Potassium sparing diuretics should not be prescribed routinely but may be useful where hypokalaemia may be expected or where any degree of hypokalaemia could be hazardous (e.g. concomitant digoxin, arrhythmias).

Amiloride

• Tablets 5mg (£15.07 = 28 tablets)

Indications

• Potassium conservation when used as an adjunct to thiazide or loop diuretics

Dose

• Used alone, initially 10mg daily or 5mg twice daily, adjusted according to response; maximum 20mg daily
• With other diuretics, congestive heart failure and hypertension, initially 5–10mg daily; cirrhosis with ascites, initially 5mg daily

Aldosterone antagonists

Spironolactone

• Tablets 25mg, 50mg, 100mg (£4.81 = 100mg daily)

Indications

• Chronic heart failure
• Resistant hypertension (unlicensed indication)

Dose

• Moderate to severe heart failure (adjunct) initially 25mg once daily, increased according to response to maximum 50mg once daily
• Resistant hypertension (adjunct) 25mg once daily (unlicensed indication)

Notes

1. In severe heart failure, spironolactone added to other treatments in a low dose can reduce mortality and morbidity. Careful monitoring for hyperkalaemia and hypovolaemia is required especially for people taking other diuretics and/or ACE inhibitors.

Eplerenone

• Tablets 25mg, 50mg (£3.86 = 50mg daily)

Indications

• Heart failure developing 3-14 days post MI

Dose

• Start at 25mg daily and increase within 4 weeks according to serum potassium (see notes below)

Notes

1. Eplerenone has been shown to reduce mortality in patients developing heart failure post MI when initiated within 3-14 days. It may be initiated at a dose of 25mg provided serum potassium less than 5mmol/L and should be titrated to 50mg within 4 weeks unless serum potassium exceeds 5mmol/L. If the serum potassium exceeds 5.5mmol//L, the dose should be reduced or withheld (consult product literature).

Finerenone

• Tablets 10mg, 20mg

​Notes​

1. NICE TA877: Finerenone (​Kerendia​) ​is recommended​ as an option for treating stage 3 and 4 chronic kidney disease (with albuminuria) associated with type 2 diabetes in adults (March 2023), only if:
1. it is an add-on to optimised standard care; this should include, unless they are unsuitable, the highest tolerated licensed dose of:
1. angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) ​and​
2. sodium-glucose cotransporter-2 (SGLT2) inhibitors ​and​
2. the person has an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73m²​ or more.