Aldosterone Inhibitors in Infants and Children

Adverse Effects

The most frequent adverse effects associated with aldosterone inhibitors are electrolyte imbalances, including hyponatremia, hyperkalemia, and hyperchloremic metabolic acidosis. Other less common adverse effects include: drowsiness, headache, lethargy, ataxia, rash, diarrhea, vomiting, abdominal cramps, and gastritis. Rare adverse effects reported with spironolactone include bone marrow suppression, gastrointestinal bleeding, ototoxicity, and nephrocalcinosis. The aldosterone inhibitors have also been shown to produce tumors in rats during chronic toxicity studies, but no cases of cancer have been reported in humans.[4,26]

With prolonged use of spironolactone, up to 10% of patients experience adverse effects from inhibition of testosterone and progesterone, including gynecomastia, impotence, and irregular menses or amenorrhea. These effects are related to both dose and duration of therapy and typically reverse with discontinuation.[4] Eplerenone, with its greater selectivity for aldosterone receptors, has much less potential to cause these effects, and may become the preferred agent for long-term therapy in children.

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