I am have now got very tender breast and had checked by my gp. He confirmed the enlargement (not massive so far) and informed me it's one of the side effects of spironolactone buy could also be caused due to cirrhosis itself. He couldn't direct me to reduce or stop the medication but to wait.for my next liver clinic and discuss with them. My questions are.
Is there another medicine I could take that doesn't have this side effect.
Or is there another drug I could take along side ro stop the side effect.
Will this simply stop as the body gets used to it
If the ascites becomes under control, can I stop the medicine
Thank you
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Male47
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I had a similar side-effect from using Spironolactone, and it also impacted my kidney function quite badly.
I was fortunate that we managed to get a handle on the Ascites relatively quickly and eliminate the fluid retention - although there is always a risk that Ascites will return!
One of my liver specialists wanted me off Spironolactone 200mg daily (principally because of the impact on the kidneys), while the other wanted to reduce it gradually (to provide continuing support to the liver). In the end they agreed to reduce it down in stages to 25mg daily over a three month period, and ceased prescribing it only after confirmation via Ultrasound that there was absolutely no retained fluid - because Spironolactone isn't just a diuretic, it also helps to retain Potassium.
There are other medications available, but I was advised that they all have some form of side-effect and that the choice of medication is a balancing act related to the interaction with other organs in the body and other conditions with which you are diagnosed. Hence, your medication is specific to your overall condition.
This is my experience, not any type of advice, and your specific situation will be different to mine.
While your GP can inform you of options, change in medication is a matter solely for your liver specialist.
So, do nothing until you have fully discussed it with your liver specialist and you are fully aware of alternate risks, so that you make an informed decision based on specialist advice relating to your specific condition.
I've experienced the same symptoms and have just been moved onto eplerenone as a replacement. The docs are doing quite careful monitoring of the impact of the change.
Just had U and E bloods back, all fine apart from my urea has gone up from 7.5 to 11.5. Could this just be because my spironolactone was increased? Because I'm eating alot more protein? Or because I'm getting rid of more water via urine but have the same intake. GP doesn't want a follow up and say satisfied but hasn't explained
Not a doctor, so can't advise but Urea is produced by protein metabolism so more likely to be as a result of increased protein consumption. Suggest you ask the GP.
I take around 1000 calories from protein sources daily. 3,000 calories a day diet x 35% max protein composition (1,050 calories). That has to be managed against a maximum calorie intake of 0.8g protein multiplied by wight in Kgs. I am 64Kgs, so that equates to suggested protein intake of 131g of protein daily - but no more than that daily. It is critical that the proteins come from of a variety of sources: eggs, porridge, Greek yoghurt, fish, meat and poultry, beans etc.
If you don't have a Dietician/Nutritionist then ask GP to refer.
With Ascites, salt intake and restricted fluid intake are critical. Do not add salt to anything, not even a salt substitute, and avoid absolutely everything with added salt - which is practically everything, sadly. Hence, no processed foods, no ready meals, no cheese, no smoked fish and try and cook everything fresh for each meal. I use herbs and balsamic vinegars to add flavour to dishes.
Having had Ascites previously I would not wish it on anyone, so I wish you well.
Feel free to reach out anytime, but do be aware I am not a doctor, can only tell you my experience and what worked and what didn't work for me.
I only buy things with low sodium and don't add any salt. I'm consuming roughly 1-1.5g a day in total. Liver team haven't given me a figure just said to avoid as much as possible
Great. Almost everything has a trace amount of sodium. So, the less salt the better, but obviously no-one can live without salt - we all need some sodium each day to survive, but strip out as much as you possibly can.
The minute I get up I have a couple of biscuits (normally oat) with my coffee. Important to eat something immediately you get up - even if you don't want to!!!
For breakfast, I typically have poached eggs (no toast, most breads contain salt); or porridge (made with full fat milk) with added single cream and honey (no sugar); or, 4oz minimum Greek yoghurt (full fat) with 4oz blueberries, blackberries or raspberries, plus honey. Any of these will keep your sodium down and your albumin up. Avoid any dairy that is low fat or semi-skimmed - low fat will not help you in your condition.
Mid morning snack (between 10am and 11am, depends when I eat breakfast) I have exactly 4oz pineapple, 4oz black or red grapes and 4oz mango (all extremely good for you). I have this every day and typically just make up a batch every three days.
Then lunch, then mid afternoon snack, then dinner.
Most important is to have something (anything, but preferably protein) for supper, before you go to bed. Both the brain and the liver consume protein while you sleep, so you need to keep feeding the liver with protein. Could be an oat biscuit, an oat bar, or even just a small bowl of porridge, must you must eat supper before you go to bed.
Your fluid intake is probably restricted, so think very carefully about which fluids you are taking. Tea, for example, provides little benefit (specialist teas may) but every bit of fluid should provide a benefit in addition to the actual fluid itself. Coffee is generally considered good for the liver, but none after lunch. I alternate between carrot, pomegranate, tomato and apple juice - all natural, nothing from concentrate and nothing with ANY additives (salt or sugars).
