Long-term therapy with spironolactone

OBJECTIVE: To evaluate the duration of therapy with spironolactone in daily practice. METHOD: A retrospective follow-up of a cohort of patients with a first prescription for spironolactone between January 1, 1990 and December 31, 1996 and at least one hospital discharge for CHF in the preceding year. RESULTS: 243 patients met the inclusion criteria and were followed until the end of data collection. The average starting dosage of spironolactone was 55 mg. 143 patients (58.8%) discontinued spironolactone therapy before the end of follow-up. 98 patients (40.8%) discontinued within 6 months of follow-up. Of the 137 patients (56.4%) who did use spironolactone and an ACE-inhibitor concomitantly, only 45 (32.8%) continued this combination until the end of follow-up. The remainder of the patients discontinued either the ACE-inhibitor (10.9%) or spironolactone (12.4%) or both (43.8%). CONCLUSION: While the reasons for discontinuation remain unclear, our data suggest that it is difficult to keep patients on both drugs. It is not certain whether these findings from past spironolactone use can be extrapolated to future use. Patients in the general population received higher average spironolactone dosages compared to the RALES study (55 mg vs. 26 mg), possibly resulting in more adverse effects and partly explaining the high discontinuation rate.