In the initial stage of dilated cardiomyopathy there is often a need to remove the excess fluid that has built up in the body and the fast acting diuretic drug (water tablet) furosemide is used. This, in combination with the recommended standard treatment of an ACE inhibitor and low dose beta blocker, is often effective in controlling symptoms and improving the function of the heart.

Where people continue to have symptoms spironolactone may be added as a second line of treatment.

Spironolactone is another type of diuretic drug, though it acts in a different way to furosemide and is classed as an 'aldosterone antagonist'. Aldosterone is a hormone, produced by the adrenal gland, which plays an important part in controlling the amount of sodium and water in the body. Spironolactone acts to block the effect of aldosterone. This has the effect of decreasing the amount of sodium and water which is reabsorbed resulting in it being excreted in the urine. This then reduces the blood pressure and the workload of the heart. The drug has the added factor of limiting the amount of potassium which is excreted and the term ‘potassium sparing diuretic’ is often used. The drug isn’t used where the person has known kidney disease or where they have a high potassium level in the blood.

Previous research has indicated that spironolactone, along with the standard therapy of ACE inhibitors and beta blockers, can result in reduced levels of mortality and hospitalisations. This is an area of ongoing investigation.

A common side effect of the drug is breast soreness and breast enlargement in men. More recently the drug eplerenone has been introduced. This has a similar action to spironolactone, but without these side effects.

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© Cardiomyopathy UK. April 2018.