It's not an easy (or cheap) diet but it really is the only way you are going to protect your liver and try to eliminate the Ascites.
FYI - I buy half-size (32g) Phd high-Protein bars from Amazon (about £1 per bar - link below). Not an advertisement or endorsement, but they work for me. I normally get the Peanut Butter variety, but other options are available are as other brands. Typically, the 32g bars contain 10g protein and you can take them anywhere to give you a protein boost or take them with, or instead of, a meal. So, if you were having a salad for lunch you could take one of these, get a 10g protein boost - or you could take it before you go to bed. Not cheap at £1 per bar, I know, but very handy for a quick boost if you're running low.
Honey is very, very confusing - as is Maple Syrup. Maple syrup has about double the sodium content of honey (1mg sodium per tablespoon of honey versus about 2.5mg per tablespoon of maple syrup - do bear in mind that almost everything you eat has a trace amount of sodium!). If you're consuming 1g to 1.5g sodium per day (which I personally think is a touch high, but not excessive) then 1mg of sodium in one tablespoon of honey is a small trace amount.
Honey contains sugar but has a lower glycaemic index (GI) than refined (white) sugar that most people use (i.e. honey doesn't affect your blood-sugar levels "as much as" refined sugars).
Honey contains more vitamins, minerals, and antioxidants, such as calcium, potassium, vitamin C, zinc, phenolic acids, and flavonoids than you will get with refined or added sugars. However, they are not massive amounts, just more than you would get if you were using refined sugar. So, by using honey or maple syrup you are squeezing out a few extra nutrients that you would not otherwise be getting - it all adds up to a more beneficial effect over time.
Similar to fluids, you need to think about what "added benefit" you are getting from every single thing that you consume. Water is lovely, adds nothing other than fluid. Sugar is sweet, adds nothing other than sweetness.
My general view, not a doctor bear in mind, is that if you are using something to sweeten food or drinks you should use honey or maple syrup rather than adding refined sugar.
Dentist will not agree, but do you prefer to keep your liver or your teeth? It's not a difficult question to answer!
As always, please discuss with your liver specialist. You may have other medical conditions of which I am not aware.
Lobe all your detailed replies, so insightful. I don't sweeten anything, porridge or coffee etc. I was only going to start eating honey as I thought it may help the liver. In terms of sodium I'm actually intaking alot less. According to the app I use I had 576mg yesterday. My blood sodium is bang in the middle of the normal scale as is.my potassium.If I continue the spironolactone (obviously taking medical advice) can the breast tenderness and swelling go once (if) I finally stop?
Honey will not do you any harm, in small quantities. No reason I'm aware of why you shouldn't take it, but check with your specialist and dietician.
Personally I wouldn't get too addicted to "apps" and if you only had 576mg of sodium yesterday then I would suggest you are approaching borderline - which, in my opinion (again, not a doctor), is not good!
Talk with your specialist or dietician, but 576mg of sodium per day is probably nearing the danger zone. No-one can survive without sodium, and most people need at least 500mg daily (depending on height, age, weight, etc,). This is why the advice is always "limit as much as you can", because they never want to put an exact figure on it - every body is different!
Regarding Spironolactone, from my experience, I would suggest that once you stop the Spironolactone then the chest size should return to normal and the tenderness should abate. However, that should not be a motivation to cease using it.
You are being prescribed Spironolactone because your organs need help, so take the help when you need it, accept that there are side-effects and if all goes well you will come off of it when appropriate and when your body can function without it.
Until then, continue to use medication as prescribed and accept that the medication is helping your liver and keeping you alive - slightly enlarged breasts and a bit of tenderness are a very small price to pay for being alive!
From a purely personal perspective, my chest (breast) didn't get overly pronounced, but it was noticeable - I just wore baggy t-shirts to make it less visible. My nipples became extremely sensitive, swollen and painful to touch. Strangely, I also noticed that my hair changed in the sense that it was thinner and more grey. Since I stopped the Spironolactone all back to normal, other than the liver.
If you follow the advice all will get better, in time. Do not stop taking prescribed medication until advised by your liver specialist.
You can get through this...and you will get through this.
As I said earlier, do feel free to reach out at any time - we are all here to help and support each other. I cannot give you medical advice - all I can tell you is what did and did not work for me.
Wow that's mad I've had two ppl say to me, you've gone grey in the last 2 days lol.Me being alive comes before looks, I will only do as my liver nurse and consultant say. I only use the app as a guide ro my intake, but will take that on board. My next liver clinic is Thurs ill ask all these questions.
All I was told was keep under 2g 1.5g if can. Maybe I've gone a bit extreme
Can you pls explain if I'm supposed be under 2g salt or 2grams sodium. Been told here to treat the same, but from everything I see 2g salt is only 775mg sodium. I've been counting salt so on the days I've had less than 600mg that's salt I.e less than 200mg sodium.
