Classifications: electrolytic and water balance agent; potassium-sparing diuretic
Pregnancy Category: D
Assessment & Drug Effects
- Check blood pressure before initiation of therapy and at regular intervals throughout therapy.
- Lab tests: Monitor serum electrolytes (sodium and potassium) especially during early therapy; monitor digoxin level when used concurrently.
- Assess for signs of fluid and electrolyte imbalance, and signs of digoxin toxicity.
- Monitor daily I&O and check for edema. Report lack of diuretic response or development of edema; both may indicate tolerance to drug.
- Weigh patient under standard conditions before therapy begins and daily throughout therapy. Weight is a useful index of need for dosage adjustment. For patients with ascites, physician may want measurements of abdominal girth.
- Observe for and report immediately the onset of mental changes, lethargy, or stupor in patients with liver disease.
- Adverse reactions are generally reversible with discontinuation of drug. Gynecomastia appears to be related to dosage level and duration of therapy; it may persist in some after drug is stopped.
Patient & Family Education
- Be aware that the maximal diuretic effect may not occur until third day of therapy and that diuresis may continue for 2–3 d after drug is withdrawn.
- Report signs of hyponatremia or hyperkalemia (see Appendix F), most likely to occur in patients with severe cirrhosis.
- Avoid replacing fluid losses with large amounts of free water (can result in dilutional hyponatremia).
- Weigh 2–3 times each week. Report gains/loss of 5 lbs.
- Do not drive or engage in potentially hazardous activities until response to the drug is known.
- Avoid excessive intake of high-potassium foods and salt substitutes.
- Do not breast feed while taking this drug.