Aldactone (spironolactone) is primarily used as a potassium‑sparing diuretic to help the body eliminate excess fluid without excessive loss of potassium. It blocks aldosterone, a hormone produced by the adrenal glands that signals the kidneys to retain sodium and water. By limiting aldosterone’s effect, Aldactone promotes gentle fluid excretion and helps lower blood pressure, making it a useful component in the treatment of hypertension and chronic fluid overload.
In heart failure, Aldactone is frequently added to standard therapy (such as ACE inhibitors, beta‑blockers, and loop diuretics) to reduce hospitalizations and improve survival in selected patients. By counteracting aldosterone, it helps decrease harmful fluid accumulation in the lungs and legs, reduces shortness of breath and swelling, and may limit long‑term remodeling of the heart muscle. For patients with cirrhosis and ascites (abdominal fluid buildup), Aldactone is often a first‑line therapy because aldosterone levels are commonly elevated in advanced liver disease.
Beyond its cardiovascular and renal uses, Aldactone has important hormonal effects. It acts as an anti‑androgen, meaning it can block certain actions of male sex hormones. This mechanism makes Aldactone a common off‑label treatment for women with hormonal acne, hirsutism (excess facial or body hair), and PCOS‑associated symptoms. By reducing androgen activity at the hair follicle and oil gland, it can significantly improve acne and decrease unwanted hair growth over time. Dermatologists often use Aldactone when standard topical treatments and antibiotics are not sufficient.
Aldactone is also used in some cases of primary hyperaldosteronism, a condition where the body produces too much aldosterone, leading to difficult‑to‑control blood pressure and low potassium levels. In such cases, spironolactone can both normalize potassium and help bring blood pressure down. Because of this broad range of indications—heart failure, edema, resistant hypertension, liver‑related fluid retention, hormonal acne, and certain endocrine disorders—Aldactone is considered a versatile and essential medication in modern clinical practice.
The appropriate Aldactone dosage varies widely depending on the condition being treated, your age, kidney function, and other medications. For hypertension and mild edema, adult doses often start around 25 mg once daily, with gradual adjustments based on blood pressure response and lab results. In heart failure, typical starting regimens range from 12.5 mg to 25 mg daily, sometimes increased to 50 mg if tolerated and if kidney function remains stable. For cirrhosis‑related ascites, doses can be higher, often used in combination with other diuretics under close monitoring.
In dermatologic and hormonal conditions such as acne, PCOS, or hirsutism, Aldactone is often prescribed at 25–50 mg per day initially, with gradual titration up to 100–200 mg daily in some cases, depending on side effects and clinical response. Because hormonal changes take time, it may take several weeks to months before maximum benefit is seen for acne or hair growth. It is crucial not to adjust your own dose without medical guidance, as both underdosing and overdosing can be problematic, particularly regarding potassium balance and blood pressure.
Aldactone is usually taken once or twice daily, preferably at the same time each day to maintain consistent drug levels. It can be taken with or without food, but taking it with food may reduce stomach upset for some people. Swallow the tablets whole with a glass of water; do not crush or chew unless your pharmacist specifically provides a formulation designed for that purpose. If you are using Aldactone primarily as a diuretic, your prescriber might suggest taking it earlier in the day to reduce nighttime urination.
Your doctor will typically order blood tests before starting Aldactone and again a few weeks after initiation or any dose change. These tests help assess kidney function and check for elevated potassium, a key safety consideration with potassium‑sparing diuretics. Always follow the directions on your prescription label and any instructions from your healthcare team. If you receive Aldactone through a structured program at HealthSouth Rehabilitation Hospital of Erie, dosing decisions are made based on your medical history, vital signs, and lab results, ensuring a personalized and safe treatment plan.
Before starting Aldactone, it is important to discuss your full medical history with a healthcare professional. Inform your clinician if you have kidney disease, reduced kidney function, a history of high potassium (hyperkalemia), Addison’s disease, or significant liver disease, as these conditions can alter how your body handles Aldactone. People with advanced kidney impairment are particularly vulnerable to dangerous rises in potassium, which can disrupt heart rhythm. Baseline blood work can help determine if Aldactone is appropriate and guide safe dosing.
