Diuretic-Related Side Effects: Development and Treatment

Impotence and decreased libido are the more frequent sexual side effects with spironolactone. Gynecomastia, another fairly frequent complication of spironolactone therapy, may be associated with mastodynia and is typically bilateral. One study reported that 91 (13%) of 699 men prescribed spironolactone, alone or in association with another antihypertensive treatment, developed dose-related gynecomastia that was reversible. At daily doses of ≤50 mg, the incidence of gynecomastia was 6.9%; at daily doses of ≥150 mg, the incidence was 52.2%. The sexual side effects of spironolactone have been attributed to endocrine dysfunction; spironolactone is structurally similar to the sex hormones and inhibits the binding of dihydrotestosterone to androgen receptors, thus producing an increased clearance of testosterone.

Eplerenone is another aldosterone-receptor antagonist which is more selective than spironolactone and is devoid of the sexual side effects seen with spironolactone.