Spironolactone vs Hydrochlorothiazide

Introduction

According to WHO, approximately 1.28 billion adults between the ages of 30 to 79 years worldwide have hypertension. Spironolactone and Hydrochlorothiazide are two common drugs prescribed to hypertensive patients to help them control their blood pressure levels. These drugs work by preventing our bodies from absorbing excessive salt.[1]

About Spironolactone and Hydrochlorothiazide

What is Spironolactone?

The FDA (Food Drug and Administration) approved Spironolactone in 2001. Spironolactone is a potassium-sparing diuretic prescribed to individuals with hypertension, cardiovascular disease, or hypokalemia. It is widely administered as an oral tablet and is available under the name Aldactone and as a generic drug. It is only available on prescription.[2][3]

What conditions is Spironolactone approved to treat?

Spironolactone is approved to treat several conditions, including[4]:

Hypertension
Heart failure
Low potassium levels
Hyperaldosteronism
Kidney disease
Liver disease

How does Spironolactone work for Hypertension?

Spironolactone is classified as an antagonist of the aldosterone receptor. This medication works by binding receptors in the distal convoluted renal tubule's sodium-potassium aldosterone-dependent exchange location. This causes the kidneys to produce higher water and sodium levels, helping reduce hypertension levels.[5]

What is Hydrochlorothiazide?

The FDA (Food Drug and Administration) approved Hydrochlorothiazide in 1977. Hydrochlorothiazide is a drug commonly prescribed to patients with hypertension, Edema, and kidney, heart, and liver disease. It belongs to a group of medications labeled as diuretics. This class of drugs encourages the kidney to excrete unwanted fluid and salt from the body through the urine. Hydrochlorothiazide is only available on a prescription basis.[6]

What conditions is Hydrochlorothiazide approved to treat?

Hydrochlorothiazide is approved to treat several conditions, including[7]:

High blood pressure
Edema (swelling) caused by heart failure, cirrhosis (liver damage), or taking drugs called estrogens or corticosteroids.
Edema caused by kidney-related conditions
Heart failure

How does Hydrochlorothiazide work for Hypertension?

Hydrochlorothiazide helps to lower blood pressure by targeting the distal convoluted tubules and blocking the sodium chloride co-transporter mechanism. This has a diuretic effect, which decreases hypertension but results in potassium loss. The effects of the drug might begin as soon as 2 hours after consumption and peak in 4 hours, lasting 6 to 12 hours.[8]

Effectiveness

How effective are Spironolactone and Hydrochlorothiazide for treating Hypertension?

Spironolactone and Hydrochlorothiazide are known as effective drugs in treating uncontrolled hypertension levels. Several studies point toward the effectiveness of these drugs in treating hypertension. However, a study conducted in 2018 pointed toward the superiority of Spironolactone over Hydrochlorothiazide in the treatment of hypertension.

The study was conducted on 566 hypertension patients. A percentage of the participants were prescribed HCTZ (25 mg/qd), whereas others were prescribed spironolactone (25 mg/qd). The study lasted over 4 weeks, and its findings indicated that in patients with uncontrolled blood pressure levels prescribing spironolactone appeared to be a better course of action than prescribing HCTZ for systolic blood pressure control, cf-PWV reduction and preventing the development of resistant hypertension.[9]

Dosage information

How is Spironolactone administered for Hypertension?

Spironolactone is available in tablet and suspension (liquid) form. Both forms of the medication are meant for oral consumption and are usually prescribed to be taken once or twice daily.

Spironolactone dosage information

The following table includes information on Spironolactone dosage for hypertension[10]:

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How is Hydrochlorothiazide administered for Hypertension?

Hydrochlorothiazide comes in two forms: tablet (capsule) and liquid solution; all meant to be taken orally. When used to treat hypertension, it is usually prescribed twice daily.[10]

Hydrochlorothiazide dosage information

The following table includes information on Hydrochlorothiazide dosage for hypertension[11]:

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Side Effects

What are the most common side effects of Spironolactone?

The most common side effects of Spironolactone include:

Fatigue (tiredness)
Vomiting
Restlessness
Diarrhea
Drowsiness
Vaginal bleeding in post-menopausal (after the end of monthly menstrual periods) women
Changes in voice (deepening of voice)
Increased hair growth on different parts of the body
Cramps and stomach pain
Enlarged or painful breasts in men or women
Irregular menstruation
Difficulty maintaining or achieving an erection

Are there any potential serious side effects of Spironolactone?

Potentially serious side effects of Spironolactone include:

Muscle pain, weakness, or cramps
Decreased urination
Flu-like symptoms
Fainting
Yellowing of the eyes or skin
Unusual bruising or bleeding
Lack of energy
Loss of appetite
Pain in the upper right portion of the stomach
Rash
Extreme fatigue (tiredness)
Excessive thirst, dry mouth, headache, dizziness, unsteadiness, or other signs of dehydration
Hives
Itching
Vomiting blood
Blood in stools
Difficulty breathing or swallowing
Numbness, burning, pain, or tingling in the feet or hands
Inability to move legs or arms
Changes in heartbeat
Confusion
Nausea

Important note! If you experience any of the above serious side effects, seek medical help immediately.

