High-Dose Spironolactone Effective in Diuretic-Resistant Heart Failure

By Kelly Young

Edited by David G. Fairchild, MD, MPH

High-dose spironolactone might be an option for patients with heart failure resistant to treatment with loop diuretics, suggests a small pilot study in the Annals of Internal Medicine.

Nineteen patients hospitalized with acute decompensated heart failure who didn't respond to intravenous furosemide were given high-dose spironolactone, starting at 100 mg per day and increasing up to 200 mg per day.

Overall, patients experienced clinically important weight loss. Fourteen of the 19 experienced reduced dyspnea. None of the patients' potassium levels exceeded 5.5 mmol/L. One patient died following cardiac arrest.

Dr. Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "Patient with acute decompensated heart failure who are resistant to loop diuretics present an immense challenge. This study is small, but its suggestion that high-dose spironolactone may help in this situation is worthy of further study."