spironolactone / Generic mfg. - LARVOL DELTA

Flood Syndrome Secondary to BuddâChiari Syndrome: A Case Report (ACG 2026) - "Prophylactic ceftriaxone, metronidazole were given and patient was optimized on a spironolactone and torsemide regimen to reduce ascitic fluid pressure. The patient was instructed on regular follow-up and strict compliance to her BCS regimen including rivaroxaban, carvedilol...This case expands the etiological spectrum of Flood syndrome and emphasizes that BCS should be considered as a potential cause in patients presenting with spontaneous umbilical ascitic leakage. Figure: Picture depicting the sinus tract on skin"

Case report • Clinical • Cardiovascular • Fibrosis • Gastroenterology • Hepatology • Immunology • Infectious Disease • Portal Hypertension • Thrombosis

Safety and Efficacy of Dapagliflozin in Ascites Management (ACG 2026) - "Standard management with spironolactone and furosemide is often limited by suboptimal efficacy and adverse effects. At 1 year, combination therapy was associated with lower all-cause mortality (13.8% vs. 17.9%; HR 0.72, 95% CI 0.60â0.85; p< 0.001) and hospitalization (18.3% vs. 22.6%; HR 0.73, 95% CI 0.63â0.86; p< 0.001), with no difference in paracentesis."

Clinical • Acute Kidney Injury • Cardiovascular • Congestive Heart Failure • Diabetes • Fibrosis • Heart Failure • Hepatology • Hypotension • Immunology • Liver Cirrhosis • Liver Failure • Metabolic Disorders • Nephrology • Renal Disease • Type 2 Diabetes Mellitus

Torsemide vs Furosemide in Cirrhosis and Ascites: A Propensity-Matched Analysis Stratified by Spironolactone Use (ACG 2026) - "The overall matched cohort included 1,666 patients per group. Torsemide was associated with lower all-cause mortality at 30 days (16.4% vs 27.3%; HR 0.53, 95% CI 0.46-0.62), 90 days (24.8% vs 33.2%; HR 0.63, 95% CI 0.55-0.72), and 1 year (31.9% vs 40.2%; HR 0.66, 95% CI 0.59-0.75). Torsemide was also associated with lower hospitalization, paracentesis, ICU admission, and decompensation across all follow-up intervals with similar renal composite outcomes and hyponatremia."

Cardiovascular • Chronic Kidney Disease • Fibrosis • Heart Failure • Hepatology • Immunology • Peritoneal Cancer • Renal Disease

Finerenone vs Spironolactone in MASH-Cirrhosis With CKD: A Propensity Score-Matched Real-World Study (ACG 2026) - "1:1 propensity score matching on demographics, heart failure, portal hypertension, varices, medications (ARBs, ACEi, furosemide, beta-blockers), and labs (potassium, bilirubin, eGFR, platelets, albumin, ALT, INR). Before matching, 207â227 finerenone and 26,400â29,701 spironolactone users were identified. Finerenone users had lower bilirubin (0.81 vs 2.21 mg/dL), higher albumin (3.89 vs 3.24 g/dL), and lower baseline eGFR (52.5 vs 71.9 mL/min/1.73m²). After PSM, 203, 224, and 210 pairs were analyzed at 1, 3, and 5 years."

Clinical • Real-world • Real-world evidence • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Congestive Heart Failure • Diabetic Nephropathy • Fibrosis • Heart Failure • Hepatology • Immunology • Liver Cirrhosis • Liver Failure • Metabolic Dysfunction-Associated Steatohepatitis • Metabolic Dysfunction-Associated Steatotic Liver Disease • Portal Hypertension • Renal Disease

When Ascites Is at Breaking Point: A Rare Case of Flood Syndrome (ACG 2026) - "The patient was discharged on hospital Day 6 with midodrine, furosemide, and spironolactone, given strict return precautions, and scheduled outpatient biweekly paracenteses with interventional radiology. In clinical cases where liver transplantation or TIPS are not options, multidisciplinary management of ascites and surgical intervention should be considered. Figure: Ulcerated focus at the most protruding portion of umbilical hernia."

