This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo


Oral formulations of spironolactone and furosemide.

Drugs List

  • spironolactone 50mg and furosemide 20mg capsules
  • Therapeutic Indications


    Essential hypertension in patients with secondary hyperaldosteronism
    Resistant oedema in patients with secondary hyperaldosteronism

    Resistant oedema or essential hypertension in patients with secondary hyperaldosteronism.

    This fixed ratio combination should only be used if titration with the component drugs separately indicates that this product is appropriate.


    Treatment with this medication should only be used in patients who don't respond to therapy with a diuretic alone at conventional doses.

    Titrate to dose required using the component drugs separately. The fixed combination product can then be used if appropriate.


    50mg spironolactone with 20mg furosemide daily to 200mg spironolactone and 80mg furosemide daily (one capsule to four capsules daily).


    Children under 18 years
    Addison's disease
    Long QT syndrome
    Renal damage secondary to nephrotoxic agents
    Renal impairment - creatinine clearance below 30ml/minute/1.73m sq
    Renal impairment associated with hepatic coma
    Renal impairment secondary to hepatotoxic agents
    Severe hypokalaemia
    Severe hyponatraemia
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Predisposition to hypotension
    Predisposition to hypovolaemia
    Predisposition to radio-contrast induced nephropathy
    Predisposition towards electrolyte imbalance
    Diabetes mellitus
    Electrolyte imbalance
    Glucose-galactose malabsorption syndrome
    Hepato-renal syndrome
    History of torsade de pointes
    Lactose intolerance
    Prostate cancer
    Renal impairment - creatinine clearance 30-60ml/minute/1.73m sq
    Systemic lupus erythematosus
    Urinary obstruction

    Correct electrolyte disorders before treatment
    Correct hypotension before initiating treatment
    May decrease glucose tolerance in patients with diabetes mellitus
    May exacerbate or activate systemic lupus erythematosus
    Advise ability to drive/operate machinery may be affected by side effects
    Correct hypovolaemia prior to administration
    Contains lactose
    Monitor serum electrolytes before and during treatment
    Consider monitoring ECG in patients at risk of QT prolongation
    Investigate any sustained increase in PSA during treatment
    Monitor closely patient with urinary obstruction
    Monitor serum potassium regularly
    Excess consumption of liquorice may increase the risk of hypokalaemia
    Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
    May cause vocal changes. Discuss with patient where job may be affected
    May precipitate diabetes mellitus
    Discontinue if evidence of significant bone marrow depression
    Temporarily suspend therapy if fluid/electrolyte imbalance occurs
    Advise patient not to take NSAIDs unless advised by clinician
    Advise on problems of salt substitutes/high intake of potassium-rich food

    Some patients with metastatic castration resistant prostate cancer, tumour progression has been observed during spironolactone treatment. Spironolactone binds to the androgen receptor and can increase the prostate specific antigen (PSA) value.

    Pregnancy and Lactation


    Use spironolactone with furosemide with caution in pregnancy.

    Avoid use during pregnancy if possible. Diuretics are no longer used as standard therapy during pregnancy and should only be used for particular indications. Furosemide may be used when treatment of cardiac or renal failure requires a diuretic. Spironolactone should only be chosen if therapy with an aldosterone antagonist is absolutely necessary.

    Antiandrogenic effects have been seen in humans and feminisation in male rat foetuses has been observed with spironolactone. In one study, rat offspring of both sexes exposed in utero in late gestation exhibited permanent dose related changes in their reproductive tracts. In animal experiments carcinogenic effects have been seen, although as yet, there are no indications of any clinical relevance of this finding to humans. No reports associating spironolactone to congenital defects (cardiovascular defects, spina bifida, polydactyly, limb reduction defects and hypospadias) in human pregnancies have been found (Briggs, 2011).

    Furosemide crosses the placenta. Following oral doses of 25 to 40 mg, peak concentrations in cord serum were seen at 9 hours. Increased foetal urine production after maternal furosemide therapy has been observed (Briggs, 2011).

    Diuretics are not recommended for use during pregnancy because of theoretical concerns that they may further reduce the circulatory blood volume in women with pre-eclampsia. If therapy is essential, the development of oligohydramnios should be ruled out in long term treatment. Hypoglycaemia in the newborn should also be determined. Schaefer (2007) concludes that therapy with a diuretic is not an indication for interrupting the pregnancy. The manufacturers state that spironolactone and furosemide tablets must not be used during pregnancy unless there are compelling medical reasons. Careful monitoring of foetal growth should be performed if used during pregnancy.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Spironolactone with furosemide is contraindicated in breastfeeding.

    It is not known whether unmetabolised spironolactone is excreted into breast milk. Canrenone, which is the principal metabolite, is excreted into human milk and has been found with a milk: plasma ratio of 0.72 at 2 hours, and 0.51 at 14.5 hours. These amounts would provide an estimated maximum of 0.2% of the mother's daily dose to the infant. Briggs (2011) consider these amounts to be clinically insignificant. The effects of spironolactone on the nursing infant are unknown. Schaefer (2007) concludes that single doses of spironolactone do not require limitation of breastfeeding, however, the therapy should be changed.

    Furosemide passes into breast milk and may inhibit lactation.

    Theoretically, intense diuresis may decrease lactation and therefore, an alternative drug may be preferred, especially whilst nursing a newborn or preterm infant.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abnormal vision
    Acute generalised exanthematous pustulosis
    Allergic reaction
    Anaphylactic reaction
    Anaphylactoid reaction
    Androgen type effects
    Aplastic anaemia
    Blood urea increased
    Bone marrow depression
    Bullous pemphigoid
    Bullous reactions
    Cardiac arrhythmias
    Decrease in blood pressure
    Decrease in plasma calcium
    Decreased glucose tolerance
    Drug rash with eosinophilia and systemic symptoms (DRESS)
    Dry mouth
    Elevated triglyceride levels
    Erythema multiforme
    Exacerbation of systemic lupus erythematosus
    Exfoliative dermatitis
    Fluctuating serum potassium levels
    Fluid and electrolyte disturbances
    Gastro-intestinal symptoms
    Haemolytic anaemia
    Hearing disturbances
    Hepatic encephalopathy
    Hypochloraemic alkalosis
    Impaired concentration
    Increase in plasma cholesterol
    Increase of liver transaminases
    Increased uric acid level
    Interstitial nephritis
    Intrahepatic cholestasis
    Lichenoid rash
    Maculopapular rash
    Menstrual disturbances
    Metabolic alkalosis
    Muscle cramps
    Muscle weakness
    Nipple discomfort
    Orthostatic hypotension
    Peptic ulceration
    Precipitation of diabetes
    Reduction of male potency
    Sensation of pressure
    Serum creatinine increased
    Stevens-Johnson syndrome
    Systemic lupus erythematosus
    Toxic epidermal necrolysis
    Urinary retention
    Voice changes


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: June 2015

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Summary of Product Characteristics: Lasilactone capsules. Sanofi. Revised, July 2018.

    NICE Evidence Services Available at: Last accessed: 11 September 2018

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Furosemide: 10 March, 2015
    Last accessed: 8 June, 2015

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Spironolactone: 10 March, 2015
    Last accessed: 8 June, 2015

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.