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LogoKeyPointsBox.pngUseful in:
  • Resistant oedema but note days lag in maximum benefit
  • Heart failure but extra care in elderly, polypharmacy, any renal impairment
  • Resistent hypertension
LogoWarningBox4.pngThe combination of aldosterone antagonist, ACE inhibitor and NSAID pretty predictably results in life threatening hyperkalaemia



Undervalued for years, and then we got evidence that a diuretic could do more than symptom control in heart failure.

Clinical Use

Given that unlike loop diuretics its use at low dose in heart failure is associated with reduced mortality it should be diuretic of choice in those not at risk of hyperkalaemia complications in this indication.




Clinical Issues

Needs careful monitoring of electrolytes when combined (which should be at low dose) with an ACE inhibitor or angiotensin-II receptor antagonist.


Cautions and Interactions

Not smart prescribing it to a patient taking regular liquorice and as to writing a script for carbenoxolone at the same time go to the bottom of the class.

Side effects

Special advice