarea electroli\u021bilor \u0219i a creatininei. A\u0219tepta\u021bi modific\u0103ri minore ale electroli\u021bilor; investiga\u021bi modific\u0103ri substan\u021biale.<\/li>\n<li><strong>4-6 s\u0103pt\u0103m\u00e2ni:<\/strong> evaluarea tensiunii arteriale \u0219i panelul metabolic complet.<\/li>\n<li><strong>Continuu:<\/strong> electroli\u021bi anuali, acid uric, glucoz\u0103 \u0219i panel lipidic odat\u0103 stabilizat. Mai frecvent \u00een insuficien\u021b\u0103 renal\u0103 cronic\u0103, insuficien\u021b\u0103 cardiac\u0103 sau la terapie combinat\u0103.<\/li>\n<li><strong>\u00centrerupe\u021bi sau reduce\u021bi doza la:<\/strong> sodiu 5,5, cre\u0219tere creatinin\u0103 &gt;30%, gut\u0103 nou\u0103, simptome severe de deshidratare.<\/li>\n<\/ul>\n<p><strong>\u00centrerupere:<\/strong> nu exist\u0103 sindrom de sevraj, dar \u00eentreruperea brusc\u0103 poate provoca reten\u021bie de volum de tip rebound la pacien\u021bii cu IC sub doze cronice mari de diuretice de ans\u0103 \u2014 reduce\u021bi progresiv doza acolo unde este posibil \u0219i monitoriza\u021bi greutatea.<\/p>\n<ul>\n<li><strong>Activitate neselectiv\u0103 la receptorii de steroizi<\/strong> produce ginecomastie (5-10%), mastalgie \u0219i iregularit\u0103\u021bi menstruale prin efecte asupra receptorilor de androgeni \u0219i progesteron. Eplerenonul este selectiv pentru MR \u0219i evit\u0103 aceste efecte; comuta\u021bi dac\u0103 apare ginecomastie.<\/li>\n<li><strong>\u00cenceput \u00eent\u00e2rziat:<\/strong> efectul apare \u00een 2-3 zile \u0219i dispare \u00een 2-3 zile; ajust\u0103rile de doz\u0103 ar trebui s\u0103 \u021bin\u0103 cont de aceast\u0103 \u00eent\u00e2rziere.<\/li>\n<li><strong>Hiperkaliemia este toxicitatea limitatoare de doz\u0103<\/strong>, \u00een special atunci c\u00e2nd este combinat cu ACEi\/ARB (standard \u00een IC \u0219i HTA). Monitoriza\u021bi potasiul \u0219i creatinina la ini\u021biere, dup\u0103 1 s\u0103pt\u0103m\u00e2n\u0103, dup\u0103 1 lun\u0103 \u0219i la fiecare 3-4 luni.<\/li>\n<li><strong>Considera\u021bii privind contracep\u021bia:<\/strong> spironolactonul este teratogen (feminizarea fetusului masculin) \u2014 femeile care iau spironolacton pentru acnee\/hirsutism trebuie s\u0103 foloseasc\u0103 metode contraceptive sigure.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Efecte Secundare<\/h2>\n<p><strong>Frecvente (&gt;1%):<\/strong><\/p>\n<ul>\n<li><strong>Hiperkaliemie<\/strong> \u2014 limitare de doz\u0103; sever\u0103 \u00een BCR sau \u00een combina\u021bie cu ACEi\/ARB<\/li>\n<li><strong>Ginecomastie \u0219i mastalgie la b\u0103rba\u021bi<\/strong> (5-10% la 25-50 mg; p\u00e2n\u0103 la 50% la doze mari &gt;150 mg)<\/li>\n<li><strong>Neregularit\u0103\u021bi menstruale la femei<\/strong><\/li>\n<li><strong>Disfunc\u021bie erectil\u0103 \u0219i libido sc\u0103zut la unii b\u0103rba\u021bi<\/strong><\/li>\n<li><strong>Disconfort gastrointestinal u\u0219or<\/strong><\/li>\n<li><strong>Acidoz\u0103 metabolic\u0103<\/strong> (sc\u0103derea secre\u021biei distale de H+) \u2014 de obicei u\u0219oar\u0103<\/li>\n<li><strong>Sindromul Stevens-Johnson<\/strong> \u2014 reac\u021bie de hipersensibilitate rar\u0103<\/li>\n<li><strong>Cre\u0219terea creatininiei<\/strong> \u2014 se a\u0219teapt\u0103 o cre\u0219tere moderat\u0103 (10-20%) la ini\u021biere; investiga\u021bi dac\u0103 dep\u0103\u0219e\u0219te 30%<\/li>\n<\/ul>\n<p><strong>Pu\u021bin frecvente, dar clinic importante:<\/strong><\/p>\n<ul>\n<li><strong>Hiponatremie sever\u0103<\/strong> \u2014 \u00een special la persoanele \u00een v\u00e2rst\u0103 cu diete s\u0103race \u00een sare, st\u0103ri predispuse la SIADH sau \u00een combina\u021bie cu SSRI. Se poate manifesta prin confuzie, c\u0103deri sau convulsii.