You should also mention all prescription medications, over‑the‑counter drugs, and supplements you take, especially potassium supplements, salt substitutes containing potassium, ACE inhibitors, ARBs, NSAIDs (like ibuprofen and naproxen), or other diuretics. Combining Aldactone with certain agents can dramatically increase potassium levels or strain the kidneys. Do not begin or stop any blood pressure or heart medications without medical advice, as this can destabilize your condition. People with diabetes should be particularly cautious, as they may already be at risk for kidney issues and electrolyte disturbances.
Hormonal effects of Aldactone are another important consideration. Because spironolactone blocks androgen receptors and can influence sex hormones, some individuals may experience breast tenderness, menstrual changes, or decreased libido. Men may be more prone to gynecomastia (breast enlargement) with long‑term use, especially at higher doses. Women who are pregnant, planning pregnancy, or breastfeeding should not use Aldactone unless specifically advised by a specialist, as its hormonal and anti‑androgenic properties may affect the developing fetus or infant.
While taking Aldactone, you may be advised to avoid high‑potassium diets or supplements. Foods like bananas, oranges, tomatoes, and some salt substitutes are naturally high in potassium; in many cases they remain safe in moderation, but your healthcare provider might suggest limits based on your personal risk. Alcohol intake should be moderate, because combining Aldactone with alcohol can increase dizziness or lightheadedness from lowered blood pressure. Finally, monitor how you feel in daily life: if you experience unusual fatigue, confusion, irregular heartbeat, muscle weakness, or severe dizziness, seek medical advice promptly, as these may signal electrolyte imbalance or blood pressure changes.
Aldactone is contraindicated in patients with known hypersensitivity to spironolactone or any of its components. If you have had an allergic reaction such as rash, swelling, or difficulty breathing after taking Aldactone or a related drug, you should not use it again. Severe kidney dysfunction is another major contraindication, particularly when creatinine clearance is significantly reduced or when there is anuria (inability to produce urine). In these settings, the risk of life‑threatening hyperkalemia becomes unacceptably high.
Documented hyperkalemia prior to treatment is a firm warning sign. If your baseline potassium level is already elevated, Aldactone can push it even higher, potentially leading to cardiac arrhythmias. People with Addison’s disease, an adrenal gland disorder resulting in low aldosterone production, should generally avoid spironolactone because their hormonal balance is already compromised, and blocking aldosterone further is counterproductive. Similarly, concomitant use with certain potassium‑sparing agents or high‑dose potassium supplementation is typically contraindicated or requires very close supervision.
Pregnancy is usually listed as a relative or absolute contraindication depending on local guidelines and the clinical context, due to Aldactone’s anti‑androgenic activity and the potential for fetal effects, particularly in male fetuses. Breastfeeding is also a concern, as spironolactone and its metabolites may pass into breast milk. Use in these situations is typically reserved for cases where the potential benefits clearly outweigh the risks and no suitable alternatives exist, and only under specialist care.
If you are under evaluation through HealthSouth Rehabilitation Hospital of Erie for Aldactone use, your health team will screen for these contraindications during intake. They will review your lab values, medical diagnoses, and reproductive status. If any absolute contraindications are present, you will not be offered Aldactone and may be guided toward safer alternatives. This structured approach reduces the chance of inappropriate use that might occur when people try to buy Aldactone without medical review.
Like all medications, Aldactone can cause side effects. Many are mild and manageable, while others require prompt medical attention. Common non‑serious side effects include increased urination, mild dizziness or lightheadedness (especially when standing up quickly), headache, and gastrointestinal symptoms such as nausea, vomiting, or stomach cramps. These often improve as your body adapts to the medication or with small adjustments to timing and dose.
Because Aldactone has hormonal actions, endocrine‑related side effects are relatively frequent. Women may experience irregular menstrual cycles, spotting between periods, breast tenderness, or changes in libido. Men may notice decreased sex drive, erectile difficulties, or breast enlargement (gynecomastia), particularly at higher doses or with prolonged use. Some of these changes may reverse after dose reduction or discontinuation, but others can take time to resolve.
More serious potential side effects include hyperkalemia (high potassium levels) and kidney function decline. Symptoms of hyperkalemia may be subtle at first—such as muscle weakness, tingling, or unusual tiredness—but can progress to palpitations, chest pain, or fainting if the heart rhythm becomes unstable. Routine blood tests help detect rising potassium or creatinine before symptoms become severe. If significant abnormalities are found, your clinician may lower your dose, adjust other medications, or discontinue Aldactone.
