COMMON USES: Oral Spironolactone is commonly used to treat heart failure and hypertension, but has off-label usage for managing female pattern hair loss.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

HOW TO USE THIS MEDICINE: HOW IS THIS DRUG BEST TAKEN? Oral Spironolactone tablets can be taken with or without food.

HOW DO I STORE AND/OR THROW OUT THIS DRUG? Keep this medicine in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet or drain. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

WHAT DO I DO IF I MISS A DOSE? If you miss a dose, take it as soon as you can. If it is almost time for your next dose, use only that upcoming dose. Do not use double or extra doses.

POSSIBLE SIDE EFFECTS: WHAT ARE SOME SIDE EFFECTS THAT I NEED TO CALL MY DOCTOR ABOUT RIGHT AWAY? WARNING/CAUTION:

Spironolactone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• Nausea / vomiting
• Diarrhea
• Stomach pain or cramps
• Enlarged or painful breasts
• Irregular menstrual periods
• Vaginal bleeding in postmenopausal ('after the change of life', the end of monthly menstrual periods) women
• Drowsiness / tiredness
• Restlessness

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• Muscle weakness, pain, or cramps
• Pain, burning, numbness, or tingling in the hands or feet
• Inability to move arms or legs
• Changes in heartbeat
• Confusion
• Extreme tiredness
• Dry mouth, thirst, dizziness, unsteadiness, or other signs of dehydration
• Unusual bleeding or bruising
• Lack of energy
• Loss of appetite
• Pain in the upper right part of the stomach
• Yellowing of the skin or eyes
• Flu-like symptoms
• Rash
• Hives
• Itching
• Difficulty breathing or swallowing
• Vomiting blood
• Blood in stools
• Decreased urination
• Fainting

If you would like to learn more about spironolactone, please see the full prescription information, here. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

WHAT MAY INTERACT WITH THIS MEDICATION? Agents increasing serum potassium: Concomitant administration can lead to hyperkalemia. Lithium: Increased risk of lithium toxicity. NSAIDs: May reduce the diuretic, natriuretic and antihypertensive effect of spironolactone. Digoxin: Spironolactone can interfere with radioimmunologic assays of digoxin exposure. Cholestyramine: Hyperkalemic metabolic acidosis has been reported with concomitant use. Acetylsalicylic Acid (ASA): ASA may reduce the efficacy of spironolactone.

This is not an exhaustive list of all potential drug interactions. Please inform your Nurx provider regarding all of your current medications.

Spironolactone is not advised for some patients, including those with:

• Hyperkalemia
• Addison’s disease
• Concomitant use of eplerenone

Spironolactone should not be used in patients who are pregnant, breastfeeding or attempting to conceive.

ADDITIONAL INFORMATION:

As with almost all medicine, the recommended treatments do not work for every single person. There is a risk the medicine will not work and your hair loss continues. If after more than 4 months your symptoms have not improved, you should consider scheduling an in-person visit with a healthcare provider

Telemedicine does not replace your primary care physician. It is important to keep your primary care and other healthcare providers, and your pharmacists informed of all medications you are taking, including those in your Nurx treatment plan, as they can interact with other medicines you may be taking.

This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.