31:
194:(RAAS) is activated and eventually, aldosterone is secreted. Aldosterone binds to aldosterone receptors (mineralocorticoid receptors) increasing sodium reabsorption in an effort to increase blood pressure and improve fluid status in the body. When excessive sodium reabsorption occurs, there is an increasing loss of K in the urine and can lead to clinically significant decreases, termed
187:. This occurs via epithelial sodium channels or ENaCs, located on the luminal surface of principal cells that line the collecting tubules. Positively-charged Na+ entering the cells during reabsorption leads to an electronegative luminal environment causing the secretion of potassium (K) into the lumen/ urine in exchange. Sodium reabsorption also causes water retention.
1680:
201:
Potassium-sparing diuretics act to prevent sodium reabsorption in the collecting tubule by either binding ENaCs (amiloride, triamterene) or by inhibiting aldosterone receptors (spironolactone, eplerenone). This prevents excessive excretion of K in urine and decreased retention of water, preventing
261:. Due to its activity as an androgen receptor antagonist and progesterone receptor agonist, spironolactone causes adverse effects, including gynecomastia or decreased libido in males and menstrual abnormalities in females. Spironolactone also causes hyperkalemia and renal insufficiency.
209:, they do not cause clinically significant blood pressure changes and thus, are not used as primary therapy for hypertension. They can be used in combination with other
191:
800:
Fairley KF, Woo KT, Birch DF, Leaker BR, Ratnaike S (October 1986). "Triamterene-induced crystalluria and cylinduria: clinical and experimental studies".
214:
561:
Lainscak M, Pelliccia F, et al. (December 2015). "Safety profile of mineralocorticoid receptor antagonists: Spironolactone and eplerenone".
1634:
1108:
344:
141:
1700:
1040:
1360:
1458:
1620:
1537:
1506:
1487:
1670:
1077:
1651:
827:
Batterink, Josh; Stabler, Sarah N; Tejani, Aaron M; Fowkes, Curt T (2010-08-04). Cochrane
Hypertension Group (ed.).
659:
Batterink, Josh; Stabler, Sarah N; Tejani, Aaron M; Fowkes, Curt T (2010-08-04). Cochrane
Hypertension Group (ed.).
78:
1181:
446:"Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society* Clinical Practice Guideline"
117:
1492:
1273:
1185:
1012:
226:
70:
409:
Weber KT, Villarreal D (January 1993). "Aldosterone and antialdosterone therapy in congestive heart failure".
1639:
1033:
74:
1350:
1269:
1062:
765:
Modell JH, Graves SA, Ketover A (August 1976). "Clinical course of 91 consecutive near-drowning victims".
137:
89:
1388:
1104:
1008:
253:. Triamterene, specifically, is a potential nephrotoxin and up to half of the patients on it can have
1418:
1705:
1234:
1204:
286:- NSAIDs: increases hyperkalemia risk and decreases diuretic effect of potassium-sparing diuretics
1580:
1259:
1239:
1026:
210:
27:
Drugs that cause diuresis without causing potassium loss in the urine and leading to hyperkalemia
1574:
1548:
987:
979:
940:
932:
893:
875:
809:
782:
747:
703:
638:
620:
578:
543:
508:
467:
426:
391:
340:
180:
162: – non-steroidal, more selective and potent than spironolactone and eplerenone
30:
1450:
1249:
1219:
971:
924:
883:
867:
836:
774:
737:
695:
668:
628:
612:
570:
535:
498:
457:
418:
381:
332:
250:
245:
On their own this group of drugs may raise potassium levels beyond the normal range, termed
156: – more selective so reduced side-effects but more expensive and less potent
1684:
1496:
1454:
1081:
58:
726:"Tubular action of diuretics: Distal effects on electrolyte transport and acidification"