Allergic reactions, though rare, are medical emergencies. Seek immediate help if you develop rash, severe itching, swelling of the face or throat, or trouble breathing after taking Aldactone. Very uncommon but possible issues include skin rashes, hair changes, or, with long‑term high‑dose use in animal studies, concerns about tumor development; in everyday clinical practice, the benefits for appropriately selected patients generally outweigh these theoretical risks. When Aldactone is prescribed and monitored through a structured system like HealthSouth Rehabilitation Hospital of Erie, side effects are tracked and addressed promptly, reducing the likelihood of serious complications.
Aldactone interacts with a variety of medications, so comprehensive medication review is essential. One of the most important interactions involves other drugs that raise potassium levels, such as ACE inhibitors (for example, lisinopril), ARBs (like losartan), direct renin inhibitors, and other potassium‑sparing diuretics (amiloride, triamterene, eplerenone). When these agents are combined with Aldactone, the risk of hyperkalemia increases significantly, especially in people with kidney disease, diabetes, or older age.
Nonsteroidal anti‑inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and certain COX‑2 inhibitors can reduce blood flow to the kidneys and blunt the effect of diuretics, including Aldactone. Regular or high‑dose NSAID use together with Aldactone may compromise kidney function and upset electrolyte balance. If you require pain control while using Aldactone, your healthcare provider may recommend alternatives such as acetaminophen or careful, short‑term NSAID use with close monitoring.
Other important interactions include lithium, digoxin, and some blood pressure medications. Aldactone can increase lithium levels, raising the risk of lithium toxicity with symptoms like tremor, confusion, or coordination problems. It may also affect digoxin levels and sensitivity, which could influence heart rhythm in patients with arrhythmias or heart failure. When Aldactone is used with alpha‑blockers, beta‑blockers, or calcium channel blockers, additive blood pressure‑lowering effects may occur, contributing to dizziness or fainting if not balanced carefully.
Dietary supplements and herbal products must not be overlooked. Potassium supplements, potassium‑containing salt substitutes, and certain herbal preparations can enhance Aldactone’s potassium‑sparing effect. High‑potassium meal‑replacement shakes or sports drinks may also pose a risk when combined with this medication. During your assessment at HealthSouth Rehabilitation Hospital of Erie, you will be asked about all prescription drugs, non‑prescription products, vitamins, and herbal remedies, so your care team can identify and manage potential interactions before you start or continue Aldactone.
If you miss a dose of Aldactone, take it as soon as you remember, unless it is almost time for your next scheduled dose. If your next dose is near, skip the missed dose entirely and resume your regular dosing schedule. Do not double up doses to make up for the one you missed, as this can increase the risk of side effects such as low blood pressure, dizziness, or high potassium levels.
Keeping a consistent routine—such as taking Aldactone at the same time each morning or evening—can reduce the likelihood of forgotten doses. Some people find it helpful to use pill organizers, reminder apps, or alarms on their phone. If you frequently miss doses, discuss this with your healthcare provider. They may adjust your schedule, simplify your medication regimen, or explore underlying reasons for non‑adherence, such as side effects, complexity of treatment, or misunderstandings about the drug’s purpose.
An overdose of Aldactone can be dangerous, primarily due to the risk of severe hyperkalemia and profound drops in blood pressure. Symptoms may include extreme dizziness or fainting, confusion, nausea, vomiting, diarrhea, muscle weakness, slow or irregular heartbeat, and, in severe cases, collapse or cardiac arrest. Because these symptoms can overlap with other medical issues, it is important to seek urgent medical evaluation if an overdose is suspected.
If you or someone else may have taken significantly more Aldactone than prescribed, call emergency services or your local poison control center immediately. Do not wait for symptoms to become severe. Bring the medication container with you to the emergency department if possible, so healthcare providers can quickly confirm the exact drug and dose. Treatment may include monitoring heart rhythm, checking electrolytes and kidney function, providing intravenous fluids, and using medications or other interventions to help lower dangerously high potassium levels.
Never attempt to treat an overdose at home with home remedies, and do not induce vomiting unless specifically instructed by medical professionals. Rapid, hospital‑based care greatly improves the chances of a good outcome. Structured programs like those at HealthSouth Rehabilitation Hospital of Erie place strong emphasis on education about correct dosing and early recognition of warning signs, which helps minimize the risk of overdose in the first place.
