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Utility of Fourier transform-Raman and Fourier transform-infrared diffuse reflectance spectroscopy for differentiation of polymorphic spironolactone samples.

Thirteen bulk pharmaceutical preparations of spironolactone were examined by Fourier transform (FT)-Raman spectroscopy and by diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS) for residual solvents (including the hydrolysis product, thioacetic acid), the presence of enolic tautomeric forms, and evidence for different polymorphic forms. One sample (L) only was found to contain solvent residue (benzene). No evidence for the possible existence of enolic tautomers in the solid state was found. From these specimens, four different representative polymorphic samples (A, B, C, and D) were selected on the basis of their DRIFTS patterns in the 3600-3200-cm-1 region. Samples K and L were considered to represent mixtures of two or more of the above representative types. Similar differentiation of the samples was made on the basis of their Raman spectra over the frequency range 1800-400 cm-1. The various fundamental stretching frequencies for the C = O and C = C bonds have been assigned, and these assignments, in turn, were used to account for all the bands in the 3600-3200-cm-1 region as overtone and combination frequencies of the fundamentals. The Raman lines at 637 and 655 cm-1 were assigned to the two C-S stretching modes of the thioacetyl moiety.

Chemistry, Pharmaceutical↗

The effect of spironolactone treatment on the cytochrome P450-mediated metabolism of the pyrrolizidine alkaloid senecionine by hepatic microsomes from rats and guinea pigs.

Spironolactone (SPL), a known inducer of cytochrome P4503A, was injected into rats and guinea pigs in order to investigate species differences in pyrrolizidine alkaloid (PA) metabolism. Liver microsomes from treated male rats showed an increased (+/-)-6,7-dihydro-7-hydroxy-1-hydroxymethyl-5H-pyrrolizine (DHP) formation of 47% from the PA senecionine, coincident with the induction of P4503A1, whereas senecionine N-oxidation was decreased by 49%, probably due to a reduction in hepatic P4502C11 concentrations. By contrast, liver microsomes from SPL-treated female rats exhibited almost a 500% increase in both DHP and senecionine N-oxide production, coincident with the marked induction of P4503A1. In guinea pigs of both sexes, oral treatment with SPL caused an approximately 50% increased formation of both DHP and senecionine N-oxide by liver microsomes. Only a slight increase in hepatic concentrations of P4503A1 occurred in the treated guinea pigs. SPL treatment increased testosterone 16 beta-hydroxylase activity by 100% in both sexes of guinea pigs. Use of the P4503A1 specific inhibitor triacetyloleandomycin showed that the P4503A sub-family played an important role in senecionine bioactivation in untreated or SPL-treated rats but not in both untreated and SPL-treated guinea pigs. This study demonstrated that P4503A was not the major enzyme for senecionine metabolism in guinea pigs.

Animals↗

Difference in metabolic profile of potassium canrenoate and spironolactone in the rat: mutagenic metabolites unique to potassium canrenoate.

The metabolic fates of potassium canrenoate (PC) and spironolactone (SP) were compared for the rat in vivo and in vitro. Approximately 18% of an in vivo dose of SP was metabolized to canrenone (CAN) and related compounds in the rat. In vitro, 20-30% of SP was dethioacetylated to CAN and its metabolites by rat liver 9000 g supernatant (S9). Thus, the major route of SP metabolism is via pathways that retain the sulfur moiety in the molecule. PC was metabolized by rat hepatic S9 to 6 alpha, 7 alpha- and 6 beta, 7 beta-epoxy-CAN. The beta-epoxide was further metabolized to its 3 alpha- and 3 beta-hydroxy derivatives as well as its glutathione (GSH) conjugate. Both 3 alpha- and 3 beta-hydroxy-6 beta, 7 beta-epoxy-CAN were shown to be direct acting mutagens in the mouse lymphoma assay, whereas 6 alpha, 7 alpha- and 6 beta, 7 beta-epoxy-CAN were not. These mutagenic metabolites, their precursor epoxides and their GSH conjugates were not formed from SP under identical conditions. The above findings appear to be due to inhibition of metabolism of CAN formed from SP by SP and/or its S-containing metabolites, since the in vitro metabolism of PC by rat hepatic microsomes was appreciably reduced in the presence of SP. The hypothesized mechanism(s) for this inhibition is that SP and its S-containing metabolites specifically inhibit an isozyme of hepatic cytochrome P-450 or SP is a preferred substrate over PC/CAN for the metabolizing enzymes. Absence of the CAN epoxide pathway in the metabolism of SP provides a possible explanation for the observed differences in the toxicological profiles of the two compounds.