<\/li>\n<li><strong>Pancreatit\u0103<\/strong> \u2014 efect rar al clasei de tiazide\/loop; \u00eentrerupe\u021bi imediat la apari\u021bia durerii abdominale superioare cu cre\u0219tere a lipazei<\/li>\n<li><strong>Trombocitopenie, leucopenie, agranulocitoz\u0103<\/strong> \u2014 reac\u021bii rare de hipersensibilitate (mai frecvente la tiazide dec\u00e2t la diureticele de ans\u0103)<\/li>\n<li><strong>Miopie acut\u0103 \u0219i glaucom cu unghi \u00eenchis<\/strong> \u2014 reac\u021bie rar\u0103 din clasa sulfonamidelor, care apare \u00een c\u00e2teva ore sau zile de la \u00eenceperea tratamentului; \u00eentrerupe\u021bi imediat dac\u0103 apar dureri oculare sau modific\u0103ri ale vederii<\/li>\n<li><strong>Sindromul Stevens-Johnson \/ necroliz\u0103 epidermic\u0103 toxic\u0103<\/strong> \u2014 extrem de rar, dar raportat<\/li>\n<li><strong>Hiperkaliemie sever\u0103<\/strong> la pacien\u021bii cu aritmie cardiac\u0103 \u2014 cel mai frecvent la pacien\u021bii cu BCR sau \u00een combina\u021bie cu ACEi\/ARB<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Contraindica\u021bii<\/h2>\n<ul>\n<li><strong>Hiperkaliemie &gt;5,5 mmol\/L la evaluarea ini\u021bial\u0103<\/strong> \u2014 verifica\u021bi \u00eenainte de \u00eenceperea tratamentului<\/li>\n<li><strong>Insuficien\u021b\u0103 renal\u0103 sever\u0103<\/strong> (eGFR &lt;30) \u2014 risc inacceptabil de hiperkaliemie<\/li>\n<li><strong>Boala Addison<\/strong> (insuficien\u021b\u0103 adrenal\u0103 primar\u0103)<\/li>\n<li><strong>Sarcin\u0103<\/strong> \u2014 teratogen (efectul anti-androgen feminizeaz\u0103 fetusii de sex masculin)<\/li>\n<li><strong>Suplimente de potasiu concomitente<\/strong> \u2014 nu combina\u021bi f\u0103r\u0103 monitorizare<\/li>\n<li><strong>Diuretice economisitoare de potasiu concomitente<\/strong> (amilorid\u0103, triamteren\u0103, eplerenon\u0103)<\/li>\n<li><strong>Anurie<\/strong><\/li>\n<\/ul>\n<p><strong>Sarcina:<\/strong> <strong>contraindicate absolut<\/strong> \u2014 activitatea anti-androgen provoac\u0103 feminizarea fetusilor de sex masculin.<\/p>\n<p><strong>Al\u0103ptarea:<\/strong> \u00een general acceptabile la doze mici; dozele mari pot suprima lacta\u021bia (\u00een special tiazidele). Antihipertensive alternative (propranolol, nifedipin\u0103) sunt preferate atunci c\u00e2nd este posibil.<\/p>\n<h2 class=\"wp-block-heading\">Interac\u021biuni medicamentoase<\/h2>\n<ul>\n<li><strong>Litiu \u2014 INTERAC\u021aIUNE CRITIC\u0102.<\/strong> Spironolactona are un efect moderat asupra clearance-ului de litiu comparativ cu tiazidele \u0219i diureticele de ans\u0103, dar monitoriza\u021bi nivelurile dac\u0103 combina\u021bia este inevitabil\u0103.<\/li>\n<li><strong>AINS<\/strong> \u2014 reduc efectul diuretic (prin blocarea prostaglandinelor) \u0219i cresc substan\u021bial riscul de insuficien\u021b\u0103 renal\u0103 acut\u0103 atunci c\u00e2nd sunt combinate cu ACEi\/ARB (\u201ctripla lovitur\u0103\u201d). Utiliza\u021bi paracetamol preferen\u021bial pentru durerea cronic\u0103.