Spironolactone is considered the drug of choice for cirrhotic ascites if there is no renal failure. In 40-75% of the cases of hepatic cirrhosis with ascites, spironolactone is sufficiently effective as a diuretic in single drug therapy. For other mainfestations of secondary hyperaldosteronism (heart failure with edema) its effect is also well documented. For primary hyperaldosteronism (Conn's syndrome) it can be used for the diagnosis or (if surgery is not feasible) for long-term treatment.

Spironolactone has a similar antihypertensive action on hypertension as thiazides and it can easily be combined with the latter. (In Great Britain it is not recommended as an antihypertensive agent as tumours have been observed in animal experiments.) Further recognized indications include hypokalemia, idiopathic edema, and nephrotic syndrome.

Its use against hirsutism has yet to be documented in controlled studies. The use of spironolactone is even less established for the treatment of acne and premenstrual syndrome.

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