1645:
1543:
1403:
1214:
1132:
1067:
888:
855:
828:
660:
633:
600:
336:
218:
147:
82:
1694:
1585:
1282:
1224:
1162:
1100:
1090:
422:
324:
258:
959:
912:
1428:
1397:
1327:
1254:
1053:
840:
672:
298:
289:- Digoxin: increases digoxin plasma concentrations, leading to increased toxicity
254:
246:
62:
574:
1604:
1599:
1593:
1570:
1378:
1297:
1287:
1142:
206:
195:
129:
856:"A Comparison of the Aldosterone-blocking Agents Eplerenone and Spironolactone"
601:"A Comparison of the Aldosterone-blocking Agents Eplerenone and Spironolactone"
1522:
1517:
1512:
1434:
1413:
1322:
1307:
1302:
1244:
1167:
1157:
1147:
1127:
1117:
303:
222:
159:
153:
17:
983:
936:
879:
624:
1527:
1408:
1368:
1317:
1312:
1292:
1229:
1152:
1122:
234:
165:
123:
105:
93:
86:
66:
50:
991:
944:
897:
778:
642:
582:
512:
471:
813:
751:
707:
547:
462:
445:
430:
395:
1589:
1472:
1467:
1373:
1332:
1209:
1199:
1190:
1177:
1137:
1049:
786:
46:
742:
725:
487:"Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study"
34:
Structural formula of the potassium-sparing diuretics. Click to enlarge.
1566:
386:
369:
230:
184:
975:
928:
871:
699:
616:
539:
503:
486:
1018:
54:
29:
854:
Struthers, Allan; Krum, Henry; Williams, Gordon H. (April 2008).
686:
Horisberger J, Giebisch G (1987). "Potassium-Sparing
Diuretics".
599:
Struthers, Allan; Krum, Henry; Williams, Gordon H. (April 2008).
217:
for potassium. For example, they are often used as an adjunct to
1477:
198:. Increased sodium reabsorption also increases water retention.
101:
97:
1022:
724:
Hropot M, Fowler N, Karlmark B, Giebisch G (September 1985).
323:
Knepper, Mark A.; Kleyman, Thomas; Gamba, Gerardo (2005),
271:
Spironolactone interacts with the following medications:
526:
Sica DA, Gehr TW (1989). "Triamterene and the Kidney".
450:
The
Journal of Clinical Endocrinology & Metabolism
1668:
960:"Spironolactone Management of Resistant Hypertension"
913:"Spironolactone Management of Resistant Hypertension"
444:
Martin KA, Anderson RB, et al. (1 April 2018).
126: – better tolerated than triamterene
1613:
1559:
1486:
1449:
1387:
1359:
1345:
1268:
1176:
1099:
1076:
1061:
274:- ACE inhibitors/ARBs: increases hyperkalemia risk
213:or drugs that cause hypokalemia to help maintain a
150: – most widespread use, inexpensive
280:- Barbiturates: risk of orthostatic hypotension
190:When the kidneys detect low blood pressure, the
132: – increased renal side-effects
1034:
363:
361:
283:- Narcotics: risk of orthostatic hypotension
8:
277:- Alcohol: risk of orthostatic hypotension
1356:
1073:
1041:
1027:
1019:
1011:at the U.S. National Library of Medicine
994:– via National Library of Medicine.
947:– via National Library of Medicine.
887:
741:
719:
717:
632:
502:
461:
385:
1675:
833:Cochrane Database of Systematic Reviews
665:Cochrane Database of Systematic Reviews
315:
92:, is also used in management of female
179:Normally, sodium is reabsorbed in the
142:mineralocorticoid receptor antagonists
7:
654:
652:
594:
592:
192:renin–angiotensin–aldosterone system
112:Types of potassium-sparing diuretics
563:International Journal of Cardiology
205:Because these diuretics are weakly
168: – very limited use
688:Kidney and Blood Pressure Research
411:The American Journal of Cardiology
337:10.1016/b978-0-7216-0258-5.50152-6
77:can also be used for treatment of
25:
829:"Spironolactone for hypertension"
661:"Spironolactone for hypertension"
325:"Diuretics: Mechanisms of Action"
1678:
249:, which risks potentially fatal
57:. They are typically used as an
1621:Hydrochlorothiazide/triamterene
1488:Vasopressin receptor inhibitors
958:Marrs, Joel C (November 2010).