Clinical • Cardiovascular • Fibrosis • Gastroenterology • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Liver Cirrhosis • Septic Shock • Thrombosis

New-Onset Decompensated Cirrhosis Secondary to Congestive Hepatopathy Complicated by Spontaneous Bacterial Peritonitis: A Case Report (ACG 2026) - "Management and Outcome: The patient received ceftriaxone IV albumin and therapeutic paracenteses...Diuresis with furosemide and spironolactone sodium restriction lactulose and carvedilol were initiated...High SAAG with high ascitic protein strongly suggests congestive hepatopathy and should prompt cardiac evaluation and optimization. Recognition of this entity may prevent delayed diagnosis and guide appropriate multidisciplinary management."

Case report • Clinical • Cardiomyopathy • Cardiovascular • Chronic Kidney Disease • Chronic Obstructive Pulmonary Disease • Congestive Heart Failure • Fibrosis • Heart Failure • Hepatology • Hypertension • Immunology • Infectious Disease • Liver Cirrhosis • Liver Failure • Respiratory Diseases

Comparative Outcomes of Proton Pump Inhibitors and H2 Receptor Antagonists in Cirrhosis: A Propensity-Matched Cohort Study (ACG 2026) - "One-to-one propensity score matching was performed for age, sex, race, socioeconomic status, tobacco and alcohol use, comorbidities, cirrhosis etiology, prior decompensating events, MELD score, and concomitant medications (lactulose, rifaximin, furosemide, and spironolactone). Propensity matching yielded two well-balanced cohorts of 8,922 patients each. Over 5-year follow-up, overall patients on PPIs had a high risk of SBP than patients on H2RAs (HR: 1.760; 95% CI: 1.135 - 2.729), however there was no difference in the risk of HE, CDI, osteoporosis/fragility fractures between the 2 groups (Table 1). On sub analysis of the 2 most commonly prescribed PPIs, omeprazole and pantoprazole, there was a higher risk of HE and CDI in omeprazole users than patients on H2RAs, while there was a higher risk for HE in patients on pantoprazole than H2RAs (Tables 2 and 3)."

Biliary Cancer • Cholangiocarcinoma • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Liver Failure • Musculoskeletal Diseases • Osteoporosis • Solid Tumor

Intestinal Lymphangiectasia as a Cause of Acute Overt Gastrointestinal Bleeding: A Case Report (ACG 2026) - "Case Description/ A 70-year-old male with congenital protein-losing enteropathy, IL, prior jejunal resection (160 cm) for bleeding IL, chronic chylothorax (status post thoracic duct surgery and pleurodesis), and pulmonary emboli on apixaban presented with weakness, dyspnea, and near-syncope...Spironolactone was added for fluid retention...Additional therapeutic options include sirolimus, surgical resection, and lymphatic embolization. Dietary optimization and long-term iron supplementation remain cornerstones of care in IL with protein-losing enteropathy. Figure: Figure 1 and 2 Figure: Figure 3 and 4"

Case report • Clinical • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Pulmonary Disease • Pulmonary Embolism • Respiratory Diseases

Losing More Than Fluid: Diuretic-Associated Agranulocytosis (ACG 2026) - "Introduction: Management of ascites in decompensated cirrhosis includes routine diuretic therapy such as furosemide and spironolactone...The patient was maintained on an increased dose of filgrastim and diuresed with ethacrynic acid instead, with noted improvement in ANC (Table 1)...Figure: Figure 1: Bone marrow core biopsy (H&E, Ã400) showing hypercellular marrow with selective granulocytic aplasia and compensatory erythroid and megakaryocytic hyperplasia. Figure: Table 1: Time course of diuretic administration and filgrastim treatment, white blood cell count, and absolute neutrophil count, demonstrating recovery of agranulocytosis following diuretic discontinuation."

Agranulocytosis • Fibrosis • Granulocytopenia • Hepatology • Immunology • Infectious Disease • Neutropenia

Chewing Toward Cirrhosis: A Case of Khat-Associated Decompensated Liver Cirrhosis (ACG 2026) - "He was already receiving Ceftriaxone...The patient was discharged on carvedilol, spironolactone, and ciprofloxacin for secondary prophylaxis, with a transplant referral...Notably, khat injury can trigger autoimmune-like serologic features, including a positive ANA, mimicking AIH. Comprehensive serology is essential to avoid misclassification and unwarranted immunosuppression."

