Short answer: The Aldactone dose depends on the condition. For heart failure it starts at 25 mg once daily and may go to 50 mg. For high blood pressure it is 25 to 100 mg a day, adjusted every two weeks. For edema it starts at 100 mg a day (range 25 to 200 mg). Before surgery for primary hyperaldosteronism it is 100 to 400 mg daily.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Aldactone is approved for: Aldactone is an aldosterone antagonist approved to treat NYHA Class III to IV heart failure with reduced ejection fraction (to increase survival, manage edema and reduce heart failure hospitalization), as add-on treatment for high blood pressure, for edema from liver cirrhosis or nephrotic syndrome that has not responded to other measures, and for primary hyperaldosteronism (section 1).
Source
ALDACTONE (spironolactone) tablets, for oral use, prescribing information. Pfizer. DailyMed, version published December 1, 2025. DailyMed setid 0fed2822-3a03-4b64-9857-c682fcd462bc
Aldactone is a tablet taken by mouth, with or without food, but consistently with respect to food (section 2.1).
It comes in 25 mg, 50 mg and 100 mg tablets; the 50 mg and 100 mg tablets are scored (section 3).
Daily doses may be given as one dose or split into divided doses for high blood pressure and edema (sections 2.3 and 2.4).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Condition | Starting dose | Adjustments the label allows |
|---|---|---|
| Heart failure (potassium 5.0 mEq/L or less, eGFR above 50) | 25 mg once daily | May increase to 50 mg once daily as clinically indicated; if hyperkalemia develops on 25 mg, reduce to 25 mg every other day |
| Heart failure with eGFR 30 to 50 mL/min/1.73 m2 | Consider 25 mg every other day | Because of the risk of hyperkalemia |
| Essential hypertension | 25 to 100 mg daily, single or divided doses | Titrate at two-week intervals; doses above 100 mg/day generally do not lower blood pressure further |
| Edema (cirrhosis or nephrotic syndrome) | 100 mg daily, single or divided doses | May range from 25 to 200 mg daily; as the sole diuretic, give for at least five days before increasing; in cirrhosis, start in hospital and titrate slowly |
| Primary hyperaldosteronism, before surgery | 100 to 400 mg daily | Not given |
| Primary hyperaldosteronism, not a surgery candidate | Lowest effective dosage for the individual | Long-term maintenance |
Potassium is checked within 1 week of starting or changing the dose and regularly after. If potassium is high, the dose is lowered or Aldactone is stopped.
In heart failure, potassium supplements are generally stopped when Aldactone is started, and potassium is checked when ACE inhibitor or ARB therapy is changed.
With aspirin, Aldactone may need to be titrated to a higher maintenance dose.
With cirrhosis, Aldactone is started at the lowest initial dose in hospital and titrated slowly.
People taking Aldactone are advised to avoid potassium supplements and foods high in potassium, including salt substitutes.
The Aldactone label gives no missed-dose rule. It does not say what to do if a dose is missed.
More on this: missed a dose of Aldactone.
In Dose Track you set up Aldactone as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.