CHF and arrhythmias:
Indications for: CAROSPIR
To increase survival, manage edema, and to reduce hospitalization for heart failure (NYHA class III–IV) and reduced ejection fraction when used in addition to standard of therapy.
Adult Dosage:
Not therapeutically equivalent to Aldactone. If serum potassium ≤5.0mEq/L and eGFR >50mL/min/1.73m2: initially 20mg (4mL) once daily; may increase to 37.5mg (7.5mL) daily if tolerant. May decrease to 20mg (4mL) every other day if hyperkalemia develops. If eGFR 30–50mL/min/1.73m2: consider initiating at 10mg (2mL). If dose >100mg required, use another formulation.
Children Dosage:
Not established.
CAROSPIR Contraindications:
Hyperkalemia. Addison's disease. Concomitant eplerenone.
CAROSPIR Warnings/Precautions:
Increased hyperkalemia risk with renal impairment; monitor closely. Monitor serum potassium within 1 week of initiation or titration and periodically thereafter; reduce dose or discontinue if hyperkalemia occurs. Monitor volume status, renal function, serum electrolytes, uric acid, and blood glucose periodically. Hepatic impairment. Elderly. Pregnancy: avoid. Nursing mothers.
CAROSPIR Classification:
Diuretic (K+ sparing).
CAROSPIR Interactions:
See Contraindications. Avoid K+-sparing diuretics, K+-supplements, K+-containing salt substitutes. Hyperkalemia more likely with ACE inhibitors, ARBs, aldosterone blockers, NSAIDs, heparin, LMWH, trimethoprim. Monitor for lithium toxicity. May be antagonized by NSAIDs, acetylsalicylic acid; monitor closely. Worsening renal function with concomitant nephrotoxic drugs (eg, aminoglycosides, cisplatin, NSAIDs). Potentiates digoxin; reduce digoxin dose by ~15–30%; monitor. May potentiate CYP2C8/CYP3A substrates (eg, repaglinide, midazolam, sirolimus, tacrolimus); may need to adjust dose of substrates. Caution with cholestyramine.
Adverse Reactions:
Gynecomastia, hyperkalemia, hypotension, hyponatremia, hypomagnesemia, hypocalcemia, hypochloremic alkalosis, hypovolemia, hyperglycemia, gastritis, diarrhea, cramping, nausea, vomiting, ataxia, drowsiness, headache, rash; neurologic impairment, coma.
Drug Elimination:
Renal (primarily), bile. Half-life: ~1–2 hours.
Generic Drug Availability:
NO
How Supplied:
Susp—118mL, 473mL
Edema:
Indications for: CAROSPIR
Edema associated with hepatic cirrhosis.
Adult Dosage:
Not therapeutically equivalent to Aldactone. Cirrhosis (initiate in hospital setting and titrate slowly): initially 75mg (15mL) daily in single or divided doses. If dose >100mg required, use another formulation. As sole agent for diuresis: administer for 5 days before increasing dose to obtain desired effect.
Children Dosage:
Not established.
CAROSPIR Contraindications:
Hyperkalemia. Addison's disease. Concomitant eplerenone.
CAROSPIR Warnings/Precautions:
Increased hyperkalemia risk with renal impairment; monitor closely. Monitor serum potassium within 1 week of initiation or titration and periodically thereafter; reduce dose or discontinue if hyperkalemia occurs. Monitor volume status, renal function, serum electrolytes, uric acid, and blood glucose periodically. Hepatic impairment. Elderly. Pregnancy: avoid. Nursing mothers.
CAROSPIR Classification:
Diuretic (K+ sparing).
CAROSPIR Interactions:
See Contraindications. Avoid K+-sparing diuretics, K+-supplements, K+-containing salt substitutes. Hyperkalemia more likely with ACE inhibitors, ARBs, aldosterone blockers, NSAIDs, heparin, LMWH, trimethoprim. Monitor for lithium toxicity. May be antagonized by NSAIDs, acetylsalicylic acid; monitor closely. Worsening renal function with concomitant nephrotoxic drugs (eg, aminoglycosides, cisplatin, NSAIDs). Potentiates digoxin; reduce digoxin dose by ~15–30%; monitor. May potentiate CYP2C8/CYP3A substrates (eg, repaglinide, midazolam, sirolimus, tacrolimus); may need to adjust dose of substrates. Caution with cholestyramine.
Adverse Reactions:
Gynecomastia, hyperkalemia, hypotension, hyponatremia, hypomagnesemia, hypocalcemia, hypochloremic alkalosis, hypovolemia, hyperglycemia, gastritis, diarrhea, cramping, nausea, vomiting, ataxia, drowsiness, headache, rash; neurologic impairment, coma.
Drug Elimination:
Renal (primarily), bile. Half-life: ~1–2 hours.
Generic Drug Availability:
NO
How Supplied:
Susp—118mL, 473mL
Hypertension:
Indications for: CAROSPIR
Adjunct in hypertension.
Adult Dosage:
Not therapeutically equivalent to Aldactone. Initially 20–75mg (4–15mL) daily in single or divided doses. Titrate at 2 week intervals. If dose >100mg required, use another formulation.
Children Dosage:
Not established.
CAROSPIR Contraindications:
Hyperkalemia. Addison's disease. Concomitant eplerenone.
CAROSPIR Warnings/Precautions:
Increased hyperkalemia risk with renal impairment; monitor closely. Monitor serum potassium within 1 week of initiation or titration and periodically thereafter; reduce dose or discontinue if hyperkalemia occurs. Monitor volume status, renal function, serum electrolytes, uric acid, and blood glucose periodically. Hepatic impairment. Elderly. Pregnancy: avoid. Nursing mothers.
CAROSPIR Classification:
Diuretic (K+ sparing).
CAROSPIR Interactions:
See Contraindications. Avoid K+-sparing diuretics, K+-supplements, K+-containing salt substitutes. Hyperkalemia more likely with ACE inhibitors, ARBs, aldosterone blockers, NSAIDs, heparin, LMWH, trimethoprim. Monitor for lithium toxicity. May be antagonized by NSAIDs, acetylsalicylic acid; monitor closely. Worsening renal function with concomitant nephrotoxic drugs (eg, aminoglycosides, cisplatin, NSAIDs). Potentiates digoxin; reduce digoxin dose by ~15–30%; monitor. May potentiate CYP2C8/CYP3A substrates (eg, repaglinide, midazolam, sirolimus, tacrolimus); may need to adjust dose of substrates. Caution with cholestyramine.
Adverse Reactions:
Gynecomastia, hyperkalemia, hypotension, hyponatremia, hypomagnesemia, hypocalcemia, hypochloremic alkalosis, hypovolemia, hyperglycemia, gastritis, diarrhea, cramping, nausea, vomiting, ataxia, drowsiness, headache, rash; neurologic impairment, coma.
Drug Elimination:
Renal (primarily), bile. Half-life: ~1–2 hours.
Generic Drug Availability:
NO
How Supplied:
Susp—118mL, 473mL