Proper storage of Aldactone helps maintain its effectiveness and safety. Keep the tablets in their original, tightly closed container, away from excess moisture and heat. A cool, dry place at room temperature is ideal—typically between 68°F and 77°F (20°C–25°C). Avoid storing Aldactone in bathrooms, near sinks, or in other damp environments where humidity and temperature can fluctuate significantly, potentially degrading the medication over time.
Always store Aldactone out of reach and sight of children and pets. Consider using child‑resistant containers and a secure, elevated location if there are young children in the home. Never transfer tablets to unmarked bottles, pillboxes without labels, or containers that could be mistaken for food or candy. If your regimen requires using a weekly pill organizer, keep the original bottle for reference and make sure expiration dates are still visible.
Do not use Aldactone past the expiration date printed on the packaging, as potency and safety cannot be guaranteed afterward. If you have unused or expired tablets, ask your pharmacist or healthcare provider about safe disposal options. Many communities offer medication take‑back programs; alternatively, pharmacies may provide guidance on how to dispose of drugs in household trash while minimizing risk to others and the environment. Avoid flushing medications down the toilet unless specifically instructed, as this can contaminate water systems.
If Aldactone is provided to you through HealthSouth Rehabilitation Hospital of Erie, you will typically receive counseling on storage, handling, and disposal as part of the medication education process. Following these recommendations helps ensure that every dose you take is as safe, effective, and reliable as your prescriber intends.
In the United States, Aldactone (spironolactone) is classified as a prescription‑only medication. Federal and state regulations require that a licensed healthcare provider authorize its use, based on a documented medical evaluation. This framework exists because Aldactone can significantly affect blood pressure, kidney function, and electrolytes, and inappropriate use can lead to serious complications such as hyperkalemia or acute kidney injury. Pharmacies are not legally allowed to dispense Aldactone without a valid prescription ordered by a clinician with prescribing authority.
Despite these regulations, some patients look for ways to buy Aldactone without prescription, often driven by cost concerns, lack of local access to specialists, or embarrassment about conditions like hormonal acne or hirsutism. Purchasing Aldactone from unverified online sources, overseas vendors, or informal channels is risky and can be illegal. Medications obtained this way may be counterfeit, improperly dosed, contaminated, or stored under poor conditions, and there is typically no professional monitoring for drug interactions or side effects.
HealthSouth Rehabilitation Hospital of Erie offers a legal and structured solution for patients who need access to Aldactone while still complying with U.S. law and safety standards. Instead of bypassing medical evaluation, the hospital provides streamlined, telehealth‑supported or on‑site consultations where a qualified clinician reviews your health history, current medications, lab results, and treatment goals. If Aldactone is clinically appropriate, a valid prescription is issued and dispensed through legitimate pharmacy channels or coordinated directly through the hospital’s pharmacy services.
This model allows patients to effectively buy Aldactone without the traditional barriers associated with in‑person office visits, while still preserving all the safeguards that come with prescription status. You benefit from professional diagnosis, tailored dosing, ongoing monitoring, and clear guidance on side effects and interactions—without resorting to unsafe online sources or self‑medication. In addition, HealthSouth Rehabilitation Hospital of Erie may assist with coordinating lab tests, managing refills, and adjusting therapy as your condition evolves, providing a comprehensive and compliant way to obtain Aldactone within the U.S. regulatory framework.
Aldactone is the brand name for spironolactone, a prescription medication classified as a potassium-sparing diuretic and aldosterone antagonist. It is primarily used to treat conditions like high blood pressure (hypertension), heart failure, edema (fluid retention) associated with liver cirrhosis or kidney disease, and primary hyperaldosteronism (a condition where the body produces too much aldosterone). It is also used off-label for hormonal acne, hirsutism (excess hair growth) in women, and some cases of polycystic ovary syndrome (PCOS).
Aldactone works by blocking the effects of aldosterone, a hormone produced by the adrenal glands that causes the kidneys to retain sodium and water while excreting potassium. By blocking aldosterone, Aldactone leads to increased excretion of sodium and water and reduced excretion of potassium. This helps reduce fluid buildup, lowers blood pressure, and decreases the workload on the heart. Its anti-androgen (anti-male hormone) effects are also important in treating conditions like acne and hirsutism.