911:Marrs, Joel C (November 2010).
841:10.1002/14651858.CD008169.pub2
673:10.1002/14651858.CD008169.pub2
331:, Elsevier, pp. 638–652,
225:) to treat fluid retention in
1:
485:Grandhi R, Alikhan A (2017).
299:C03D Potassium-sparing agents
575:10.1016/j.ijcard.2015.05.127
423:10.1016/0002-9149(93)90238-8
1701:Potassium-sparing diuretics
1009:Potassium+Sparing+Diuretics
39:Potassium-sparing diuretics
1722:
79:primary hyperaldosteronism
45:refer to drugs that cause
1629:
964:Annals of Pharmacotherapy
917:Annals of Pharmacotherapy
368:Rose BD (February 1991).
118:Epithelial sodium channel
1013:Medical Subject Headings
227:congestive heart failure
71:congestive heart failure
1389:Aldosterone antagonists
138:Aldosterone antagonists
75:aldosterone antagonists
779:10.1378/chest.70.2.231
90:aldosterone antagonist
35:
463:10.1210/jc.2018-00241
33:
1614:Combination products
1419:Potassium canrenoate
730:Kidney International
1581:mercurial diuretics
1235:Hydrochlorothiazide
1205:Bendroflumethiazide
860:Clinical Cardiology
802:Clinical Nephrology
743:10.1038/ki.1985.154
605:Clinical Cardiology
175:Mechanism of action
1656:Never to phase III
1260:Trichlormethiazide
1240:Hydroflumethiazide
387:10.1038/ki.1991.43
211:anti-hypertensives
181:collecting tubules
36:
1666:
1665:
1549:Lithium carbonate
1451:Osmotic diuretics
1445:
1444:
1347:Potassium-sparing
1341:
1340:
976:10.1345/aph.1P338
970:(11): 1762–1769.
929:10.1345/aph.1P338
923:(11): 1762–1769.
872:10.1002/clc.20324
700:10.1159/000173130
617:10.1002/clc.20324
540:10.1159/000185375
504:10.1159/000471799
346:978-0-7216-0258-5
267:Drug Interactions
61:in management of
16:(Redirected from
1713:
1683:
1682:
1681:
1674:
1357:
1250:Methyclothiazide
1220:Cyclopenthiazide
1074:
1043:
1036:
1029:
1020:
996:
995:
955:
949:
948:
908:
902:
901:
891:
851:
845:
844:
824:
818:
817:
797:
791:
790:
762:
756:
755:
745:
721:
712:
711:
694:(3–4): 198–220.
683:
677:
676:
656:
647:
646:
636:
596:
587:
586:
558:
552:
551:
523:
517:
516:
506:
497:(2–3): 141–144.
482:
476:
475:
465:
456:(4): 1233–1257.