Clinical • Alpha-1 Antitrypsin Deficiency • Autoimmune Hepatitis • Cardiovascular • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hematological Disorders • Hepatology • Hypertension • Immunology • Infectious Disease • Inflammation • Liver Cirrhosis • Liver Failure • Metabolic Disorders • Movement Disorders • Pulmonary Disease • Respiratory Diseases

Cytology-Positive Malignant Ascites With Concurrent High-SAAG Physiology: When Portal Hypertension Is Not the Whole Story (ACG 2026) - "All five met criteria for refractory ascites despite furosemide (5) and spironolactone (3), with ascitic fluid reaccumulation at a mean of 2.8 days. Baseline demographic and clinical characteristics at initial presentation in patients with cytology-confirmed malignant ascites and concurrent high SAAG physiology (N=5) Figure: Table 2. Comprehensive ascitic fluid analysis and serum laboratory profiles at time of diagnostic evaluation in patients with cytology-positive high-SAAG malignant ascites (N=5)"

Cytology • Addiction (Opioid and Alcohol) • Cardiovascular • CNS Disorders • Fibrosis • Gastroenterology • Heart Failure • Hepatitis B • Hepatitis C • Hepatocellular Cancer • Hepatology • Hypertension • Immunology • Infectious Disease • Metabolic Disorders • Portal Hypertension • Thrombosis

The 2,000 Club: High Triglycerides and a Tan-Yellow Drain: A Chylous Tale (ACG 2026) - "Following resolution of the chylous output, she was started on diuretics (furosemide/spironolactone) for portal hypertensive ascites and discharged in stable condition. Nutritional intervention is paramount: MCTs are absorbed directly into the portal venous system, bypassing the intestinal lymphatic vessels and allowing the leak to heal. Figure: CT of the abdomen and pelvis demonstrating trace fluid in the right upper quadrant [yellow arrow] which clinical and laboratory correlation later identified as chylous ascites."

Cardiovascular • Dyslipidemia • Fibrosis • Gastroenterology • Hepatology • Hypertension • Hypertriglyceridemia • Immunology • Mood Disorders • Portal Hypertension • Primary Biliary Cholangitis

SGLT-2 Inhibitors Are Associated With Reduced Hepatic Decompensation and Mortality in Patients With Cirrhosis and Type 2 Diabetes: A Propensity-Matched Real-World Analysis (ACG 2026) - "Adults with cirrhosis and T2DM receiving dapagliflozin, empagliflozin, or canagliflozin were compared with matched controls receiving furosemide and spironolactone without SGLT2 inhibitor exposure. : After PSM, SGLT2 inhibitor use was associated with a significantly lower risk of the composite hepatic decompensation outcome at 3 years (2.3% vs 3.6%; HR 0.58, 95% CI 0.49-0.69; p< 0.001). Individual analyses demonstrated lower risks of SBP (HR 0.43, 95% CI 0.31-0.58; p< 0.001) and peritoneal drainage/paracentesis-related procedures (HR 0.63, 95% CI 0.52-0.76; p< 0.001). Independent assessment of variceal bleeding was limited by low event counts."

Clinical • Real-world • Real-world evidence • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Fibrosis • Hepatocellular Cancer • Hepatology • Immunology • Liver Failure • Metabolic Disorders • Nephrology • Renal Disease • Solid Tumor • Type 2 Diabetes Mellitus

Home Lactulose and Rifaximin Are Associated With Lower In-Hospital Mortality, and Spironolactone With Lower Rates of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis and Ascites (ACG 2026) - "Among 247 hospitalizations (median age 58, median MELD-Na 22.6), 48 (19.4%) died. 141 (57.1%) were on home lactulose, 118 (47.8%) on rifaximin, 126 (51.0%) on spironolactone, 142 (57.5%) on loop diuretic, and 39 (15.8%) on NSBB. After adjustment, only lactulose (aOR 0.28, 95% CI 0.14â0.58) and rifaximin (aOR 0.37, 95% CI 0.18â0.76) were associated with lower mortality."