<\/li>\n<li><strong>Inhibitori ACE \u0219i ARB<\/strong> \u2014 risc adi\u021bional de hiperkaliemie \u2014 monitoriza\u021bi \u00eendeaproape potasiul, \u00een special la pacien\u021bii cu BCR. Standard \u00een IC-REF (ACEi\/ARB + spironolacton\u0103) cu monitorizare atent\u0103; periculos la pacien\u021bii cu potasiu bazal &gt;5,0 sau eGFR &lt;30.<\/li>\n<li><strong>Suplimente de potasiu \u0219i diuretice economisitoare de potasiu<\/strong> \u2014 nu combina\u021bi; risc adi\u021bional de hiperkaliemie.<\/li>\n<li><strong>Digoxin\u0103<\/strong> \u2014 hipokaliemia poten\u021beaz\u0103 toxicitatea digoxinului (diureticele loop \u0219i tiazidice); spironolactona reduce direct clearance-ul digoxinului. Monitoriza\u021bi nivelurile de digoxin \u0219i potasiu la \u00eenceperea sau modificarea diureticului.<\/li>\n<li><strong>Corticoesteroide orale, amfotericina B, laxative stimulante<\/strong> \u2014 hipokaliemie aditiv\u0103 (diuretice loop\/tiazidice) sau necesitate mascat\u0103 de potasiu (spironolacton\u0103).<\/li>\n<li><strong>Antidiabetice orale, insulin\u0103<\/strong> \u2014 diureticele tiazidice \u0219i (\u00een mai mic\u0103 m\u0103sur\u0103) cele loop \u00eenr\u0103ut\u0103\u021besc toleran\u021ba la glucoz\u0103; poate fi necesar\u0103 ajustarea dozei.<\/li>\n<li><strong>Colestiramin\u0103 \/ colestipol<\/strong> \u2014 reduce absorb\u021bia tiazidelor \u0219i a diureticelor de ans\u0103 cu 40-85%. Administrarea trebuie separat\u0103 cu 4 ore.<\/li>\n<li><strong>Inhibitori puternici ai CYP3A4<\/strong> (claritromicin\u0103, ritonavir, itraconazol) \u2014 cresc nivelurile metabolitei canrenon\u0103; cresc riscul de hiperkaliemie.<\/li>\n<li><strong>Alcool<\/strong> \u2014 hipotensiune postural\u0103 aditiv\u0103.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Pozi\u021bia Aldactonei \u00een Clasa Diureticelor<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Clas\u0103<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Reprezentan\u021bi<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Utilizare tipic\u0103<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Tiazid\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/aquazide\/\">HCTZ<\/a>, clortalidon\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">HTN prim-line, pietre de calciu, DI nefrogen<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Asem\u0103n\u0103tor tiazidelor<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/natrilix-sr\/\">Indapamid\u0103<\/a>, metolazon<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">HTN (v\u00e2rstnici, dovezi HYVET), blocaj secven\u021bial al nefronului<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Diuretic de ans\u0103 (scurt)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/lasix\/\">Furosemid\u0103<\/a>, bumetanid\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Edem pulmonar acut, ICC, ascit\u0103, hipercalcemie<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Bucl\u0103 (lung\u0103)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/dytor\/\">Torasemid\u0103<\/a><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">IC cronic\u0103, HTA (singura bucl\u0103 cu dovezi pentru HTA), edem la BCR<\/td>\n<\/tr>\n<tr style=\"background:#fff3cd;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Antagonist de