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Spotlight on Spironolactone Oral Suspension for the Treatment of Heart Failure: Focus on Patient Selection and Perspectives

Authors Manolis AA, Manolis TA, Melita H, Manolis AS

Received 1 November 2019

Accepted for publication 8 December 2019

Published 30 December 2019 Volume 2019:15 Pages 571—579


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Pietro Scicchitano

Antonis A Manolis,1 Theodora A Manolis,2 Helen Melita,3 Antonis S Manolis4

1Patras University School of Medicine, Patras, Greece; 2Red Cross Hospital, Athens, Greece; 3Onassis Cardiac Surgery Center, Athens, Greece; 4Athens University School of Medicine, Athens, Greece

Correspondence: Antonis S Manolis
Third Department of Cardiology, Ippokrateio Hospital, Vas. Sofias 114, Athens, 115 27, Greece
Tel +30-213-2088470
Fax +30-213-2088676
Email [email protected]

Abstract: Spironolactone, an antagonist of aldosterone, initially used as a potassium-sparing diuretic, was subsequently shown to be a very effective adjunctive agent in the treatment of patients with heart failure with reduced ejection fraction, by halting the disease progression, with significant beneficial effects on both morbidity and mortality. Other uses comprise resistant hypertension, edema in patients with cirrhosis, and other on- and off-label uses. Recent data indicate that spironolactone also may offer some symptomatic relief in patients with heart failure and preserved ejection fraction. However, a variable percentage of patients, particularly among the aged group, may have difficulty in swallowing or may be unable to swallow tablets and thus are deprived of the benefits of such therapy. In 2017, the FDA approved a liquid suspension formulation of spironolactone, CaroSpir®, which will enable more heart failure and other patients in need of aldosterone inhibition to avail themselves of the protective and beneficial effects of spironolactone. The new drug formulation comes as a banana-flavored oral suspension that contains 25 mg/5 mL of spironolactone, supplied in 4-ounce (118 mL) and 16-ounce (473 mL) bottles. The details of this drug formulation development and the benefits of spironolactone use in patients with heart failure with a focus on patient selection are herein reviewed.

Keywords: spironolactone, mineralocorticoid receptor antagonists, spironolactone oral suspension, heart failure, heart failure with reduced ejection fraction, hyperkalemia, ability to swallow

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