A very, good question. Salt and Sodium are different - they are not the same! Salt is a crystal. Sodium is a mineral that is found in almost all foods, including Salt (hence, Salt contains Sodium).
An easy way to think of it is that Sodium is in everything you eat (almost everything you eat contains a trace amount of Sodium). Salt is what you add to that which you eat, in addition to to the trace amounts of Sodium already in your food.
The broad conversion is 1g (1000mg) Salt = 400mg Sodium; 1g (1000mg) Sodium = 2.5g (2500mg) Salt (not precisely exact, but broadly correct).
When your doctors advise you stay in the range of 1.5mg to 2mg per day they are talking about SODIUM. 1.5g (1500mg) to 2g (2000mg) a day of Sodium translates to 3.75g to 5g SALT per day (based on 400mg Sodium to Salt conversion). Hence the advice not to add ANY Salt to your food. The absolute MINIMUM amount of Sodium you should be taking is 500mg from all foods (which is equivalent to, broadly 1.25g (1250mg) Salt contained in the food that you eat - avoid going below this level.
Your body needs Sodium for fluid balance, blood pressure control, as well as the nerves and muscles - and for you to stay alive!!! The normal blood sodium level is 135 to 145 milliequivalents/liter (mEq/L) - you must NEVER go below this range and this should be tested at least monthly and your GP should be monitoring it.
Don't know who on this forum would advise you that Sodium and Salt are the same because everyone with a Liver problem knows that they are not. You need Sodium to survive. You cannot live without Sodium. All that your doctors are asking you to do is restrict Sodium and not add ANY Salt.
Again, I am not a doctor or a nurse so you need to get the GP to refer you to a Dietician/Nutritionist to ensure what I am saying is correct - which, having been through it all and based on the professional advice I've been given. it probably is, broadly correct - though as I am not aware of all of your symptoms you need to check what I am saying regarding how it relates to you (particularly if you have any Renal problems related to the Spironolactone).
Check, check, check, and then check again!
Feel free to reach out anytime.
Have a nice Easter weekend...and treat yourself to something: God knows we all need a treat now and again.
You really are a star. Thank you so so much. Back at clinic Thurs. I'm gather as much information as possible so I can ask them the questions. Sorry if I go over kill on the amount of posts , I'm just new to all this. Hoping you're having a lovely time. Thanks again
As for today. Bloods all ok. Your correct regarding 2g sodium not salt. I can be a little more flexible with sodium n fluid intake. That's the good news. Bad news, spironolactone the best for me to stay on as working, but the tender and growth in breats is a side effect to put up with. The really bad news, first fibro scan.. 75kpaHey well, we keep going
In a word, Yes. Diet is critical, exercise is critical. Weight is important. No idea what weight you are but the first step is to get to the lower end of your BMI. You can do this via exercise and diet. I'm not suggesting you take up marathon running or pole vaulting. 30 mins to 1 hour of gentle walking a day will help. Start with 10 mins to 15 mins walking each day and work it up gently and slowly - do not overdo any exercise as you will add stress to your body (gradual increase in exercise!). Instead of driving, taking a bus or taxi, walk if you can. Avoid any processed food and, obviously, no added salt or alcohol.
But, the answer is, in time and with the right behaviours, yes!
No longer a problem for me as I have come out as transgender and am now on hrt and couldn't be happier apart from the cirrhosis but I would ask your GP to test your hormone levels.
I am very familiar with the side effects you are describing. Firstly I should obviously state that I am a patient and not a doctor so my advice and thoughts are based on my own experience and not any professional opinion.
Spironolactone is known to have strong side effects and reduce testosterone levels dramatically. It is a drug prescribed for those choosing to go through gender reassignment. That's how potentially powerful this drug can be.
After significant changes in male breast tissue and libido I researched heavily and had great advice from this forum
In the end I presented the advice to my GP who concurred I should come off it, and if Ascites returned an alternative drug could be prescribed.
Within days of coming off Spironolactone I experienced a return to physical normality, no male breast pain and the return of a healthy libido. My Ascites has not returned.
I would encourage you to satisfy yourself with good research and present it to your GP. Sometimes my experience has shown that we, as patients, also have to take the lead - push, research and help shape a future that is best for you.
If you are in tune with your body, follow those instincts.
Update - Bern for bloods done to check U n E mainly sodium n potassium, awaiting these results, beeb informed back today. Advised drop spironolactone back to 200mg from 300mg until I can see gastroenterology next Thursday. Will raise swapping meds then n take advice
Update... now off the spironolactone. Only been 1 week, no return of ascites fluid, breast tenderness more or less gone. Swelling in breast area down, think will be left with a little growth of tissue there but it's earlier days. Sex drive coming back and had testosterone bloods checked.. in range. So all positive news except, still having difficulty with E.D. but being being looked at by GP and liver clinic.. so far pointing that it could be anxiety based n physical but obviously I do have cirrhosis
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