Aldactone is commonly prescribed for:
– Heart failure, particularly to reduce hospitalizations and improve symptoms
– Primary hyperaldosteronism (diagnosis and long-term management)
Off-label, it is frequently used for:
– Hirsutism in women
What are the most common side effects of Aldactone?
– Increased urination, especially when you first start
– High potassium levels (hyperkalemia), which may cause muscle weakness, fatigue, or heart rhythm changes
– Irregular menstrual periods, spotting, or changes in cycle
Most side effects are mild, but high potassium levels and significant changes in blood pressure can be serious and require medical attention.
Aldactone is not appropriate for everyone. It should usually be avoided or used with extreme caution in people who have:
– Anuria (inability to make urine)
– Addison’s disease (adrenal insufficiency)
People taking certain medications that also increase potassium (like some other potassium-sparing diuretics or high-dose ACE inhibitors/ARBs) may not be good candidates or will need very close monitoring. Pregnant or breastfeeding women should speak with their healthcare provider about risks and alternatives.
Yes, Aldactone is widely used off-label for acne and other androgen-related skin conditions in adult women. Its anti-androgen properties help reduce oil production, acne breakouts, and excess hair growth. It is particularly effective for:
– Acne that flares before menstruation
It is not typically used for acne in men because its anti-androgen effects can cause unwanted side effects like breast enlargement, reduced libido, and sexual dysfunction.
The onset of benefit depends on the condition:
– For heart failure: improvements in symptoms and reduced hospitalizations are evaluated over weeks to months.
Consistency in taking the medication as prescribed is important for best results.
Dosage varies depending on the condition and individual factors:
– Heart failure: often 12.5–25 mg once daily, adjusted based on kidney function and potassium levels
– Primary hyperaldosteronism: can range from 100–400 mg per day for diagnosis and treatment
Your doctor will tailor the dose based on your condition, lab results, and how you respond to the medication.
Because Aldactone is a potassium-sparing diuretic, it can cause elevated potassium levels (hyperkalemia). Signs and symptoms may include:
– Tingling or numbness
– Nausea or feeling unwell without clear reason
– In severe cases, collapse or cardiac arrest
Are there any important drug interactions with Aldactone?
– ACE inhibitors (like lisinopril, enalapril) and ARBs (like losartan, valsartan): raise potassium, especially when combined
– Potassium supplements and high-potassium salt substitutes: further raise potassium levels
– Certain blood pressure medications and diuretics: may increase risk of low blood pressure or dehydration
Always tell your healthcare provider and pharmacist about all medications, supplements, and herbal products you use.
Moderate alcohol use may be permissible for some patients, but caution is advised. Alcohol can:
– Lower blood pressure further, increasing the risk of fainting
If you have liver disease, heart failure, or kidney problems, your doctor may recommend minimizing or avoiding alcohol entirely. Always follow your healthcare provider’s specific guidance.
Aldactone is generally not recommended during pregnancy because of its anti-androgen effects, which could potentially affect the developing fetus, particularly a male fetus. Women who are pregnant or planning to become pregnant should discuss alternative medications with their healthcare provider.
What should I do if I miss a dose of Aldactone?
Can Aldactone cause weight loss or weight gain?
– It may cause a decrease in weight initially by reducing excess fluid (edema). This is loss of water, not body fat.
Any sudden or significant changes in weight—especially rapid gain in people with heart failure or liver disease—should be reported to your doctor, as it may indicate fluid retention or worsening of the underlying condition.
Men can take Aldactone when medically indicated (for example, for heart failure, edema, or hyperaldosteronism). However, they have a higher likelihood of experiencing hormonal side effects such as:
– Decreased libido
These effects are dose- and duration-dependent and may not occur in all men. If these side effects become bothersome, your provider may adjust the dose or switch you to an alternative medication.
Regular monitoring is crucial to use Aldactone safely. Your healthcare provider will typically:
– Repeat blood tests 1–2 weeks after starting or changing the dose, then periodically (for example, every 3–6 months, or more often if you have kidney disease or are on interacting drugs)
– For long-term, higher-dose use (particularly in women using it for acne), periodic lab checks remain important even if you feel well
General tips include:
– Because it increases urination, many people prefer taking it in the morning to avoid nighttime bathroom trips; if prescribed twice daily, ask your doctor about timing.