441:
435:
434:
406:
400:
399:
389:
365:
356:
355:
354:
353:
320:
140:, also known as
73:. The steroidal
49:without causing
21:
1721:
1720:
1716:
1715:
1714:
1712:
1711:
1710:
1691:
1690:
1689:
1679:
1677:
1669:
1667:
1662:
1661:
1646:Clinical trials
1625:
1609:
1555:
1490:
1482:
1441:
1383:
1337:
1264:
1191:Calcium-sparing
1189:
1172:
1095:
1065:
1057:
1047:
1005:
1000:
999:
957:
956:
952:
910:
909:
905:
853:
852:
848:
826:
825:
821:
799:
798:
794:
764:
763:
759:
723:
722:
715:
685:
684:
680:
658:
657:
650:
598:
597:
590:
560:
559:
555:
525:
524:
520:
484:
483:
479:
443:
442:
438:
408:
407:
403:
367:
366:
359:
351:
349:
347:
322:
321:
317:
312:
295:
269:
243:
241:Adverse effects
177:
114:
43:antikaliuretics
28:
23:
22:
15:
12:
11:
5:
1719:
1717:
1709:
1708:
1703:
1693:
1692:
1688:
1687:
1664:
1663:
1660:
1659:
1658:
1657:
1654:
1643:
1637:
1631:
1630:
1627:
1626:
1624:
1623:
1617:
1615:
1611:
1610:
1608:
1607:
1602:
1597:
1577:
1563:
1561:
1557:
1556:
1554:
1553:
1552:
1551:
1546:
1544:Demeclocycline
1533:
1532:
1531:
1530:
1525:
1520:
1515:
1502:
1500:
1484:
1483:
1481:
1480:
1475:
1470:
1464:
1462:
1447:
1446:
1443:
1442:
1440:
1439:
1438:
1437:
1424:
1423:
1422:
1421:
1416:
1411:
1406:
1404:Spironolactone
1393:
1391:
1385:
1384:
1382:
1381:
1376:
1371:
1365:
1363:
1354:
1343:
1342:
1339:
1338:
1336:
1335:
1330:
1325:
1320:
1315:
1310:
1305:
1300:
1295:
1290:
1285:
1279:
1277:
1270:Thiazide-likes
1266:
1265:
1263:
1262:
1257:
1252:
1247:
1242:
1237:
1232:
1227:
1222:
1217:
1215:Chlorothiazide
1212:
1207:
1202:
1196:
1194:
1174:
1173:
1171:
1170:
1165:
1160:
1155:
1150:
1145:
1140:
1135:
1133:Etacrynic acid
1130:
1125:
1120:
1114:
1112:
1097:
1096:
1094:
1093:
1087:
1085:
1071:
1068:etacrynic acid
1059:
1058:
1048:
1046:
1045:
1038:
1031:
1023:
1017:
1016:
1004:
1003:External links
1001:
998:
997:
950:
903:
866:(4): 153–158.
846:
819:
792:
757:
736:(3): 477–489.
713:
678:
648:
611:(4): 153–158.
588:
553:
534:(4): 454–461.
518:
477:
436:
401:
357:
345:
314:
313:
311:
308:
307:
306:
301:
294:
291:
268:
265:
242:
239:
219:loop diuretics
176:
173:
172:
171:
170:
169:
163:
157:
151:
148:Spironolactone
135:
134:
133:
127:
113:
110:
83:Spironolactone
26:
24:
18:Antikaliuretic
14:
13:
10:
9:
6:
4:
3:
2:
1718:
1707:
1704:
1702:
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1618:
1616:
1612:
1606:
1603:
1601:
1598:
1595:
1591:
1587:
1586:Chlormerodrin
1583:
1582:
1578:
1576:
1572:
1568:
1565:
1564:
1562:
1558:
1550:
1547:
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1501:
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1471:
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1460:
1456:
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1448:
1436:
1433:
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1431:
1430:
1426:
1425:
1420:
1417:
1415:
1412:
1410:
1407:
1405:
1402:
1401:
1400:
1399:
1398:Spirolactones
1395:
1394:
1392:
1390:
1386:
1380:
1377:
1375:
1372:
1370:
1367:
1366:
1364:
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1358:
1355:
1352:
1348:
1344:
1334:
1331:
1329:
1326:
1324:
1321:
1319:
1316:
1314:
1311:
1309:
1306:
1304:
1301:
1299:
1296:
1294:
1291:
1289:
1286:
1284:
1283:Chlortalidone
1281:
1280:
1278:
1275:
1271:
1267:
1261:
1258:
1256:
1253:
1251:
1248:
1246:
1243:
1241:
1238:
1236:
1233:
1231:
1228:
1226:
1225:Cyclothiazide
1223:
1221:
1218:
1216:
1213:
1211:
1208:
1206:
1203:
1201:
1198:
1197:
1195:
1192:
1187:
1183:
1179:
1175:
1169:
1166:
1164:
1163:Tienilic acid
1161:
1159:
1156:
1154:
1151:
1149:
1146:
1144:
1141:
1139:
1136:
1134:
1131:
1129:
1126:
1124:
1121:
1119:
1116:
1115:
1113:
1110:
1106:
1102:
1098:
1092:
1091:Acetazolamide
1089:
1088:
1086:
1083:
1079:
1078:CA inhibitors
1075:
1072:
1069:
1064:
1060:
1055:
1051:
1044:
1039:
1037:
1032:
1030:
1025:
1024:
1021:
1014:
1010:
1007:
1006:
1002:
993:
989:
985:
981:
977:
973:
969:
965:
961:
954:
951:
946:
942:
938:
934:
930:
926:
922:
918:
914:
907:
904:
899:
895:
890:
885:
881:
877:
873:
869:
865:
861:
857:
850:
847:
842:
838:
834:
830:
823:
820:
815:
811:
808:(4): 169–73.