Clinical • Acute Kidney Injury • Chronic Kidney Disease • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Liver Failure • Nephrology • Renal Disease

Colonic Pseudo-Obstruction as Cause and Effect of Hypokalemia: A Case Report Highlighting Pathophysiology (ACG 2026) - "Despite aggressive repletion and spironolactone, potassium remained difficult to correct and symptoms persisted...Figure: Figure 1. Axial Abdominal CT Scan Demonstrating Colonic Dilation Up To 12 cm"

Case report • Clinical • Acute Kidney Injury • Cardiovascular • Hypertension • Metabolic Disorders • Renal Disease

Hidradenitis Suppurativa from Preconception to Lactation: Clinical Treatment Decision-Making Review. (PubMed, Dermatol Ther (Heidelb)) - "Topical clindamycin, benzoyl peroxide, chlorhexidine, and selected beta-lactam antibiotics appear to represent preferred options for mild disease or acute flares, whereas tetracyclines, retinoids, spironolactone, apremilast, Janus kinase inhibitors, and most glucagon-like peptide-1 (GLP-1) receptor agonists require avoidance or discontinuation because of fetal or neonatal safety concerns. Among biologics, tumor necrosis factor-α inhibitors remain the best-characterized agents, with certolizumab pegol offering minimal placental transfer and adalimumab or infliximab requiring individualized decisions regarding continuation and timing of discontinuation. Evidence for newer agents, including secukinumab and bimekizumab, is evolving but remains more limited. The review also highlights the importance of preconception counseling, medication transition, multidisciplinary delivery planning, postpartum flare prevention, breastfeeding-compatible therapy, and individualized..."

Journal • Review • Dermatology • Hidradenitis Suppurativa • Immunology • Oncology • Women's Health

Post-trial provisions: Unblinding after a randomized blinded trial of spironolactone or doxycycline to treat acne in women. (PubMed, J Invest Dermatol) - No abstract available

Journal • Acne Vulgaris

Oral medications for hair loss in the elderly (EADV 2026) - "This includes low-dose oral minoxidil, finasteride, dutasteride, spironolactone, hydroxychloroquine and JAK inhibitors. Learning Objectives After this presentation, participants should be able to: Select suitable oral treatments for androgenetic alopecia, frontal fibrosing alopecia and alopecia areata.Assess cardiovascular, renal, thrombotic, infectious and oncological risks before treatment. Apply recent recommendations on low-dose oral minoxidil and JAK inhibitors."

Clinical • Alopecia • Cardiovascular • Fibrosis • Immunology • Infectious Disease • Lichen Planus • Nephrology • Renal Disease • Thrombosis

NEPHRON: A Study Comparing the Clinical Benefit of Finerenone Versus a Fixed Dose Combination (FDC) of Extended-Release Torsemide and Spironolactone in Patients With Hypertension and Chronic Kidney Disease (clinicaltrials.gov) - P3 | N=0 | Withdrawn | Sponsor: Sarfez Pharmaceuticals, Inc. | N=30 ➔ 0 | Initiation date: Dec 2025 ➔ May 2025 | Recruiting ➔ Withdrawn

Enrollment change • Trial initiation date • Trial withdrawal • Cardiovascular • Chronic Kidney Disease • Hypertension • Nephrology • Renal Disease

Thoracoscopic diaphragmatic plication technique in a patient with refractory hepatic hydrothorax (PubMed, Rev Med Inst Mex Seguro Soc) - "Diuretic therapy with propranolol, furosemide, and spironolactone was administered, along with sodium restriction (80-90 mEq/day) and fluid restriction (< 2 L/day), without improvement and with symptom progression. Chemical pleurodesis induces pleural adhesion and obliteration of the space. The combination of both techniques increases therapeutic effectiveness."