aldosteron\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/aldactone\/\">Spironolacton\u0103<\/a>, eplerenon\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">IC-FER (RALES), HTA rezistent\u0103 (PATHWAY-2), sindrom Conn, ascit\u0103 cirotic\u0103<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Alte economizoare de potasiu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Amilorid\u0103, triamteren (de obicei \u00een combina\u021bii)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Prevenirea hipokaliemiei atunci c\u00e2nd se adaug\u0103 la bucl\u0103\/tiazidic\u0103<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Anhidraz\u0103 carbonic\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Acetazolamid\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Mal de altitudine, glaucom, alcaloz\u0103 metabolic\u0103<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">Depozitare<\/h2>\n<p>P\u0103stra\u021bi Aldactone la o temperatur\u0103 sub 25\u00b0C \u00een ambalajul original blister. \u021aine\u021bi departe de copii.<\/p>\n<h2 id=\"faqs\">\u00centreb\u0103ri frecvente<\/h2>\n<h3 class=\"wp-block-heading\">C\u00e2nd ar trebui s\u0103 iau Aldactone \u2014 diminea\u021ba sau seara?<\/h3>\n<p><strong>Diminea\u021ba<\/strong> \u00een aproape toate cazurile. Efectul diuretic produce o cre\u0219tere a produc\u021biei de urin\u0103 timp de 2-8 ore dup\u0103 administrare. Administrarea seara provoac\u0103 nicturie \u0219i perturb\u0103 somnul. Pacien\u021bii care iau diuretice de ans\u0103 de dou\u0103 ori pe zi le administreaz\u0103 de obicei la micul dejun \u0219i la pr\u00e2nz (nu la culcare).<\/p>\n<h3 class=\"wp-block-heading\">Este Aldactone un medicament de prim\u0103 linie pentru hipertensiune?<\/h3>\n<p><strong>Nu \u2014 spironolactona este un antihipertensiv de linia a patra.<\/strong> Este op\u021biunea preferat\u0103 de ad\u0103ugare atunci c\u00e2nd tensiunea arterial\u0103 r\u0103m\u00e2ne necontrolat\u0103 pe o combina\u021bie de trei medicamente: inhibitor ACE\/ARB + blocant al canalelor de calciu + tiazidic\u0103 (dovezile din studiul PATHWAY-2). De asemenea, are roluri specifice de prim\u0103 linie \u00een <strong>hiperaldosteronism primar<\/strong>, <strong>insuficien\u021ba cardiac\u0103 cu frac\u021bie de ejec\u021bie redus\u0103<\/strong>, \u0219i <strong>ascit\u0103 cirotic\u0103<\/strong>.<\/p>\n<h3 class=\"wp-block-heading\">Va afecta Aldactone nivelul meu de potasiu?<\/h3>\n<p>Da \u2014 spironolactona <strong>cre\u0219te<\/strong> potasiul (este un medicament care p\u0103streaz\u0103 potasiul). Hiperkalemia (&gt;5,5 mmol\/L) este principala preocupare de siguran\u021b\u0103, mai ales atunci c\u00e2nd este combinat\u0103 cu inhibitori ACE sau ARB (care este combina\u021bia standard pentru insuficien\u021ba cardiac\u0103). Verifica\u021bi nivelul de potasiu \u00eenainte de \u00eenceperea tratamentului, apoi la 1 s\u0103pt\u0103m\u00e2n\u0103, 1 lun\u0103 \u0219i la fiecare 3-4 luni ulterior. \u00centrerupe\u021bi Aldactone dac\u0103 potasiul dep\u0103\u0219e\u0219te 5,5 \u0219i investiga\u021bi.<\/p>\n<h3 class=\"wp-block-heading\">Am gut\u0103 \u2014 pot lua Aldactone?<\/h3>\n<p>Da \u2014 spironolactona este <strong>neutr\u0103 fa\u021b\u0103 de urat sau u\u0219or hipouricemiant\u0103<\/strong> \u0219i nu precipiteaz\u0103 gut\u0103. Este o alegere rezonabil\u0103 de diuretic pentru pacien\u021bii cu gut\u0103.