Spironolactone and hydrochlorothiazide both belong to the family of medications called diuretics (water pills). This combination medication is used to treat edema (fluid retention) that occurs with congestive heart failure and disorders of the kidney and liver. This combination of medications is also used to treat high blood pressure. It works by making the body lose excess water and salt.

One of the diuretics, spironolactone, is called a potassium-sparing diuretic and helps the body to retain potassium. Hydrochlorothiazide, on the other hand, causes potassium to be lost from the system. Potassium supplements are usually not required with this medication as the effects of the two diuretics balance each other out. This medication is normally used once the best strength of each of the ingredients is determined individually.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended adult doses range from 1 tablet (containing 25 mg spironolactone and 25 mg hydrochlorothiazide) daily to 4 tablets (containing 50 mg spironolactone and 50 mg hydrochlorothiazide) daily, taken in single or divided doses as prescribed by the doctor. Since this medication increases urine output, it is better to take it early in the day (i.e., with breakfast if you are taking a once-daily dose).

For children, this medication is based on body weight. It will be calculated by your child's doctor to give 1.65 mg to 3.3 mg of spironolactone per each kilogram of body weight.

Spironolactone - hydrochlorothiazide may be taken with or without food, however, it should be taken the same way each day so that levels of the medication in the body remain steady. If stomach upset occurs, always take the medication with food.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture and keep out of the reach of children.

Do not take spironolactone - hydrochlorothiazide if you:

• are allergic to spironolactone, hydrochlorothiazide, or any ingredients of the medication
• are allergic to the class of medications called sulfonamides
• are unable to produce urine
• have Addison's disease
• have high levels of potassium or calcium in your blood
• have severely reduced liver function or progressive liver disease, except in certain circumstances
• have significantly reduced kidney function
• are using eplerenone, heparin, or a low molecular weight heparin
• are pregnant
• are breast-feeding

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• breast tenderness (women)
• constipation
• decreased appetite
• decreased interest in sexual activity
• decreased sexual ability
• diarrhea
• dizziness or lightheadedness when getting up from a lying down or sitting position
• drowsiness
• dry mouth
• enlargement of breasts (men)
• fatigue
• fever
• headache
• heartburn
• increased sensitivity of skin to sunlight
• increased size of glands in the mouth
• muscle cramps or spasms
• nausea
• numbness
• restlessness
• sensation that your surroundings are moving
• stomach cramps
• tingling, pins and needles feeling in fingers
• upset stomach
• vomiting
• weakness

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• breast pain
• confusion
• difficulty breathing
• discoloured patches or lumps on the skin that change slowly over time
• frequent signs of infection (symptoms may include fever or chills, cough or hoarseness, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• irregular menstrual periods
• rapid weight loss
• signs of an allergic reaction (e.g., skin rash or hives)
• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• signs of changes in the amount of potassium in the blood (e.g., confusion, dry mouth, increased thirst, unusual tiredness or weakness, muscle cramps or pain)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of electrolyte problems (e.g., weakness, drowsiness, muscle pain or cramps, irregular heartbeat)
• signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine, swelling of the extremities)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• skin rash
• stomach pain or burning (signs of stomach ulcer)
• symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
• vision changes or blurred vision

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• signs of pancreatitis (inflammation of the pancreas; e.g., severe upper abdominal pain, loss of appetite, vomiting)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Breast enlargement in men: Men may develop breast enlargement with the use of spironolactone - hydrochlorothiazide. If this occurs, tell your doctor. In the great majority of cases, breast enlargement disappears once the medication is stopped.

Cholesterol levels: Increases in cholesterol and triglyceride levels may occur when taking spironolactone - hydrochlorothiazide. If you have high blood cholesterol or triglyceride levels, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Diabetes: This medication can cause changes in blood sugar control for people with diabetes. People with diabetes may find it necessary to monitor their blood sugar more often while using this medication.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dizziness: Spironolactone - hydrochlorothiazide may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you. This medication may also cause dizziness or lightheadedness when moving from lying or sitting to an upright position.

Fluid and electrolyte balance: Spironolactone - hydrochlorothiazide may cause the levels of electrolytes such as potassium, sodium, and chloride in the blood to change while taking this medication. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible. Your doctor will do blood tests regularly to monitor the levels of these electrolytes in your blood while you are taking this medication.

Gout: Spironolactone - hydrochlorothiazide may increase the level of uric acid in the body. If you develop painful, warm, and swollen joints or difficulty with urination, contact your doctor as soon as possible.

If you have a history of gout, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Small changes to electrolytes and fluid in the body can cause changes to liver function. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Potassium levels: Spironolactone - hydrochlorothiazide can have varying effects on blood potassium levels. Your doctor will check these levels with blood tests and advise you on the appropriate intake of potassium.

