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Precautions and Warnings With Spironolactone-HCTZ

Precautions and warnings with spironolactone-HCTZ should be reviewed with your healthcare provider before beginning treatment. For example, tell him or her if you have gout, diabetes, or liver disease, as well as all other medications you are taking to help prevent drug interactions. Other precautions and warnings with spironolactone-HCTZ include the safety of taking the medicine if you have kidney problems and the risk of electrolyte imbalances.

Spironolactone-HCTZ: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking spironolactone-HCTZ (Aldactazide®) if you have:
  • Liver disease, including cirrhosis
  • Kidney disease or kidney failure
  • Diabetes
  • Addison's disease
  • Systemic lupus erythematosus (lupus or SLE)
  • Gout
  • Fluid or electrolyte problems
  • Any allergies, including allergies to sulfa drugs, foods, dyes, or preservatives.
Also, let your healthcare provider know if you are:
  • Pregnant or trying to become pregnant
  • Breastfeeding.
Tell your healthcare provider about all other medicines you are currently taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Specific Precautions and Warnings With Spironolactone-HCTZ

Warnings and precautions to be aware of prior to taking spironolactone-HCTZ include the following:
  • The medication can cause low potassium levels (hypokalemia), high potassium levels (hyperkalemia), or other electrolyte imbalances. If you notice any symptoms of a possible electrolyte imbalance, contact your healthcare provider. These symptoms may include:
    • Dry mouth
    • Thirst
    • Weakness
    • Lethargy
    • Drowsiness
    • Restlessness
    • Muscle pain or muscle cramps
    • Low blood pressure (hypotension)
    • Decreased urination
    • Rapid heart rate (tachycardia), slow heart rate (bradycardia), or irregular heart rhythm (arrhythmia)
    • Nausea or vomiting.
Changes in potassium levels can be dangerous. Because there are sometimes no symptoms, your healthcare provider should measure your potassium levels regularly while you are taking the drug using a simple blood test.
  • Do not use salt substitutes while taking spironolactone-HCTZ. Salt substitutes usually contain potassium, and combining them with spironolactone-HCTZ can increase the risk of high potassium levels in your blood (hyperkalemia). Herb-type salt substitutes that do not contain potassium are okay to use.
  • The medication should be started with caution in people with liver disease, as a fluid or electrolyte imbalance can be especially dangerous in people with liver disease.
  • If kidney problems seem to be getting worse (especially for those with severe kidney disease), spironolactone-HCTZ should be stopped, since the medication can sometimes make kidney problems worse.
  • Breast enlargement (known medically as gynecomastia) has occurred in men taking spironolactone-HCTZ. This is most likely due to the spironolactone component of the drug, which can affect male hormones. Usually, the breast enlargement goes away once spironolactone-HCTZ is stopped.
  • Spironolactone (one of the components of spironolactone-HCTZ) has been shown to cause tumors in rats. It is not known if it also causes tumors in humans.
  • Spironolactone-HCTZ can cause systemic lupus erythematosus (lupus or SLE) or may make lupus worse.
  • The medication may cause gout or make it worse. Make sure to tell your healthcare provider if you have gout or if your gout is becoming worse while taking spironolactone-HCTZ.


  • Drugs that contain hydrochlorothiazide (including this medication) can sometimes cause a potentially dangerous eye reaction (a particularly dangerous type of glaucoma). This reaction usually occurs within days to weeks of starting the drug. 
Because this reaction can permanently damage vision, let your healthcare provider know right away if you develop vision changes and/or eye pain. The main treatment for this reaction is to stop taking this medication, although other treatment (including surgery) may sometimes be necessary.
  • A number of medicines may interact with spironolactone-HCTZ (see Drug Interactions With Spironolactone-HCTZ).
  • Spironolactone-HCTZ is considered a pregnancy Category C medication. This means that it may not be safe to use during pregnancy, although the full risks are not known. Talk to your healthcare provider about the risks and benefits of using the drug when pregnant (see Aldactazide and Pregnancy).
  • Spironolactone-HCTZ passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Aldactazide and Breastfeeding).
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