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Overview: Spironolactone/hydrochlorothiazide is mainly used to treat high blood pressure, heart failure, and fluid build up in people with certain liver or kidney problems. It works by decreasing the amount of sodium and water your body keeps. This can help lower blood pressure and prevent fluid from building up and causing problems. The most common side effects are low blood pressure, high potassium levels, and increased peeing.

Uses

What is spironolactone/hydrochlorothiazide used for?

Spironolactone/hydrochlorothiazide is commonly used for the following conditions.

  • To help lower high blood pressure (hypertension)
  • To help reduce fluid build up in certain people with heart failure, a condition where the heart is not pumping blood as well as it should
  • To help reduce fluid build up in people who have cirrhosis or nephrotic syndrome

Spironolactone/hydrochlorothiazide may also be used for other conditions as determined by your healthcare provider.

How does spironolactone/hydrochlorothiazide work (mechanism of action)?

Spironolactone/hydrochlorothiazide helps decrease the amount of sodium and water your body retains. This can help lower blood pressure and prevent fluid from building up and causing problems. 

How is spironolactone/hydrochlorothiazide supplied (dosage forms)?

Brands and other names

  • Aldactazide

Dosage forms and strengths

  • 25 mg/25 mg oral tablets

How should I store spironolactone/hydrochlorothiazide?

Spironolactone/hydrochlorothiazide should be stored below 77 F (25 C). Store in a cool, dry place.

Side Effects

What are the most common side effects of spironolactone/hydrochlorothiazide?

The most common side effects of spironolactone/hydrochlorothiazide are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Low blood pressure (see below)
  • High potassium levels (see below)
  • Electrolyte changes and increased blood sugar (see below)
  • An increase in how much you pee
  • Gynecomastia (see below) 
  • Dizziness

There may be other side effects of spironolactone/hydrochlorothiazide that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of spironolactone/hydrochlorothiazide?

While less common, the most serious side effects of spironolactone/hydrochlorothiazide are described below, along with what to do if they happen.

Low Blood Pressure and Dehydration. Spironolactone/hydrochlorothiazide can cause low blood pressure and dehydration, which may lead to kidney damage. Drink enough water to stay hydrated, especially if you have excess sweating, vomiting, or diarrhea. Get out of bed or from a seated position slowly. If you feel faint or dizzy, lie down. Tell your healthcare provider right away if you have any of the following symptoms.

  • Dizziness, feeling lightheaded, or fainting
  • Weakness or unusual tiredness
  • Confusion
  • Unsteadiness
  • Peeing less than normal
  • Swelling in your legs, ankles, and feet
  • Loss of appetite or nausea
  • Difficulty catching your breath or chest pain or pressure
  • Seizures
  • Extreme thirst

High Potassium Levels (Hyperkalemia). Spironolactone/hydrochlorothiazide can cause a high potassium level (hyperkalemia), which can be serious and may lead to death. Your healthcare provider may check your potassium levels, especially if you take certain other medicines. Call your healthcare provider right away if you have any of the following symptoms of a high potassium level.

  • Muscle weakness or unusual tiredness
  • Slow heartbeat or feeling of skipped heartbeats
  • Nausea or vomiting
  • Trouble breathing
  • Abnormal heart rhythm

Electrolyte Changes and Increased Blood Sugar. Spironolactone/hydrochlorothiazide may increase your blood sugar (glucose) levels and cause changes to the levels of certain minerals in your body, called electrolytes. For example, low sodium levels (hyponatremia), low magnesium levels (hypomagnesemia), or high calcium levels (hypercalcemia). These changes can be serious. Your healthcare provider will do bloodwork to check your glucose and electrolyte levels. Keep your appointments to have your blood checked. Call your healthcare provider if you have any of the following symptoms.

  • Weakness
  • Unusual tiredness
  • Muscle cramps or twitching
  • Constipation
  • Nausea, vomiting, or loss of appetite
  • Dizziness
  • Restlessness or irritability
  • Difficulty breathing
  • Confusion or decreased alertness

Short-Sightedness and Glaucoma. Spironolactone/hydrochlorothiazide may make it harder to see faraway objects (short-sightedness). It may also increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. These issues may be more likely if you have a penicillin allergy. Tell your healthcare provider right away if you have any of the following symptoms.

  • Trouble seeing faraway objects
  • Loss of vision
  • Eye pain or redness
  • Severe headache or vomiting
  • Seeing bright, colorful circles around lights (vision halos)

Gynecomastia. Spironolactone/hydrochlorothiazide may cause a condition called gynecomastia, which means enlargement of the breast tissue in men. This is more likely to happen with higher doses or long-term use of spironolactone/hydrochlorothiazide. In most cases, the breast enlargement goes away after you stop taking the medicine. Tell your healthcare provider right away if you notice increased tenderness or size of breasts.

Severe Allergic Reactions. Spironolactone/hydrochlorothiazide may cause allergic reactions, including a specific type of allergic reaction called DRESS. DRESS stands for Drug Reaction with Eosinophilia and Systemic Symptoms. It is also sometimes called multiorgan hypersensitivity. This is a reaction that can affect multiple parts of the body, including your liver, kidneys, and heart. Stop taking the medicine and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain
  • Dark colored urine
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Warnings & Precautions

Who should not use spironolactone/hydrochlorothiazide?

Allergies to Ingredients. People who are allergic to any of the following should not take spironolactone/hydrochlorothiazide.