Journal • Cardiovascular • Fibrosis • Hepatology • Hypertension • Immunology • Pain • Portal Hypertension • Primary Biliary Cholangitis • Pulmonary Disease • Respiratory Diseases

Serum Potassium and Mineralocorticoid Receptor Antagonists As Modifiers of Atrial Arrhythmia Recurrence After Catheter Ablation for Atrial Fibrillation: A Narrative Review With Systematic Search and Mechanistic Synthesis. (PubMed, Cureus) - "We aimed to synthesize the clinical and mechanistic evidence on whether serum potassium, potassium-management strategies, and MRA therapy (steroidal: spironolactone, eplerenone; nonsteroidal: esaxerenone, finerenone) modify recurrence, and to derive a testable mechanistic framework. Current evidence supports avoiding hypokalemia and hyperkalemia, correcting reversible disturbances, and prescribing MRAs for established indications with appropriate monitoring; it does not justify routine potassium supplementation or MRA use solely to prevent post-ablation recurrence. Prospective, adequately powered randomized studies with longitudinal potassium assessment and rigorous rhythm monitoring are required before mechanism-based post-ablation interventions can be recommended."

Journal • Review • Atrial Fibrillation • Cardiovascular • Immunology

Real-World Utilisation and Cost Trends of Mineralocorticoid Receptor Antagonists in England: A Population-Level Prescribing Analysis From 2022 to 2025. (PubMed, Cardiovasc Ther) - "Spironolactone remained the most frequently dispensed MRA in England between 2022 and 2025. Eplerenone utilisation increased, whereas its cost per item declined markedly by 2025, and finerenone showed rapid uptake from a very low baseline while retaining the highest cost per item. These descriptive findings identify changing utilisation and expenditure patterns but do not establish indication-specific use, comparative effectiveness, safety, adherence or cost-effectiveness and should be considered hypothesis-generating."

Journal • Observational data • Real-world evidence • Retrospective data • Cardiovascular • Nephrology • Renal Disease

Early mineralocorticoid receptor antagonism for end-organ protection in hypertension: Implications for disparities and rethinking the timing paradigm. (PubMed, Dialogues Health) - "We searched PubMed/MEDLINE and the Cochrane Library (inception-July 2026) using terms including mineralocorticoid receptor antagonist, aldosterone, spironolactone, eplerenone, finerenone, hypertension, resistant hypertension, end-organ damage, fibrosis, hyperkalemia, chronic kidney disease, heart failure, and health disparities. In selected higher-risk patients with preserved renal function and controlled potassium, earlier MR antagonism may warrant prospective evaluation as a tissue-protective, disparity-reducing strategy. This framework is hypothesis-generating and is intended to stimulate research, not to alter current guideline-directed therapy."

Journal • Review • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Fibrosis • Heart Failure • Hypertension • Immunology • Inflammation • Nephrology • Renal Disease

Comparison of steroidal and nonsteroidal mineralocorticoid receptor antagonists on the incidence of new-onset cardiac arrhythmias following myocardial infarction: A retrospective cohort study. (PubMed, Pol Merkur Lekarski) - " Our findings showed no difference in the incidence of new-onset cardiac arrhythmias or in secondary outcomes between patients treated with nonsteroidal versus steroidal MRAs. Prospective, standardized studies are needed to validate these results."

Clinical • Journal • Retrospective data • Cardiovascular • Myocardial Infarction

GPER and EGFR cross-talk highlight aldosterone- and MR antagonist-induced NO production in cultured endothelial cells. (PubMed, Front Pharmacol) - "All three MR antagonists blocked the aldosterone responses, yet each also evoked intrinsic, concentration-dependent NO production in the absence of aldosterone, eplerenone and spironolactone showing greater intrinsic efficacy than finerenone. Pretreatment with 100 nM of the GPER antagonist G-36 or 100 nM AG-1478 significantly reduced both aldosterone-induced DAF-NO signaling and vasodilation, whereas endothelium removal or L-NAME converted vasodilation into vasoconstriction...Because recent cryo-EM work reveals a non-canonical extracellular GPER architecture, the docking results are interpreted as structurally plausible interaction scenarios rather than definitive orthosteric assignments; whether the behaviour reflects direct partial agonism at GPER or an indirect, GPER-dependent mechanism remains to be established by direct-binding studies. These findings expand current understanding of MR antagonist pharmacology."

Journal • Cardiovascular • EGFR