<\/p>\n<h3 class=\"wp-block-heading\">Sunt diabetic \u2014 este Aldactone sigur?<\/h3>\n<p>Da. Spironolactonul este <strong>neutru metabolic<\/strong> \u00een ceea ce prive\u0219te glucoza \u0219i lipidele. Are dovezi specifice la pacien\u021bii cu insuficien\u021b\u0103 cardiac\u0103 diabetic\u0103 (popula\u021bia RALES a inclus 26% diabetici) \u0219i nu agraveaz\u0103 controlul diabetic.<\/p>\n<h3 class=\"wp-block-heading\">Pot lua ibuprofen cu Aldactone?<\/h3>\n<p>Utilizarea ocazional\u0103 pe termen scurt este de obicei \u00een regul\u0103. NSAID-urile utilizate zilnic pe termen lung (ibuprofen, diclofenac, naproxen) <strong>reduc efectul diuretic \u0219i antihipertensiv<\/strong> a Aldactone (blocarea prostaglandinelor) \u0219i cre\u0219te substan\u021bial riscul de insuficien\u021b\u0103 renal\u0103 acut\u0103 atunci c\u00e2nd este combinat cu un inhibitor ACE sau ARB \u2014 \u201ctriplul impact\u201d. Utiliza\u021bi paracetamol preferen\u021bial pentru durerea cronic\u0103.<\/p>\n<h3 class=\"wp-block-heading\">Voi urina mai mult noaptea?<\/h3>\n<p>De obicei nu, dac\u0103 lua\u021bi Aldactone diminea\u021ba. Efectul diuretic atinge maximul la 2-8 ore dup\u0103 administrare \u0219i se diminueaz\u0103 \u00een mare parte p\u00e2n\u0103 seara. Nocturia este o pl\u00e2ngere frecvent\u0103 c\u00e2nd pacien\u021bii trec la administrarea seara; reveni\u021bi la administrarea diminea\u021ba \u0219i nocturia se rezolv\u0103 \u00een 1-3 zile.<\/p>\n<h3 class=\"wp-block-heading\">Pot lua Aldactone \u00een timpul sarcinii?<\/h3>\n<p><strong>Nu \u2014 absolut contraindicated.<\/strong> Activitatea anti-androgen\u0103 a spironolactonului provoac\u0103 feminizarea fetu\u0219ilor de sex masculin. Femeile \u00een v\u00e2rst\u0103 de reproducere care iau spironolacton (pentru orice indica\u021bie, inclusiv acnee \u0219i hirsutism) trebuie s\u0103 foloseasc\u0103 metode contraceptive sigure. Pentru femeile care planific\u0103 sarcin\u0103, trece\u021bi la o alternativ\u0103 \u00eenainte de concep\u021bie.<\/p>\n<h3 class=\"wp-block-heading\">Ce fac dac\u0103 uit o doz\u0103?<\/h3>\n<p>Lua\u021bi-l c\u00e2t mai cur\u00e2nd v\u0103 aminti\u021bi, cu excep\u021bia cazului \u00een care este aproape timpul pentru urm\u0103toarea doz\u0103 \u2014 \u00een acest caz omite\u021bi doza ratat\u0103. Nu dubla\u021bi doza. O singur\u0103 doz\u0103 ratat\u0103 nu afecteaz\u0103 semnificativ controlul tensiunii arteriale pe termen lung sau al fluidelor.<\/p>\n<h3 class=\"wp-block-heading\">Unde pot cump\u0103ra Aldactone online?<\/h3>\n<p>Pute\u021bi achizi\u021biona Aldactone (25 \/ 50 \/ 100 mg spironolacton\u0103, 30-180 comprimate) de la MedsBase cu ambalaj discret \u0219i livrare la nivel mondial.<\/p>\n<h2 class=\"wp-block-heading\">Antihipertensive \u0219i Diuretice Asem\u0103n\u0103toare pe MedsBase<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/amifru\/\">Amifru \u2014 Furosemid\u0103 + Amilorid\u0103 (diuretic de ans\u0103 + economisitor de potasiu)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/dytor\/\">Dytor \u2014 Torasemid\u0103 (diuretic de ans\u0103, biodisponibilitate mai predictibil\u0103)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/hydrocl\/\">Hydrocl \u2014 Hidroclorotiazid\u0103 (HCTZ)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/lasix\/\">Lasix \u2014 Furosemid\u0103 40 mg (loop)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/silectone\/\">Silectone \u2014 Spironolacton\u0103 (antagonist al aldosteronului)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/telma-h\/\">Telma H \u2014 combina\u021bie fix\u0103 de Telmisartan + HCTZ<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/high-blood-pressure-medication\/\"><strong>R\u0103sfoi\u021bi toate medicamentele pentru hipertensiune arterial\u0103<\/strong><\/a><\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:24px 0;border-radius:4px;\"><strong>\u2695 Dezaprobare medical\u0103.<\/strong> Aceast\u0103 pagin\u0103 are scop informativ \u0219i nu \u00eenlocuie\u0219te sfatul medical al unui medic calificat. Hipertensiunea, insuficien\u021ba cardiac\u0103 \u0219i aritmiile necesit\u0103 diagnostic, monitorizare \u0219i individualizarea dozei de c\u0103tre un medic \u2014 utiliza\u021bi \u00eentotdeauna beta-blocante sub \u00eendrumare medical\u0103.<\/div>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h3 class=\"wp-block-heading\">Alternative conexe<\/h3>\n<p>Alte produse din <strong>Afec\u021biuni cronice<\/strong> pe care clien\u021bii le vizualizeaz\u0103 de asemenea:<\/p>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/brufen\/\">Brufen<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/lipril-h\/\">Lipril-H<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/hisone\/\">Hisone<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/tiova-inhaler\/\">Tiova Inhaler<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/natrilix-sr\/\">Natrilix SR<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Aldactone este marca de referin\u021b\u0103 pentru spironolacton\u0103 (25\/50\/100 mg) \u2014 antagonist al receptorului de mineralocorticoizi pentru insuficien\u021b\u0103 cardiac\u0103 cu frac\u021bie de ejec\u021bie redus\u0103 (studiul RALES \u2014 reducere a mortalit\u0103\u021bii cu 30%), hipertensiune rezistent\u0103 (PATHWAY-2 \u2014 cel mai bun agent de linia a patra), aldosteronism primar, ascit\u0103 cirotic\u0103 \u0219i utilizare off-label \u00een PCOS\/hirsutism. Economise\u0219te potasiu; monitoriza\u021bi hiperkalemia. Ginecomastie 5-10% (trece\u021bi la eplerenon\u0103 dac\u0103 este problematic\u0103).<\/p>","protected":false},"featured_media":61000,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3260,3356],"product_tag":[4964,4680],"class_list":{"0":"post-60999","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-chronic-conditions","8":"product_cat-heart-blood-pressure","9":"product_cat-high-blood-pressure-medication","10":"product_tag-aldactone","11":"product_tag-spironolactone","13":"first","14":"instock","15":"shipping-taxable","16":"purchasable","17":"product-type-variable","18":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product\/60999","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/comments?post=60999"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media\/61000"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media?parent=60999"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_brand?post=60999"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_cat?post=60999"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_tag?post=60999"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}