Animals↗

The influence of unithiol and spironolactone on the biliary excretion of 203Hg in rat.

Rats with cannulated bile ducts were intravenously given 203HgCl2 in the dose of 120 microgram of Hg2+ per rat. Intramuscular administration of Unithiol (sodium 2,3-dimercaptopropanosulphonate) 4 and 7 h after 203Hg injection markedly increased both biliary and urinary excretion of 203Hg. In rats with Spironolactone (17-Hydroxy-7alpha-mercapto-3-oxo-17alpha-pregn-4-ene-21-carboxylic acid, gamma-lactone, acetate) pretreatment the effect of Unithiol on the biliary excretion of 203Hg was enhanced. Urinary excretion of mercury was lowest in comparison with Unithiol treated group.

Animals↗

Pharmacokinetics of canrenone after oral administration of spironolactone and intravenous injection of canrenoate-K in healthy man.

Five healthy male volunteers received canrenoate-K 200 mg (Sincomen pro injectione) by intravenous injection and one week later spironolactone 200 mg (Sincomen-100) orally. Plasma levels and urinary excretion of unchanged canrenone were determined up to 24 h by a specific HPLC method. Following intravenous administration, the maximum plasma level of 2066 +/- 876 ng/ml was found after 29 +/- 15 min and thereafter the concentration declined with a half-life of 3.7 +/- 1.2 h. Total clearance was 4.2 +/- 1.7 ml/min . kg. After oral ingestion, the maximum concentration of 177 +/- 33 ng/ml was observed at 4.4 +/- 0.9 h. The absolute bioavailability of canrenone was 25 +/- 9%. Within 24 h, respectively 0.4 and 0.6 mg, canrenone were excreted by the kidney after intravenous and oral administration. The half-life of elimination was 4.9 +/- 1.8 h (i.v.) and 3.9 +/- 1.2 h (p.o.).

Administration, Oral↗

Comparison of plasma levels of canrenone and metabolites after base hydrolysis in young and elderly subjects following single and multiple doses of spironolactone.

Plasma levels of canrenone and 'total metabolites' after base hydrolysis were compared in young and elderly subjects following single and multiple doses of spironolactone. After the initial dose on Day 1, plasma levels of canrenone and 'total metabolites' were higher in the young than in the elderly group, and significant differences were found between the two age groups in the AUC for both canrenone and 'total metabolites'. However, these differences between the two age groups diminished after multiple dosing on Day 8, and the steady state pre-dose plasma levels of canrenone and 'total metabolites' were significantly higher in the elderly subjects. The accumulation ratios of canrenone and 'total metabolites' were significantly higher in the elderly than in the young subjects. Both canrenone and canrenoic acid were extensively bound to plasma protein, but no differences were found between the two age groups in protein binding. Observed differences in plasma levels after single and multiple dosing between young and old subjects may be consequences of many factors such as a proportionate shift in metabolism with age; impaired oral absorption of the parent compound; and/or altered volume of distribution of the drug.

Adult↗

Spironolactone antagonism of aldosterone action on Na+ transport and RNA metabolism in toad bladder epithelium.

