スピロノラクトン 化学特性,用途語,生産方法
外観
白色～うすい黄褐色, 結晶～粉末
溶解性
エタノール、メタノール及びアセトンに溶け、水にほとんど溶けない。
解説
7α-acetylthio-17α-hydroxy-3-oxopregn-4-ene-21-carboxylic acid γ-lactone．C24H32O4S(416.58)．17α-エチニル-5-アンドロステロン-3β,17β-ジオールを原料として，17位を不飽和ラクトンとし，還元後チオ酢酸と加熱して合成する．スピロノラクトンは，微黄色～淡黄褐色の粉末．わずかに特異な臭気があり，味はわずかに苦い．融点134～135 ℃(再固化し201～202 ℃ で分解)．ほとんどの有機溶媒に可溶，水に不溶．[α]D20"－33.5°(クロロホルム)．λmax 238 nm(ε 20200)．アルドステロンきっ抗利尿薬として用いられる．LD50 ＞ 1000 mg/kg(ラット，経口)． 森北出版「化学辞典（第2版）
用途
特に、アルドステロン分泌が異常亢進する原発性アルドステロン症では第一選択の治療薬である。
用途
スピロノラクトン (spironolactone) はカリウム保持性利尿薬（抗アルドステロン薬）のひとつ。主に心不全、肝硬変性腹水、高血圧治療薬としてフロセミドやクロロチアジドと併用される。
用途
抗アルドステロン剤です。ア
ルドステロンに拮抗し、ナトリウム排泄を促
進し、ナトリウム- カリウムイオン交感反応
抑制作用を示します。
用途
アルドステロン拮抗作用物質
です。
用途
利尿剤。副腎(ふくじん)皮質ホルモンのうちの鉱質コルチコイドであるアルドステロンの拮抗(きっこう)物質である。腎の遠位尿細管においてアルドステロンと拮抗し、ナトリウムの排泄(はいせつ)を促進し、カリウムの排泄を阻害して、利尿効果を発揮する。降圧作用も有する。チアジド系降圧利尿薬に比べカリウムの喪失が少ない。心性浮腫(ふしゅ)、腎性浮腫、肝性浮腫などの浮腫や高血圧症の治療に用いられる。微粉末とすることにより効果の増大をみる。1日50～100ミリグラムを経口投与する。［幸保文治］
効能
血圧降下薬, 利尿薬, アルドステロン拮抗薬
商品名
アルダクトン (ファイザー); スピロノラクトン (キョーリンリメディオ)
化学的特性
White to Off White Solid
使用
Spironolactone, an aldosterone-, and competitive androgen-receptor-antagonist and 5-alpharductase- inhibitor, indicated for the treatment of androgen dependent hirsutism, ideally in doses of 50 to 200 mg per day accompanying the intake of oral contraceptives with the same seven day break in between. Side effects concerning the length of the menstrual cycle, the increase of blood pressure or potassium levels may occur. Spironolactone is the number one drug in the treatment of hirsutism in the US (Farquhar et al., 2003). In other countries the prescription of spironolactone for the treatment of hirsutism may be off-label.
適応症
Spironolactone (Aldactone) is a compound originally
developed as a mineralocorticoid antagonist and is used
as a diuretic and antihypertensive agent. However, at high doses spironolactone binds to the
androgen receptor. In clinical practice it is a weak androgen
antagonist used to treat hirsutism in women by
blocking testosterone binding to androgen receptors in
hair follicles. Use of spironolactone in women for the
treatment of hirsutism or male pattern baldness can result
in elevated serum potassium levels; these levels
should be checked within 1 month of starting the medication.
定義
ChEBI: A steroid lactone that is 17alpha-pregn-4-ene-21,17-carbolactone substituted by an oxo group at position 3 and an alpha-acetylsulfanyl group at position 7.
世界保健機関（WHO）
Spironolactone, an aldosterone antagonist, has been widely used
for over 25 years in the treatment of hypertension and in the management of
refractive oedema. Evidence that long-term administration of high doses are
tumorigenic in the rat has recently led to restriction of its use by some national
regulatory authorities although the significance of this finding with respect to
clinical use is not certain. In 1987 spironolactone was transferred from the main list
to the complementary list of the WHO Model List of Essential Drugs. (See also WHO comments for canrenone and potassium canrenoate).
(Reference: (WHODI) WHO Drug Information, 2(1), , 1988)
生物学の機能
Spironolactone (Aldactone) is structurally related to
aldosterone and acts as a competitive inhibitor to prevent
the binding of aldosterone to its specific cellular binding
protein. Spironolactone thus blocks the hormone-induced
stimulation of protein synthesis necessary for Na
+ reabsorption
and K
+ secretion. Spironolactone, in the presence
of circulating aldosterone, promotes a modest increase in
Na
+ excretion associated with a decrease in K
+ elimination.
The observations that spironolactone is ineffective in
adrenalectomized patients and that the actions of
spironolactone can be reversed by raising circulating al-dosterone blood levels (surmountable antagonism) support
the conclusion that spironolactone acts by competitive
inhibition of the binding of aldosterone with receptor
sites in the target tissue. Spironolactone acts only when
mineralocorticoids are present.