807:
803:
796:
793:
788:
784:
780:
776:
772:
768:
761:
758:
753:
749:
744:
739:
735:
731:
727:
720:
718:
714:
709:
705:
701:
697:
693:
689:
682:
679:
674:
670:
666:
662:
655:
653:
649:
644:
640:
635:
630:
626:
622:
618:
614:
610:
606:
602:
595:
593:
589:
584:
580:
576:
572:
568:
564:
557:
554:
549:
545:
541:
537:
533:
529:
522:
519:
514:
510:
505:
500:
496:
492:
488:
481:
478:
473:
469:
464:
459:
455:
451:
447:
440:
437:
432:
428:
424:
420:
417:(3): A3–A11.
416:
412:
405:
402:
397:
393:
388:
383:
380:(2): 336–52.
379:
375:
371:
364:
362:
358:
348:
342:
338:
334:
330:
326:
319:
316:
309:
305:
302:
300:
297:
296:
292:
290:
287:
284:
281:
278:
275:
272:
266:
264:
263:
260:
259:urinary casts
256:
252:
248:
240:
238:
236:
232:
228:
224:
220:
216:
212:
208:
203:
202:hypokalemia.
199:
197:
193:
188:
186:
182:
174:
167:
164:
161:
158:
155:
152:
149:
146:
145:
143:
139:
136:
131:
128:
125:
122:
121:
119:
116:
115:
111:
109:
107:
103:
99:
95:
91:
88:
84:
80:
76:
72:
68:
64:
60:
56:
52:
48:
44:
40:
32:
19:
1579:
1536:
1505:
1429:Nonsteroidal
1427:
1396:
1361:ESC blockers
1346:
1328:Quinethazone
1255:Polythiazide
1063:Sulfonamides
967:
963:
953:
920:
916:
906:
863:
859:
849:
832:
822:
805:
801:
795:
773:(2): 231–8.
770:
766:
760:
733:
729:
691:
687:
681:
664:
608:
604:
566:
562:
556:
531:
527:
521:
494:
490:
480:
453:
449:
439:
414:
410:
404:
377:
373:
350:, retrieved
329:Hypertension
328:
318:
288:
285:
282:
279:
276:
273:
270:
262:
255:crystalluria
247:hyperkalemia
244:
215:normal range
204:
200:
189:
178:
106:other causes
63:hypertension
53:loss in the
42:
38:
37:
1642:from market
1605:Cicletanine
1600:Theobromine
1594:Meralluride
1571:Isopropanol
1379:Triamterene
1298:Clorexolone
1288:Clofenamide
1272:(primarily
1143:Indacrinone
491:Dermatology
370:"Diuretics"
251:arrhythmias
207:natriuretic
196:hypokalemia
183:of a renal
130:Triamterene
1706:Cardiology
1695:Categories
1523:Satavaptan
1518:Mozavaptan
1513:Conivaptan
1435:Finerenone
1414:Eplerenone
1323:Metolazone
1308:Indapamide
1303:Fenquizone
1245:Mebutizide
1168:Torasemide
1158:Piretanide
1148:Muzolimine
1128:Bumetanide
1118:Furosemide
374:Kidney Int
352:2024-03-24
310:References
304:Kaliuresis
223:furosemide
160:Finerenone
154:Eplerenone
120:blockers:
1652:Phase III
1640:Withdrawn
1528:Tolvaptan
1409:Canrenone
1369:Amiloride
1318:Meticrane
1313:Mefruside
1293:Clopamide
1230:Epitizide
1178:Thiazides
1153:Ozolinone
1123:Azosemide
1050:Diuretics
984:1060-0280
937:1060-0280
880:0160-9289
625:0160-9289
569:: 25–29.