In earlier studies, aldosterone increased the incorporation of precursors into a class of cytoplasmic RNA with the characteristics of messenger RNA (mRNA), in toad bladder epithelium. In the present studies, this effect was analyzed further with a competitive antagonist, spironolactone (SC-9420). Paired hemibladders were labeled with 3H-uridine (30 min pulse - 140 min chase), with or without aldosterone (3.5 x 10(-8) M, 7 X 10(-8) M) in the presence or absence of SC-9420 (7 X 10(-6) M, 2.5 X 10(-5) M) at molar ratios of 200:1 to 280:1. Cytoplasmic RNA, either the total phenol-SDS extract or polyadenylated-RNA (poly(A)(+)-RNA) obtained by oligo-deoxythymidylate-cellulose (oligo(dT)-cellulose) chromatography was analyzed in linear 5 -- 20% sucrose gradients. Eight sets of experiments were completed in which the short-circuit current (scc) was monitored for 180 min and the incorporation of 3H-uridine (30 min pulse -- 150 min chase) was simultaneously determined on pools of epithelia from 5 to 10 hemibladders. The fractional change in scc correlated linearly with the fractional change in 3H-uridine of 12S cytoplasmic RNA (r=0.95, p less than 0.001). The poly(A)(+)-RNA fraction had no detectable rRNA or tRNA and gave a heterogeneous pattern, typical of mRNA, in the sucrose gradients. In the presence of exogenous aldosterone, SC-9420 inhibited the incorporation of 3H-uridine into poly(A)(+)-RNA (particularly 12S). These results support the inference that induction of mRNA mediates the action of aldosterone on Na+ transport.

Aldosterone↗

Effect of spironolactone on p-nitrophenol glucuronidation in isolated rat hepatocytes.

The effect of spironolactone (SP) on p-nitrophenol (PNP) glucuronidation was studied in isolated rat hepatocytes with appropriate viability conditions. A significant increase of protein concentration and PNP glucuronidation was found in the hepatocytes from SP-treated rats. Increased enzyme activity apparently was related to the SP dose. The results favor the conclusion that SP may induce PNP glucuronidation in the hepatocyte.

Animals↗

Aminoglutethimide but not spironolactone enhances the anticonvulsant effect of some antiepileptics against amygdala-kindled seizures in rats.

Aminoglutethimide (AGLD, an inhibitor of adrenal steroid synthesis) up to 5 mg/kg and spironolactone (SPIR, a mineralocorticosteroid antagonist and a weak antiandrogen) up to 50 mg/kg did not affect any seizure parameter in amygdala-kindled rats. AGLD (10 mg/kg) significantly reduced seizure activity in rats of both gender. The combination of AGLD (5 mg/kg) with phenobarbital (PB, applied at its subeffective dose of 15 mg/kg) significantly shortened motor seizure and afterdischarge duration in amygdala-kindled seizures. The combined treatment of AGLD (5 mg/kg) and clonazepam (CLO) at its subeffective dose of 0.01 mg/kg caused significant reduction of the seizure severity, seizure duration and afterdischarge duration. Finally, AGLD (5 mg/kg) proved ineffective upon the action of valproate (VPA) in this model of epilepsy. In contrast to AGLD, SPIR (50 mg/kg) did not affect the action of PB, CLO or VPA against kindled seizures in rats. AGLD did not alter the free plasma levels and brain concentration of PB or CLO, so a pharmacokinetic interaction does not seem probable. Among a variety of chemoconvulsants, bicuculline and N-methyl-D-aspartic acid reversed the effects of AGLD/PB and AGLD/CLO combinations. Aminophylline, kainic acid, strychnine and the glucocorticosteroid (hydrocortisone) were ineffective in this respect. Our data confirm the hypothesis that AGLD-mediated events may play a role in seizure activity and can affect the anticonvulsant activity of some conventional antiepileptic drugs against kindled seizures. Moreover, extrapolation of obtained results to clinical practice may indicate that patients with complex partial seizures may be safely co-medicated with AGLD or SPIR without the risk of worsening of seizure control.

Adrenergic Agents↗

Spironolactone induces apoptosis in human mononuclear cells. Association between apoptosis and cytokine suppression.