一般的な説明
Spironolactone, 7α-(acetylthio)-17α-hydroxy-3-oxopregn-4-ene-3-one-21-carboxylic acidγ-lactone (Aldactone) is an aldosterone antagonist of greatmedical importance because of its diuretic activity.
危険性
Questionable carcinogen.
生物活性
Competitive mineralocorticoid (aldosterone) receptor antagonist that exhibits antihypertensive activity in vivo . Also displays antiandrogen activity and inhibits steroid hormone biosynthesis.
作用機序
Spironolactone is a potassium sparing diuretic that has a different mechanism of action
than other drugs of this class.
It is a competitive antagonist of aldosterone, and its action is most effective when the
level of circulated aldosterone in the organism is high.
薬理学
Spironolactone (Aldactone) is the only diuretic that has
been shown in a double-blind multicenter prospective
clinical trial to improve survival in CHF. The addition
of spironolactone to digitalis and an angiotensinconverting
enzyme (ACE) inhibitor significantly improved
survival among patients with chronic severe
heart failure.
Spironolactone competitively inhibits the binding of
aldosterone to cytosolic mineralocorticoid receptors in
the epithelial cells in the late distal tubule and collecting duct of the kidney. Aldosterone enhances salt and
water retention at the expense of enhanced renal K
and H excretion. Spironolactone enhances diuresis by
blocking sodium and water retention while retaining
potassium. An obvious potential side effect is hyperkalemia,
which is aggravated by the potassium-retaining
properties of the ACE inhibitors. The likely concomitant
use of the loop diuretic furosemide, which depletes
K , dictates careful monitoring of serum potassium to
avoid life-threatening rhythm disturbances.
There is also evidence for the existence of mineralocorticoid
receptors on cardiac myocytes. This raises the
intriguing possibility that spironolactone could mediate
important direct effects on the myocardium in CHF.
臨床応用
Spironolactone has been used clinically in the following
conditions:
1. Primary hyperaldosteronism. Used as an aid in
preparing patients with adrenal cortical tumors
for surgery.
2. Hypokalemia. Used in patients with low serum K
+
resulting from diuretic therapy with other agents.
Its use should be restricted to patients who are unable
to supplement their dietary K
+ intake or adequately
restrict their salt intake or who cannot
tolerate orally available KCl preparations.
3. Hypertension and congestive heart failure.
Although spironolactone may be useful in combination
with thiazides, the latter remain the
drugs of first choice. Fixed-dose combinations of
spironolactone and a particular thiazide (e.g.,
Aldactazide) generally offer no therapeutic advantage
over either component given separately
and tend to restrict the ability of the clinician to
determine the optimal dosage of each drug for a
particular patient.
4. Cirrhosis and nephrotic syndrome. Spironolactone
is a mild diuretic and may be useful in treating the
edema that occurs in these two clinical conditions,
that is, when excessive K
+ loss is to be avoided.
副作用
Serum electrolyte balance should be monitored periodically,
since potentially fatal hyperkalemia may occur,especially in patients with impaired renal function or excessive
K
+ intake (including the K
+ salts of coadministered
drugs, e.g., potassium penicillin). Spironolactone
can induce hyponatremia and in cirrhotic patients, metabolic
acidosis.A variety of gastrointestinal disturbances
may accompany spironolactone administration. These
include diarrhea, gastritis, gastric bleeding, and peptic ulcers.
Spironolactone is contraindicated in patients with
peptic ulcers. Spironolactone may also cause elevated
blood urea nitrogen, drowsiness, lethargy, ataxia, confusion,
and headache. Gynecomastia and menstrual irregularity
in males and females, respectively, can occur.
Painful gynecomastia (directly related to dosage level
and duration of therapy), which is generally reversible,
may necessitate termination of therapy. Animal studies
demonstrating tumorigenic potential support the clinical
judgment that spironolactone alone or in combination
should not be used for most patients who require diuretic
therapy and its unnecessary use should be
avoided.
安全性プロファイル
Poison by intraperitoneal route. Human reproductive effects by ingestion and possibly other routes: men, impotence and breast development; women, menstrual cycle changes or disorders, changes in the breasts and lactation. An experimental teratogen. Other experimental reproductive effects. Other human systemic effects by ingestion: agranulocytosis, kidney tubule damage, increased urine volume, and changes in blood sodium and calcium levels. Questionable carcinogen. When heated to decomposition it emits toxic fumes of SOx,. Used to treat hypertension, edema of congestive heart failure, cirrhosis, and kidney failure.
0
代謝
Spironolactone is poorly absorbed after oral administration
and has a delayed onset of action; it may take several
days until a peak effect is produced. It has a somewhat
slower onset of action than triamterene and
amiloride (discussed later), but its natriuretic effect is
modestly more pronounced, especially during long-term
therapy. Spironolactone is rapidly and extensively metabolized,
largely to the active metabolite canrenone.
Canrenone and potassium canrenoate, its K
+ salt, are
available for clinical use in some countries outside the
United States. Canrenone has a half-life of approximately
10 to 35 hours.The metabolites of spironolactone are excreted
in both the urine and feces. New selective aldosterone
receptor antagonists (SARA), such as eplerenone,
have been developed but have not yet been introduced
into clinical practice. Eplerenone and canrenone exhibit
fewer steroidlike side effects (gynecomastia, hirsutism).
スピロノラクトン 上流と下流の製品情報
原材料
準備製品