Spironolactone may be used initially in the treatment of patients with oedema and ascites associated with hepatic cirrhosis to avoid depletion of potassium or precipitation of hepatic coma that may follow use of a thiazide diuretic. If more profound diuresis is necessary or in patients with congestive heart failure and the nephrotic syndrome, a thiazide or other diuretics may be given concomitantly with spironolactone.
Spironolactone may be effective in treating patients who do not respond satisfactorily to other diuretic agents but it is most useful when given with another diuretic.
Spironolactone is reported to have a hypotensive effect in patients with essential hypertension. The rise in serum potassium levels produced by spironolactone in patients with primary hyperaldosterone has been used as an aid in the diagnosis of this affliction.