Long test: 400mg spironolactone is administered daily for three to four weeks. Correction of hypokalaemia and of hypertension provides presumptive evidence for the diagnosis of primary hyperaldosteronism. Many of these problems can be avoided by careful choice and use of drugs. The Renal Drug Database seeks to assist healthcare professionals in this process. Physical Examination Procedures for Advanced Practitioners and Non-Medical Prescribers - 2nd ed. (2015)

Summary of Product Characteristics: Spironolactone Film-coated Tablets 12.5mg. ADVANZ Pharma. Revised October 2020. Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press. Accessed on 03 June 2015. The manufacturers information should always be followed unless a renal specialist advises otherwise. Prescribing or administering a medication outside the manufacturers information may render the medicine being used off-label. Summary of Product Characteristics (SmPC)

Uses

Children aged 1 month to 18 years: 3mg/kg daily, maximum dose 50mg daily, for two to four weeks (up to a maximum duration of six weeks in tinea pedis). Oropharyngeal and oesophageal candidiasis: 200mg to 400mg loading dose on first day followed by 100mg to 200mg daily. Metabolism: Very few drugs are 100% excreted via either the liver or the kidneys. Many are metabolised by the liver to either active or inactive metabolites, and some of these may be excreted via the kidneys. Pharmacologically active metabolites that undergo renal excretion must be taken into account when prescribing the parent drug in patients with renal impairment. Treatment given for fourteen to thirty days in other mucosal infections (oesophagitis, candiduria, non-invasive bronchopulmonary infections). One limitation is that the handbook is a UK publication so some of the drugs and dosing recommendations are not relevant to the Australian situation. Perhaps a consideration for future editions might be to include some general comments on the use of various drug classes in patients with renal disease.

Pharmacokinetics: Basic pharmacokinetic data such as molecular weight, half-life, percentage protein-binding, volume of distribution and percentage excreted unchanged in the urine are quoted, to assist in predicting drug handling in both renal impairment and renal replacement therapy. Vaginal candidiasis prophylaxis and treatment (four or more episodes yearly): 150mg every 72 hours for three doses followed by 150mg once weekly maintenance dose for six months. Children have a higher fluconazole clearance than observed for adults. A dose of 100mg, 200mg and 400mg in adults corresponds to a 3mg/kg, 6mg/kg and 12mg/kg dose in children, respectively. Maintenance therapy to prevent relapse of cryptococcal meningitis in patients with high risk of recurrenceOther information: Details given here are only relevant to the use of that particular drug in patients with impaired renal function or on renal replacement therapy. For more general information, please refer to the Summary of Product Characteristics for that drug. The tablets should be taken in the morning before breakfast with water or a very small amount of food. The manufacturer recommends a washout period of around 1 week after a single-dose or discontinuation of a course of treatment before becoming pregnant. Pregnancy and Lactation Pregnancy

Acute or recurrent vaginal candidiasis, candidal balanitis. Consider treatment of partners who present with symptomatic genital candidiasis. Mucosal candidiasis including oropharyngeal, oesophageal, candiduria, chronic mucocutaneous candidiasis and chronic oral atrophic candidiasis (denture sore mouth). Diuretics are no longer used as standard therapy during pregnancy and should only be used for particular indications. Spironolactone should only be chosen if therapy with an aldosterone antagonist is absolutely necessary. Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.The manufacturer advises that mothers should not receive this treatment whilst breastfeeding. Briggs suggests due to the prolonged nature of the therapy, the potential for serious toxicity in a nursing infant may be increased. Advise patients, tablets should preferably be taken at the same time each day and can be taken on an empty stomach or after a meal. Prescribers are advised to take into account the prevalence of resistance in various Candida species to fluconazole as alternative antifungal therapy secondary to treatment failure may be required.