I spent 2 years on Spironolactone to combat severe ascites and pulmonary effusion caused by constrictive pericarditis, prior to having a complete pericardiectomy.
It worked.
I was in a parlous state prior and may well not have survived without it. Which is a big plus.
However the side effects were significant. I was not appraised of them at any time.
Subsequently my endogenous test levels tanked completely. I managed to avoid gynocemastia.
My Cardiologist point blank denied that it had an anti androgen effect. It was only by chance from a trans friend that I learned of this aspect.
Among the Trans community it has a very bad reputation.
I was also (and remain) on digoxin and the interaction of the two was sub optimal.
I have kept several of my prior to 2019 med books because of the corruption of drug research and manipulation of data….the grossest seen with COVID vac and the vicious lethal degrading of HCQ and ivermectin. I trust much of the older drugs that we know much much more than what are now very expensive drugs…just look at many of the new anti -cancer drugs and the still limited success…huge costs. My late wife of 40+ yrs was places on 3 separate new drugs with zero benefit yet only a benefit from an old standard employed too late after extensive mets…I suspect she was but a lab rat experiment after FDA approval. I do not trust any of these “new” drugs approved by THIS FDA… they have zero credibility.
I agree with trial results. Who sponsored the trial. I am sure many more inexpensive molecules can get amazing results, if tested in RCTs. Colchicine is another good example.
Has anyone had a study on the impact of spironolactone on individuals with Prostate Cancer due to its anti androgen effect ? Could it have any synergistic effect with lupron or casodex . Any additional impact ?
“Minimum effective dose” - General question (from a layperson trying to advocate for my husband) - he can barely tolerate any cardiac drugs and I have been trying to find information about “Minimum effective dose”, does anyone have any suggestions or pointers please?
So for example Eplerenone, what might the minimum dose be that would still provide a (any) level of benefit?
Or for say Dapagliflozin?
Instinctively with regards to processes like metabolism changing as we get older I just feel even a lower dose might provide benefit compared to the “one size fits all” dosages pushed?!?
I was a fellow when this trial came out. I’ve been a believer ever since. However, it is interesting to note that the trial was stopped early, and how that might exaggerate the “true” effect size.
Darn. It prevents death from arrhythmias - exactly how I want to die if I have heart failure. I'm not taking beta blockers, because they prevent sudden death, now it looks like spironolactone is another drug keeping me from a quick end.
If you look at the side effects of metoprolol and spironolactone as reported to the FDA (see, for example, rxisk.com), you'll see that the side effects of both can result in death. At it's not a rare occurrence. Plus the other side effects are awful. So I decided years ago I can't take beta or calcium channel blockers or any of the other toxic solutions out there.
Zade -- when death is the primary endpoint of a trial, if the drug caused death, you'd likely see that in the results. Instead, in this population of HF patients, the death rate was a lot lower on the drug.
So that applies to the type of patient you're describing in this article, but for those whose hearts are less injured, the harm done by the med is not insignificant.
I am very liberal with spironolactone in treating hypertension and oedema, specially in overweight patients, the fibrosis hypothesis is disease modifying like statins in atherosclerosis. Both cheap and well studied medications with robust data.
I apologize for using the word “plants” rather than herbs, medicinal herbs, or medicinal foods. For instance, dandelion roots are a great diuretic, and as far as I know, any side effects would be mild if there were any. Reactions to medicinal herbs don’t include “total mortality” as do some of the side effects listed on pharmaceutical drugs. My question was, and still is, are there any medicinal herbs that offer similar benefits to this drug without all the side effects?
Well, I'm thinking of the time I tried valerian for sleep and not just the plant, it was the extract. It gave me insomnia. And isn't black cohosh known to cause kidney injury in some? Cinnamon ( not so much the Ceylonese stuff but the more common variety) can also damage the kidneys. I do use lemon balm tea for sleep (I grow my own). So far no ill effects.
Believe me, if I can find an herbal remedy I'm going to use it but with the awareness that these are complex sources and can injure.
My interest in herbs is fairly new, but it has intensified during the last four years. I’m still, and probably always will be, learning. Last night, I mentioned to my daughter the reply I wrote to you. She knows more about herbs than I do, and she said something very similar to what you just wrote in your latest reply. She added that when trying a new herb, first of all I should be 100% sure I have correctly identified the herb, find out everything I can that is already published about it, and then, use just a little, at first, to see if I have any adverse reaction.
I grow lemon balm, too, as well as lavender. I would like to grow marshmallow, also, but right now, I buy marshmallow root and add it to the lemon balm and lavender that I have harvested and dried to make a tea for sleep. The combination of the three works great. Recognizing that there are plants right in my own yard that deliver health benefits has been exhilarating. My favorite is the common dandelion. I use the flowers, leaves, and roots. I also enjoy the benefits from pine needles, rose hips, horseradish leaves, willow bark, cone flowers (echinacea), and I have read cattails are good, too, although I haven’t used them, yet. I have also have been enjoying the tinctures I have made from Rosemary, valerian (you mentioned using), and several others.
Thank you for your comments and input. In general, I believe herbs are underutilized and much safer than pharmaceutical drugs. For several years, I have not used any prescription drugs or over the counter drugs, either, and I am very happy about that!
