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spironolactone

spironolactone

Brand names: Aldactone

Form	Strength
TABLET, ORAL	25 mg; 100 mg

Display Mineralocorticoid (Aldosterone) Receptor Antagonists, Potassium-sparing Diuretics Class: 243220, 243616

Medication comments:

USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances. The following outlines must be followed.
generic (Brand) Route [Packaging: Manufacturer ⇒ Dispense]	Activities
spironolactone (Aldactone) PO [UD ⇒ UD]	25 mg tablet 100 mg tablet (IMH)	Stock @ IDBH? Y NIOSH Table 2^↑
Pharmacy: Receiving / Storage / Preparation Exposure Risk: minimal	• Handling/preparation PPE Requirements: n/a
	• Receiving from Distributor: Standard
	• Pharmacy Storage Area: Carousel
	• Packaging/Reconstitution Location: n/a
	• Compounding (Non-Sterile/Sterile) Location: n/a
	• Omnicell Load: Yes
Transport	• Transport (dose is placed inside a plastic sealable bag): Standard
Nursing: Storage / Administration Exposure Risk: low	• Handling/administration PPE Requirements: via Mouth- Single pair of CX approved gloves via Tube- double CX gloves and gown Wash hands after handling
	• Storage of Finished dose in Nursing Area/Procedural Area: Omnicell
	• Signage on Patient Door Required: No
	• Manipulation of Dosage Form: Standard
	• Special Manipulation for Administration: n/a
Disposal / Spills	• Disposal of Drug Waste: Full- blue bin Trace/packaging- trash
	• Disposol of Used PPE: trash bin (inside plastic bag)
	• Spill management: n/a
NIOSH Supplemental Information: BBW for tumorogenicity in lab studies
Reason for exemption of USP<800> Containment Requirements: Purchased in final dosage form; packaged as unit dose. Does not require additional manipulation for dispensing.

2023 American Geriatrics Society Beers Criteria^® for potentially inappropriate medication use in older adults.
Medication:	spironolactone (Aldactone, Carospir)
Criteria 3: Potentially inappropriate medications: drugs to be used with caution in older adults. (Table 4)
Drug(s)	diuretics
Rationale	May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation	Use with caution
Quality of evidence: Moderate, Strength of Recommendation: Strong

Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es)	potassium-sparing diuretics ⇄ RAS inhibitors (ACEIs, ARBs, ARNIs, aliskiren)
Risk Rationale	Increased risk of hyperkalemia.
Recommendation	Avoid routinely using 2 or more RAS inhibitors, or a RAS inhibitor and potassium-sparing diuretic, concurrently in those with chronic kidney disease Stage 3a or higher.
Quality of evidence: Moderate, Strength of Recommendation: Strong

Criteria 5: medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults. (Table 6)
CrCl (mL/min) at which action is required	<30
Rationale	Hyperkalemia
Recommendation	Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong

Last updated: Sep. 19, 2025

Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug / Assessment of Risk
Black Box Warnings Possible tumorigen

UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

This site is intended for the staff of Iredell Health System. While others may view accessible pages, Iredell Health System makes no warranty, express or implied, as to the use of this information outside of Iredell Health System. The content of this policy and procedure document serves as guidance to the delivery of quality patient care. Care providers are expected to exercise critical thinking and situational awareness skills, and in specific situations to take such action as is necessary for the delivery of quality patient care.