  • Aldactazide
  • Spironolactone
  • Hydrochlorothiazide
  • Any other medicine known as a thiazide diuretic
  • Any other medicine known as a sulfonamide (sulfa drug)
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific spironolactone/hydrochlorothiazide products they stock.

No Urine Production. Do not take spironolactone/hydrochlorothiazide if you are making very little to no pee. This condition is also called anuria.

Kidney Problems. Spironolactone/hydrochlorothiazide should not be taken if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough to take this medicine.

Liver Problems. Spironolactone/hydrochlorothiazide should not be taken if your liver is not working as well as it should be. If there is a concern about the health of your liver, your healthcare provider may do tests to determine if it is working well enough to take this medicine.

High Potassium Levels (Hyperkalemia). People who have very high potassium levels in the blood should not start or take spironolactone/hydrochlorothiazide until the potassium levels return to normal. Your doctor may monitor your potassium levels with a blood test after starting or while on spironolactone/hydrochlorothiazide. 

High Calcium Levels (Hypercalcemia). People who have very high calcium levels in the blood should not start or take spironolactone/hydrochlorothiazide until the calcium levels return to normal. Your doctor may monitor your calcium levels with a blood test after starting or while taking this medicine. 

Addison’s Disease. Spironolactone/hydrochlorothiazide should not be taken by people who have a condition where your body’s adrenal glands stop making as much cortisol (the stress hormone) as they should, also known as Addisons’ Disease.

What should I know about spironolactone/hydrochlorothiazide before using it?

Do not take spironolactone/hydrochlorothiazide unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share spironolactone/hydrochlorothiazide with other people, even if they have the same condition as you. It may harm them.

Keep spironolactone/hydrochlorothiazide out of the reach of children.

Spironolactone/hydrochlorothiazide can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how spironolactone/hydrochlorothiazide can affect you. 

Spironolactone/hydrochlorothiazide may cause your skin to become very sensitive to light from the sun and devices that give off similar light, such as sunlamps and tanning beds. Use sunscreen and wear a hat and clothes that cover your skin if you need to be in the sunlight. Talk to your healthcare provider about checkups for skin cancer.

What should I tell my healthcare provider before using spironolactone/hydrochlorothiazide?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if spironolactone/hydrochlorothiazide is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Liver problems
  • Kidney problems
  • Electrolyte imbalance, such as high levels of potassium or calcium
  • Diabetes
  • Gout

Systemic Lupus Erythematosus. Spironolactone/hydrochlorothiazide may activate or worsen systemic lupus erythematosus. Tell your healthcare provider if you develop or have worsening rash, joint pain, fever, or unusual tiredness.

Other Medicines and Supplements. Spironolactone/hydrochlorothiazide may interact with other medicines and supplements. Before using spironolactone/hydrochlorothiazide, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Spironolactone/hydrochlorothiazide may cause harm to an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should take spironolactone/hydrochlorothiazide while you are pregnant or trying to get pregnant. 

Breastfeeding. Spironolactone/hydrochlorothiazide passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take spironolactone/hydrochlorothiazide while breastfeeding.

Interactions

Does spironolactone/hydrochlorothiazide interact with foods or drinks?

There are no known interactions between spironolactone/hydrochlorothiazide and foods or drinks. However, because spironolactone/hydrochlorothiazide increases potassium levels, your healthcare provider may suggest avoiding foods, drinks, and salt-substitutes that are high in potassium.

It is unknown if drinking alcohol will affect spironolactone/hydrochlorothiazide. The risk of dizziness and low blood pressure may be increased if you drink alcohol while taking spironolactone/hydrochlorothiazide. It is best to limit the amount of alcohol you drink while taking this medicine.

Does spironolactone/hydrochlorothiazide interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. 

In particular, make sure you discuss if you are using any of the following before taking spironolactone/hydrochlorothiazide.

  • An angiotensin-converting enzyme (ACE) inhibitor, such as enalapril or lisinopril, which is a medicine for high blood pressure, heart failure, and certain kidney problems
  • An angiotensin II receptor blocker (ARB), such as losartan or valsartan, which is a medicine for high blood pressure, heart failure, and other heart conditions
  • Amiloride (Midamor), eplerenone (Inspra), triamterene (Dyrenium), or spironolactone (Aldactone, Carospir), which is a type of diuretic, also called a water pill
  • Potassium chloride (Klor-Con and others), which is a medicine used to raise potassium levels
  • Heparin or enoxaparin (Lovenox), which is a medicine to help prevent the blood from clotting
  • Lithium, which is a medicine for certain mental health conditions
  • A barbiturate, such as phenobarbital, butalbital, or primidone, which is a medicine that may be used to treat insomnia, migraines, or seizures
  • An opioid, such as oxycodone, morphine, codeine, or fentanyl, which is a medicine used for certain types of pain
  • A corticosteroid, such as prednisone, methylprednisolone, or dexamethasone, which is a medicine for certain inflammatory conditions
  • A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which are contained in many prescription and OTC products for pain, swelling, and fever
  • Aspirin, which is in many prescription and OTC products, including those for pain, swelling, and fever
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • Cholestyramine, which is a medicine to lower cholesterol
  • Abiraterone, a hormone therapy drug
  • A medicine for high blood pressure
  • A medicine for diabetes

This may not be a complete list of medicines that can interact with spironolactone/hydrochlorothiazide. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much spironolactone/hydrochlorothiazide?

If you or someone else has used too much spironolactone/hydrochlorothiazide, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of spironolactone/hydrochlorothiazide?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.

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