235:cirrhosis
221:(usually
166:Canrenone
124:Amiloride
94:hirsutism
87:steroidal
67:cirrhosis
51:potassium
1685:Medicine
1590:Mersalyl
1473:Glycerol
1468:Mannitol
1374:Benzamil
1333:Xipamide
1210:Butizide
1200:Altizide
1138:Etozolin
992:20978214
945:20978214
898:18404673
643:18404673
583:26404748
513:28472793
472:29522147
293:See also
47:diuresis
1567:Ethanol
1507:Vaptans
1105:Na-K-Cl
889:6652937
814:3780069
752:4068482
708:2455308
634:6652937
548:2662034
528:Nephron
431:8422002
396:2002648
231:ascites
185:nephron
59:adjunct
1671:Portal
1635:WHO-EM
1538:Others
1015:(MeSH)
990:
982:
943:
935:
896:
886:
878:
812:
787:780069
785:
750:
706:
641:
631:
623:
581:
546:
511:
470:
429:
394:
343:
69:, and
1560:Other
1182:Na-Cl
1066:(and
767:Chest
100:from
55:urine
1575:2M2B
1495:and
1478:Urea
1349:(at
1101:Loop
1080:(at
988:PMID
980:ISSN
941:PMID
933:ISSN
894:PMID
876:ISSN
810:PMID
783:PMID
748:PMID
704:PMID
639:PMID
621:ISSN
579:PMID
544:PMID
509:PMID
468:PMID
427:PMID
392:PMID
341:ISBN
229:and
102:PCOS
98:acne
96:and
85:, a
1493:DCT
1274:DCT
1186:DCT
1184:at
1107:at
1054:C03
972:doi
925:doi
884:PMC
868:doi
837:doi
775:doi
738:doi
696:doi
669:doi
629:PMC
613:doi
571:doi
567:200
536:doi
499:doi
495:233
458:doi
454:103
419:doi
382:doi
333:doi
257:or
233:in
104:or
41:or
1697::
1648::
1592:,
1588:,
1573:,
1569:,
1497:CD
1459:DL
1457:,
1455:PT
1351:CD
1109:AL
1082:PT
986:.
978:.
968:44
966:.
962:.
939:.
931:.
921:44
919:.
915:.
892:.
882:.
874:.
864:31
862:.
858:.
835:.
831:.
806:26
804:.
781:.
771:70
769:.
746:.
734:28
732:.
728:.
716:^
702:.
692:10
690:.
667:.
663:.
651:^
637:.
627:.
619:.
609:31
607:.
603:.
591:^
577:.
565:.
542:.
532:51
530:.
507:.
493:.
489:.
466:.
452:.
448:.
425:.
415:71
413:.
390:.
378:39
376:.
372:.
360:^
339:,
327:,
237:.
144::
108:.
81:.
65:,
1673::
1596:)
1584:(
1499:)
1491:(
1461:)
1453:(
1353:)
1276:)
1193:)
1188:,
1180:(
1111:)
1103:(
1084:)
1070:)
1056:)
1052:(
1042:e
1035:t
1028:v
974::
927::
900:.
870::
843:.
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816:.
789:.
777::
754:.
740::
710:.
698::
675:.
671::
645:.
615::
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573::
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538::
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501::
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460::
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421::
398:.
384::
335::
20:)
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