Spironolactone (SPIR) has been described to suppress accumulation of pro-inflammatory cytokines. Here, the suppression of TNF-alpha in lipopolysaccharide (LPS)-stimulated mononuclear cell cultures was confirmed. However, SPIR was also found to induce apoptosis, prompting the investigations of a possible association between the two effects: The apoptosis-inducing and the cytokine-suppressive effects of SPIR correlated with regard to the effective concentration range. Also, pre-incubation experiments demonstrated a temporal separation of the two effects of < or = 4 h, with TNF-alpha suppression preceding apoptosis. An association between the two effects was also seen when testing several SPIR analogues. Contrary to TNF-alpha, the levels of IL-1beta increased in SPIR-treated cultures. However, the amount of IL-1beta in the supernatants depended upon the order of SPIR and LPS addition, as IL-1beta was non-detectable in cultures treated with SPIR prior to LPS, whereas elevated IL-1beta levels were seen when SPIR was added after LPS-stimulation. It is possible that the extracellular accumulation of IL-1beta is due to an increased release of already produced IL-1beta as a result of cell death. In conclusion, suppression of cytokine production by SPIR may be associated with its apoptotic potential, either directly (apoptosis is a consequence of suppressed cytokine production, or vice-versa) or indirectly (suppressed cytokine production and apoptosis are parallel but otherwise unrelated phenomena).

Apoptosis↗

Beta-blockers and spironolactone in heart failure.

Neurohormonal antagonism is now recognized as an essential treatment modality for heart failure. As a prime example, the benefits of blocking the renin-angiotensin system with angiotensin converting enzyme inhibitors are clearly established for all four New York Heart Association classes. In this clinical trials review, we discuss two other therapies with neurohormonal targets: beta-blockers and the sympathetic nervous system, and the aldosterone antagonist spironolactone.

Adrenergic beta-Antagonists↗

Clinical update: spironolactone and altizide as monotherapy in systemic hypertension.

A large-scale, open, nonrandomized, multicenter, 90-day study of the safety and efficacy of a thiazide diuretic and aldosterone antagonist combination (Aldactazine, 25 mg spironolactone and 15 mg altizide, 1/day) as monotherapy was performed in 946 patients with mild to moderate hypertension (diastolic blood pressure [BP] between 90 and 120 mm Hg). Adverse effects were assessed, and body weight, heart rate, serum potassium, creatinine and uric acid measurements were monitored. On day 45 of the study, BP was normalized (diastolic BP less than or equal to 90 mm Hg) in 72% of the patients. The dose was increased to 2 tablets per day in the patients whose BP did not reach normal levels. By the end of the study, BP was controlled in 83% of the patients. No significant changes were noted in body weight, heart rate or laboratory values; however, treatment had to be discontinued in 6 patients because of hypokalemia (n = 4) or elevated serum creatinine levels (n = 2). Serum uric acid levels were increased in 5.5% of patients. The rate of adverse effects, as reported by the patients, was low (5%). Thus, this study demonstrates that diuretics, especially the combination of a thiazide diuretic and aldosterone antagonist, remain a safe, effective and economical therapy for patients with mild to moderate hypertension.

Adolescent↗

Spironolactone and altizide in systemic hypertension: ambulatory multicenter study.

A multicenter study was performed in 919 hypertensive patients, 780 of whom could be evaluated. Patients in group I (n = 482) were treated with Aldactazine alone (altizide + spironolactone, 2 tablets per day). The other 298 patients (group II) were treated with 1 or 2 tablets per day of Aldactazine plus a conventional antihypertensive agent, e.g., a beta blocker, alpha-methyldopa or clonidine. After 45 days of treatment with Aldactazine alone, mean systolic and diastolic blood pressure (BP) decreased by 15 and 14%, respectively, vs baseline values. The addition of the other antihypertensive agent decreased BP further; however, the best results were obtained with the combination of Aldactazine and clonidine. With this combination, systolic and diastolic BP decreased by 16.6 and 18%, respectively, vs baseline. In terms of adverse effects, a few cases of gastrointestinal disturbances and orthostatic hypotension were reported.

Adrenergic beta-Antagonists↗

Spironolactone and altizide versus converting enzyme inhibitor (enalapril).