I'm allergic to guaifenesin, had an anaphylactic reaction to it one night. Before I discovered N-acetylcysteine is a very good expectorant, I actually harvested leaves of the long-leafed plantain (plantago lanceolata) that's all over the place in my neighborhood. I made a tea of them. It seemed to loosen phlegm, just not quite as effectively as NAC 500 mg I use.
It's great that you're so open minded. I don't have many friends who understand my experimenting with herbs.
By the way, in reference to what I just posted, I have absolutely no medical training, I certainly am NOT a doctor, and I am not giving medical advice. I think it’s a little like taking some chicken soup to a friend who has a cold in hopes that they might feel better. I do have a curiosity about why herbs are so demonized, though, and I have a growing love for the complexity and benefits I’ve found in the herbs I’ve come to know and use.
Your friends don’t know what they’re missing. I have such a sense of freedom and empowerment when I know I can care for myself in non life threatening situations which, thankfully, most ailments are.
Phlegm- I immediately thought of ginger tea or garlic in honey, among others. Then I searched for what herbs help with phlegm, and many sites popped up. One said tea made with thyme or peppermint helps. I grow both of those, so good to know! My favorite, though, is to take a piece of ginger root, mince it up, pour hot water over it, add a little honey, and sip it slowly. I also breathe in the steam coming out of the cup by putting my hands around the top of the cup and resting my face in my hands. I do that until it’s cooled enough to sip. I’d love it if it would work for you instead of having to rely on a pharmaceutical drug.
Great question! I have attempted to look into this (not much luck yet) as my husband doesn’t tolerate prescription drugs well at all although I appreciate “taming” this cascade could be beneficial.
I find spironolactone in general is not appropriately loved. I use it for blood pressure control and in part because there is a lot of undiagnosed hyperaldo out there, it is very effective.
My one question about this study: I was surprised at the large increase in non-cardiovascular cause death in the placebo group. Any thoughts on this?
Love your approach to therapy studies! This one really became a classic though its importance didn’t click with me (retired ER doc) when it first came out. One of these days do a diagnosis study for general docs. Eg high sensitivity troponin, if you haven’t already.
Rales and Cast, Cardiology is probably the leader in well done courageous RCT despite the complex cases.
I spent 2 years on Spironolactone to combat severe ascites and pulmonary effusion caused by constrictive pericarditis, prior to having a complete pericardiectomy.
It worked.
I was in a parlous state prior and may well not have survived without it. Which is a big plus.
However the side effects were significant. I was not appraised of them at any time.
Subsequently my endogenous test levels tanked completely. I managed to avoid gynocemastia.
My Cardiologist point blank denied that it had an anti androgen effect. It was only by chance from a trans friend that I learned of this aspect.
Among the Trans community it has a very bad reputation.
I was also (and remain) on digoxin and the interaction of the two was sub optimal.
I have kept several of my prior to 2019 med books because of the corruption of drug research and manipulation of data….the grossest seen with COVID vac and the vicious lethal degrading of HCQ and ivermectin. I trust much of the older drugs that we know much much more than what are now very expensive drugs…just look at many of the new anti -cancer drugs and the still limited success…huge costs. My late wife of 40+ yrs was places on 3 separate new drugs with zero benefit yet only a benefit from an old standard employed too late after extensive mets…I suspect she was but a lab rat experiment after FDA approval. I do not trust any of these “new” drugs approved by THIS FDA… they have zero credibility.
I might be calculating this incorrectly, but isn't the relative risk reduction 23%?
1 - (35/46) = 0.23
or
(46-35)/46 = 0.23
Wonderful example of an effective and inexpensive intervention is sick subjects.
What’s the rational role of digoxin therapy in CHFrEF?
And the evidence on spironolactone in combinations with the drugs that have flooded the CHF market over the last decade?
I agree with trial results. Who sponsored the trial. I am sure many more inexpensive molecules can get amazing results, if tested in RCTs. Colchicine is another good example.
Has anyone had a study on the impact of spironolactone on individuals with Prostate Cancer due to its anti androgen effect ? Could it have any synergistic effect with lupron or casodex . Any additional impact ?
Gerald M Casey MD
“Minimum effective dose” - General question (from a layperson trying to advocate for my husband) - he can barely tolerate any cardiac drugs and I have been trying to find information about “Minimum effective dose”, does anyone have any suggestions or pointers please?
So for example Eplerenone, what might the minimum dose be that would still provide a (any) level of benefit?
Or for say Dapagliflozin?
Instinctively with regards to processes like metabolism changing as we get older I just feel even a lower dose might provide benefit compared to the “one size fits all” dosages pushed?!?
I was a fellow when this trial came out. I’ve been a believer ever since. However, it is interesting to note that the trial was stopped early, and how that might exaggerate the “true” effect size.
Darn. It prevents death from arrhythmias - exactly how I want to die if I have heart failure. I'm not taking beta blockers, because they prevent sudden death, now it looks like spironolactone is another drug keeping me from a quick end.