– Maintain consistent dietary habits, especially regarding potassium intake, as sudden changes can affect your potassium levels.
In many cases, Aldactone can be stopped without tapering from a pharmacologic standpoint, but whether it should be stopped suddenly depends on why you are taking it. Stopping abruptly may:
– Cause blood pressure to rise again in people using it for hypertension
Any decision to stop or reduce Aldactone should be made with your healthcare provider, who can monitor your condition and adjust other therapies as needed.
Aldactone is a potassium-sparing diuretic and aldosterone antagonist, whereas furosemide is a loop diuretic. The main differences are:
– Site of action: Aldactone works on the distal nephron and blocks aldosterone; furosemide acts on the loop of Henle and is more potent for rapid fluid removal.
They are often used together in heart failure or cirrhosis to balance fluid removal and potassium levels.
Aldactone (spironolactone) and eplerenone are both aldosterone antagonists and potassium-sparing diuretics, but they differ in selectivity and side-effect profiles:
– Potency and cost: Aldactone is generally more potent per milligram and is usually much less expensive than eplerenone.
– Dosing: Eplerenone doses are typically higher (e.g., 25–50 mg twice daily) compared with Aldactone (12.5–50 mg daily) for heart failure.
Is Aldactone better than eplerenone for heart failure?
– Evidence: Both medications have strong clinical trial evidence supporting their use in reduced ejection fraction heart failure.
– Cost and accessibility: Aldactone is usually generic and cheaper, making it the initial choice in many guidelines, with eplerenone reserved for people who cannot tolerate Aldactone.
How does Aldactone differ from other potassium-sparing diuretics like amiloride and triamterene?
– Mechanism: Aldactone blocks aldosterone receptors; amiloride and triamterene block sodium channels in the distal kidney tubules without directly affecting aldosterone receptors.
– Uses: Amiloride and triamterene are commonly used in combination with thiazide diuretics to offset potassium loss. Aldactone is used for heart failure, hyperaldosteronism, cirrhosis-related edema, resistant hypertension, and hormonal conditions.
Is Aldactone more effective than amiloride for resistant hypertension?
– Aldactone directly antagonizes aldosterone, which is frequently elevated in resistant hypertension, and multiple studies show it can substantially lower blood pressure in this setting.
Some research suggests that sufficiently high doses of amiloride can approach the blood pressure–lowering effect of Aldactone, but Aldactone is generally considered the first choice for resistant hypertension unless side effects or contraindications arise.
When treating edema, loop diuretics and Aldactone play different but complementary roles:
– Potassium balance: Aldactone conserves potassium, while loop diuretics promote potassium loss; combining them can help maintain a more stable potassium level.
In practice, many patients with chronic edema due to heart failure or cirrhosis may be on both a loop diuretic and Aldactone for optimal control.
A doctor may switch from Aldactone to eplerenone for several reasons:
– Patient preference: if side effects are impacting quality of life.
However, because eplerenone is often more expensive and requires similar monitoring for kidney function and potassium, Aldactone is typically tried first.
Aldactone and thiazide diuretics both lower blood pressure and treat edema, but they differ significantly:
– Electrolytes: Thiazides can cause low potassium and low sodium; Aldactone can cause high potassium.
– Indications: Thiazides are often first-line for uncomplicated hypertension. Aldactone is used as an add-on in resistant hypertension, heart failure, and states of aldosterone excess, and for some hormonal conditions.
Is there a difference between brand-name Aldactone and generic spironolactone?
– Efficacy: For most people, generic spironolactone works just as well as brand-name Aldactone.
– Cost: Generic spironolactone is usually significantly cheaper and more widely available.
When would eplerenone be chosen instead of Aldactone for high blood pressure?
– Patients who developed gynecomastia or other hormonal side effects on Aldactone.
– Some individuals where minimizing endocrine side effects is a high priority, and insurance coverage or cost is not a major barrier.
Can Aldactone and eplerenone be used together?
– Both are aldosterone antagonists and potassium-sparing diuretics.
In rare, highly specialized circumstances, a heart failure or hypertension specialist might consider complex regimens, but for almost all patients, one aldosterone antagonist at a time is the standard approach.