The safety and antihypertensive effectiveness of a fixed-dose combination form of spironolactone + altizide (S/A) were compared with those of enalapril, an angiotensin-converting enzyme inhibitor in a randomized, double-blind, parallel-group study of 186 patients with moderate essential hypertension. The 2 treatment groups were comparable in terms of age, gender, duration and severity of hypertension, diastolic blood pressure (BP), serum potassium and creatinine, and 24-hour urinary sodium excretion after a 4-week washout phase. After 8 weeks of treatment, both S/A and enalapril decreased BP significantly and to about the same extent. Enalapril, however, was more effective in decreasing supine diastolic BP in patients younger than age 50, whereas S/A yielded better results in those older than 50. Laboratory values were similar after both drugs were administered, and there were no clinically significant changes. The study demonstrated that S/A safely reduces elevated BP, particularly in older patients.

Adult↗

Inactivation of rat hepatic cytochrome P-450 by spironolactone.

Administration of antimineralocorticoid spironolactone (SPL) to rats results in modest destruction of hepatic cytochrome P-450 with parallel loss of heme. This process is accentuated by pretreatment with dexamethasone (DEX), an inducer of cytochrome P-450p and is associated with marked functional loss of cytochrome P-450p-dependent hydroxylases. Cytochrome P-450 destruction may be replicated in vitro when microsomes from DEX-pretreated rats are incubated with SPL and NADPH and is impaired when these rats are given triacetyloleandomycin, an inhibitor of cytochrome P-450p. In vitro SPL-mediated cytochrome P-450 destruction is accompanied by a loss of heme, which appears to be converted to reactive intermediates which covalently bind to microsomes or are converted to polar metabolites.

Animals↗

Effect of spironolactone on bilirubin metabolism in rat liver and small intestinal mucosa.

In vitro and in vivo experimental models were designed for the study of the effect of spironolactone (SP) on bilirubin metabolism in rat liver and small intestinal mucosa. In vitro studies included uptake of bilirubin by liver slices and intestinal sheets, determination of glucuronyltransferase activity in mucosal homogenates, and the handling of bilirubin by the isolated perfused liver after bilirubin overload. In vitro studies were carried out to measure the plasma disappearance rate of bilirubin and to determine the extent of bilirubin conjugation and biliary excretion of the pigment infused intravenously. The results obtained suggested that the mechanisms involved in the uptake of bilirubin by tissues were not influenced by SP pretreatment. Glucuronyltransferase activity in the small intestinal mucosa was significantly induced by SP, as previously observed in rat liver. Isolated perfused livers from SP-treated rats, as well as treated living rats, exhibited a greater than normal capacity for bilirubin excretion into bile at the expense of bilirubin diglucuronide. Conjugated bilirubin in the small intestinal mucosa of rats infused with unconjugated pigment was also increased after SP pretreatment. The results favoured the conclusion that SP is an inducer of bilirubin conjugation in the livers as well as in extrahepatic tissues, such as the small intestinal mucosa.

Animals↗

Formation of bilirubin monoglucuronide and diglucuronide in isolated rat hepatocytes. Effect of spironolactone.

The formation of bilirubin monoglucuronide (BMG) and diglucuronide (BDG) was studied in isolated rat hepatocytes with appropriate viability. Isolated cells were obtained from normal rats and from rats pretreated with spironolactone (SP). A fixed number of cells (4.8 X 10(6)) was incubated in a medium containing uridine diphosphoglucuronic acid (UDPGA, 3.4 mM) and bilirubin (11.3 microM, 29 microM, 50 microM and 81 microM) for different time intervals (from 0 to 25 min). The pellet of cells and the supernatant fraction were subjected to alkaline methanolysis, and the proportions of BMG and BDG were estimated by thin-layer chromatography. No conjugates were detected at time O or in the absence of UDPGA in the incubation system. BMG and BDG were detected after 2 min of incubation and then they increased up to 15 min of incubation. Both conjugates were mostly found in the supernatant fraction, and a predominance of BMG was apparent. Normal cells also synthesized increasing amounts of BMG and BDG with the increase of bilirubin substrate concentration up to 50 microM. When hepatocytes from SP-treated rats were used, a more rapid rate of glucuronidation, that was mainly produced at the expense of BMG found in the supernatant fraction, was clear. The results probably indicate that enzymic conversion of BMG to BDG may be rate limiting in isolated hepatocytes although other possible mechanisms were not excluded.

Animals↗