What are the most common side effects of Hydrochlorothiazide?

The most common side effects of Hydrochlorothiazide include[12]:

Cramping
Spinning sensation
Severe sunburn
Weakness
Difficulty having a bowel movement (stool)
A constant movement of surroundings or self
Thinning of hair
Hair loss
Redness or discoloration of the skin
Restlessness
Difficulty having or keeping an erection
Enhanced skin sensitivity to sunlight
loss in sexual drive, performance, desire, or ability
Muscle spasms
Decreased Libido (need to be sexually active)

Are there any potential serious side effects of Hydrochlorothiazide?

Potentially serious side effects of Hydrochlorothiazide include:

Leg, stomach, or back pains
Bloating
Blood in the stools or urine
Blue fingernails and lips
Black, tarry stools
Bleeding gums
Unusual weakness or tiredness
Increased urination
Indigestion
Peeling, loosening, or blistering of the skin
Blurred vision
Itching, numbness, crawling, burning, prickling, or tingling feelings
Chest tightness or pain
Chills
Clay-colored stools
Cloudy urine
Dry mouth
Difficult, noisy, or fast breathing
Difficulty swallowing
Lightheadedness, dizziness, or faintness when getting up from a sitting or lying position
Cold sweats
Vomiting of blood
Coughing up blood
Heaviness or weakness of the legs
Weight gain
White, waxy, or yellow scar-like area
Muscle pain or cramps
Vomiting or nausea
Nosebleeds
Pain, numbness, weakness, or tingling in the hands
Yellowing of eyes or skin
Confusion
Constipation
Cough or hoarseness
Coughing that sometimes produces a frothy pink sputum
Cracked skin
Darkened urine
Decrease in the urine-concentrating ability
Decreased amount or frequency of urine
Diarrhea
Fast or irregular heartbeat
Fever
Pink growth
Flushed, dry skin
Fruit-like breath odor
Generally swollen body
A general feeling of illness or discomfort
Swelling or puffiness of the eyelids or around the face, eyes, lips, or tongue
Decreased frequency of urination or amount of urine
Difficulty or pain during urination
Pains in the side or stomach (possibly radiating to the back)
Pale skin
Persistent non-healing sore
Pinpoint red spots on the skin
Red, irritated eyes
Increased sweating
Increased thirst
Red skin lesions (purple center)
Red, swollen skin
Loss of heat from the body
A reddish patch or irritated area
Soreness, redness, or scaly skin
Sores, blisters, or welting
Swelling of the legs, ankles, face, fingers, feet, or lower legs
Unpleasant breath odor
Painful or swollen glands
Tender salivary glands
Thickening of bronchial secretions
Unusual bruising or bleeding
Joint pain, stiffness, or swelling
Appetite loss
Lower side or back pain
Trembling
Seizures
Trouble breathing
Shiny bump
Sore throat
Unusual weight loss
Headaches
Itching, rash, hives
Increased hunger
Ulcers, sores, or white spots on the mouth or lips

Important note! If you experience any of the above serious side effects, seek medical help immediately.

Contraindications and interactions

Warnings and general precautions for Spironolactone and Hydrochlorothiazide

Spironolactone and hydrochlorothiazide can cause severe allergic reactions in rare cases. It is important to tell your healthcare provider if you are allergic to these medications or any other thiazide diuretics. It is also critical to share with your doctor if you are breastfeeding, pregnant, or becoming pregnant when taking Spironolactone and hydrochlorothiazide.

Spironolactone has been known to cause tumors in laboratory animals during testing. Talk to your healthcare provider about the risks attached to this medication and its benefits for your health condition.[13]

Contraindications and important interactions for Spironolactone and Hydrochlorothiazide

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Cost Comparison

How much do Spironolactone and Hydrochlorothiazide cost?

25 mg Spironolactone oral tablets cost approximately $13 (30 tablets), whereas 25 mg hydrochlorothiazide oral tablets cost approximately $10 (7 tablets). On the other hand, 25 mg hydrochlorothiazide/spironolactone oral tablets cost approximately $23 (30 tablets). These values can vary depending on your location and the pharmacy you visit. [14]

Popularity of Spironolactone and Hydrochlorothiazide

Both spironolactone and hydrochlorothiazide are popular drugs prescribed for the treatment of hypertension. However, in recent years, the popularity of spironolactone has decreased due to its tendency to cause tumors and estrogenic side effects. Hydrochlorothiazide remains one of the most popular thiazide diuretics prescribed to treat hypertension.[15]

Conclusion

Takeaway

Both spironolactone and hydrochlorothiazide have a promising track record of treating hypertension and several other diseases. In some cases, doctors may also combine both drugs to treat uncontrolled hypertension levels in patients effectively. However, hydrochlorothiazide is more popular than spironolactone.

Spironolactone tumor-causing and estrogenic side effects make it a less sought-after treatment for hypertension. It is important to share your medical history and any medications you might be taking, including other relevant information, with your doctor to help them decide which drug to prescribe for your hypertension treatment.