Sensitivity to sunlight: This medication may increase the sensitivity of the skin to sunlight, increasing the risk of sunburn. Avoid exposure to sunlight for long periods of time, particularly between the hours of 10 am and 2 pm, while you are taking this medication. Wear a broad-spectrum sunscreen and lip balm with an SPF of 30 or higher. If you notice any unusual skin rash or peeling, contact your doctor immediately.

Skin cancer: Recent studies of hydrochlorothiazide have connected long-term use of the medication with an increased risk of developing non-melanoma skin cancer. This often appears as a lump or discoloured patch of skin that slowly changes appearance or size. Check your skin regularly for unusual growths or discolouration and report any changes to your doctor as soon as possible. Talk to your doctor about any concerns you may have.

Systemic lupus erythematosus: This medication can worsen or activate the symptoms of lupus. If you experience swollen and painful joints, fever, fatigue, or rash on the nose and cheeks while taking this medication, contact your doctor.

Vision changes: Hydrochlorothiazide occasionally causes vision changes including increased eye pressure and myopia (nearsightedness), or an abnormal buildup of fluid in the eye. If you experience any eye symptoms, such as pain, blind spots, blurred vison, or changes in vision, contact your doctor as soon as possible.

Pregnancy: Both spironolactone and hydrochlorothiazide cross into the placenta and may affect the developing baby if taken by a woman when she is pregnant. If you become pregnant while taking spironolactone - hydrochlorothiazide, talk to your doctor about the potential benefits and risks of taking this medication during pregnancy.

Breast-feeding: Spironolactone and hydrochlorothiazide pass into breast milk. If you are breast-feeding and are taking spironolactone - hydrochlorothiazide, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

There may be an interaction between spironolactone - hydrochlorothiazide and any of the following:

• abiraterone
• acetylsalicylic acid (ASA)
• aclidinium
• alcohol
• aldesleukin
• aliskiren
• allopurinol
• alpha-/beta-agonists (e.g., epinephrine, norepinephrine)
• alpha-agonists (e.g., clonidine, methyldopa)
• alpha-blockers (e.g., alfuzosin, doxazosin, tamsulosin)
• alprazolam
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril, enalapril, lisinopril, ramipril)
• angiotensin receptor blockers (ARBs; losartan, valsartan, candesartan)
• antihistamines (e.g., azelastine, cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, pimozide, quetiapine, risperidone)
• apomorphine
• atropine
• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
• belladonna
• benztropine
• beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
• beta 2 agonists (e.g., salbutamol, formoterol, terbutaline)
• bortezomib
• brimonidine
• bromocriptine
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• calcium salts (e.g., calcium carbonate, calcium citrate)
• carbamazepine
• cholestyramine
• ciprofloxacin
• colestipol
• inhaled corticosteroids (e.g., budesonide, ciclesonide, fluticasone)
• oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
• cyclosporine
• darifenacin
• dexmethylphenidate
• diabetes medications (e.g., acarbose, canagliflozin, glyburide, insulin, liraglutide, lixisenatide, metformin, rosiglitazone)
• digoxin
• disopyramide
• other diuretics (water pills; e.g., furosemide, hydrochlorothiazide)
• domperidone
• drospirenone
• duloxetine
• eplerenone
• flavoxate
• glycopyrrolate
• heparin, including low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• ipratropium
• iron sucrose
• ivabradine
• ketotifen
• levodopa
• lithium
• methadone
• lomitapide
• methylphenidate
• metoclopramide
• minoxidil
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• multivitamins (Vitamins A, D, E) and minerals
• nabilone
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
• nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• nitroglycerin
• nitrofurantoin
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen)
• obinutuzumab
• orphenadrine
• oxcarbazepine
• oxybutynin
• paclitaxel
• pentoxifylline
• phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• potassium-containing medications (e.g., potassium chloride, potassium citrate, potassium gluconate, potassium iodide, potassium phosphate)
• other potassium-sparing diuretics (e.g., amiloride, triamterene)
• pramipexole
• quinidine
• repaglinide
• riociguat
• ropinirole
• rotigotine
• sacubitril
• scopolamine
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• sirolimus
• sodium phosphates
• solifenacin
• "statin" cholesterol medications (e.g., atorvastatin, simvastatin)
• tacrolimus
• tiotropium
• tizanidine
• tolterodine
• tolvaptan
• topiramate
• tretinoin
• triazolam
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• trimethoprim
• umeclidinium
• vitamin D analogues (e.g., alfacalcidol, calcifediol, calcitriol, cholecalciferol)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.