If you look at the side effects of metoprolol and spironolactone as reported to the FDA (see, for example, rxisk.com), you'll see that the side effects of both can result in death. At it's not a rare occurrence. Plus the other side effects are awful. So I decided years ago I can't take beta or calcium channel blockers or any of the other toxic solutions out there.
Zade -- when death is the primary endpoint of a trial, if the drug caused death, you'd likely see that in the results. Instead, in this population of HF patients, the death rate was a lot lower on the drug.
So that applies to the type of patient you're describing in this article, but for those whose hearts are less injured, the harm done by the med is not insignificant.
I am very liberal with spironolactone in treating hypertension and oedema, specially in overweight patients, the fibrosis hypothesis is disease modifying like statins in atherosclerosis. Both cheap and well studied medications with robust data.
This drug has a significant list of side effects. Does anyone know if there are any plants that offer similar benefits?
Plants can have some bad side effects as well.
I apologize for using the word “plants” rather than herbs, medicinal herbs, or medicinal foods. For instance, dandelion roots are a great diuretic, and as far as I know, any side effects would be mild if there were any. Reactions to medicinal herbs don’t include “total mortality” as do some of the side effects listed on pharmaceutical drugs. My question was, and still is, are there any medicinal herbs that offer similar benefits to this drug without all the side effects?
Isn't digitalis from foxglove?
Well, I'm thinking of the time I tried valerian for sleep and not just the plant, it was the extract. It gave me insomnia. And isn't black cohosh known to cause kidney injury in some? Cinnamon ( not so much the Ceylonese stuff but the more common variety) can also damage the kidneys. I do use lemon balm tea for sleep (I grow my own). So far no ill effects.
Believe me, if I can find an herbal remedy I'm going to use it but with the awareness that these are complex sources and can injure.
My interest in herbs is fairly new, but it has intensified during the last four years. I’m still, and probably always will be, learning. Last night, I mentioned to my daughter the reply I wrote to you. She knows more about herbs than I do, and she said something very similar to what you just wrote in your latest reply. She added that when trying a new herb, first of all I should be 100% sure I have correctly identified the herb, find out everything I can that is already published about it, and then, use just a little, at first, to see if I have any adverse reaction.
I grow lemon balm, too, as well as lavender. I would like to grow marshmallow, also, but right now, I buy marshmallow root and add it to the lemon balm and lavender that I have harvested and dried to make a tea for sleep. The combination of the three works great. Recognizing that there are plants right in my own yard that deliver health benefits has been exhilarating. My favorite is the common dandelion. I use the flowers, leaves, and roots. I also enjoy the benefits from pine needles, rose hips, horseradish leaves, willow bark, cone flowers (echinacea), and I have read cattails are good, too, although I haven’t used them, yet. I have also have been enjoying the tinctures I have made from Rosemary, valerian (you mentioned using), and several others.
Thank you for your comments and input. In general, I believe herbs are underutilized and much safer than pharmaceutical drugs. For several years, I have not used any prescription drugs or over the counter drugs, either, and I am very happy about that!
I'm allergic to guaifenesin, had an anaphylactic reaction to it one night. Before I discovered N-acetylcysteine is a very good expectorant, I actually harvested leaves of the long-leafed plantain (plantago lanceolata) that's all over the place in my neighborhood. I made a tea of them. It seemed to loosen phlegm, just not quite as effectively as NAC 500 mg I use.
It's great that you're so open minded. I don't have many friends who understand my experimenting with herbs.
By the way, in reference to what I just posted, I have absolutely no medical training, I certainly am NOT a doctor, and I am not giving medical advice. I think it’s a little like taking some chicken soup to a friend who has a cold in hopes that they might feel better. I do have a curiosity about why herbs are so demonized, though, and I have a growing love for the complexity and benefits I’ve found in the herbs I’ve come to know and use.
Your friends don’t know what they’re missing. I have such a sense of freedom and empowerment when I know I can care for myself in non life threatening situations which, thankfully, most ailments are.
Phlegm- I immediately thought of ginger tea or garlic in honey, among others. Then I searched for what herbs help with phlegm, and many sites popped up. One said tea made with thyme or peppermint helps. I grow both of those, so good to know! My favorite, though, is to take a piece of ginger root, mince it up, pour hot water over it, add a little honey, and sip it slowly. I also breathe in the steam coming out of the cup by putting my hands around the top of the cup and resting my face in my hands. I do that until it’s cooled enough to sip. I’d love it if it would work for you instead of having to rely on a pharmaceutical drug.
Great question! I have attempted to look into this (not much luck yet) as my husband doesn’t tolerate prescription drugs well at all although I appreciate “taming” this cascade could be beneficial.
I bet a large fraction of heart failure patients are still not on. It
I find spironolactone in general is not appropriately loved. I use it for blood pressure control and in part because there is a lot of undiagnosed hyperaldo out there, it is very effective.
My one question about this study: I was surprised at the large increase in non-cardiovascular cause death in the placebo group. Any thoughts on this?
Love your approach to therapy studies! This one really became a classic though its importance didn’t click with me (retired ER doc) when it first came out. One of these days do a diagnosis study for general docs. Eg high sensitivity troponin, if you haven’t already.