Before starting

Heart failure

• Baseline
  • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
  • Urea and electrolytes

Care initiating

Consider whether initiation is appropriate where:

Potassium

Potassium is greater than 5.0 mmol/L

Creatinine

Creatinine is greater than 220 micromol/L

After started or dose changed

Heart failure

• Before and after change
  • Blood pressure
• After 1 week; then monthly for first 3 months
  • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
  • Urea and electrolytes

Ongoing once stable

Heart failure

• Every 3 - 6 months
  • Serum creatinine (for creatinine clearance) or Estimated glomerular filtration rate
  • Urea and electrolytes

Abnormal results

Reduce dose or reduce frequency

Reduce dose to 25mg on alternate days or halve the dose if any of the following met.

Potassium

Potassium is greater than 5.5 mmol/L

Creatinine

Creatinine is greater than 220 micromol/L

Estimated glomerular filtration rate

eGFR is less than 30mL/min/1.73m²

Stop and seek advice

Stop and seek specialist advice if any of the following met.

Potassium

Potassium is greater than 6 mmol/L

Creatinine

Creatinine is greater than 310 micromol/L

Estimated glomerular filtration rate

eGFR is less than 20mL/min/1.73m²

Notes

Advice to patients

Advise patients to:

• Avoid NSAIDs unless prescribed
• Avoid salt substitutes containing potassium
• Omit spironolactone and contact prescriber if diarrhoea, vomiting, or infection with fever and sweating occurs

Bibliography

• Pfizer Limited. Summary of Product Characteristics – Aldactone 100 mg Film-Coated Tablets. Last revised 05/2019 [cited 12/02/2020]
• National Institute for Health and Care Excellence (NICE). Chronic heart failure in adults: diagnosis and management [NG106]. Sep 2018 [cited 12/02/2020]
• Ponikowski P, Voors A A, Anker S D, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, Volume 37, Issue 27, 14 July 2016, Pages 2129–2200 [cited 08/01/2020]
• Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic heart failure  (Guideline 147). March 2016 [cited 08/01/2020]
• Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [cited 12/02/2020]