Spironolactone + Benazepril

By Kayla Hyland, DVM

What is spironolactone + benazepril?

Spironolactone + benazepril (brand name Cardalis®) is a combination aldosterone antagonist (spironolactone) and angiotensin-converting enzyme inhibitor or ACE inhibitor (benazepril) used to treat certain types of congestive heart failure in dogs.

Use to treat other heart conditions or in other species is “off label” or “extra label”. Many drugs are commonly prescribed for off-label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions carefully.

How do I give my pet spironolactone + benazepril?

Spironolactone + benazepril comes in a chewable tablet form (with meat flavoring).

  • Tablets are given orally (by mouth). 
  • This medication should be given to your pet with food or within 30 minutes of feeding. 
  • Give this medication to your pet for the entire time prescribed by your veterinarian, even if it appears that your pet is feeling better.
  • Ensure access to fresh water at all times.

This medication will take effect quickly, in about 1 to 2 hours. This medication is short-acting, meaning that effects should stop after 24 hours but may be prolonged in pets with kidney and/or liver disease.

What if I miss giving my pet the medication?

Give the missed dose as soon as you remember and then continue with the regular dosing schedule. If it is almost time for the next dose, skip the missed dose and continue with the regular schedule. Do not give the pet two doses at once.

Are there any potential side effects from spironolactone + benazepril?

Spironolactone + benazepril may cause the following side effects:

  • excessive thirst and/or increased urination
  • vomiting and/or diarrhea
  • decreased appetite
  • tiredness or decreased energy level

The following reactions are rare, but if they occur, contact your veterinarian immediately:

  • an allergic reaction such as irregular breathing, rash, fever, puffiness and swelling around the face
  • trouble walking or keeping balance, collapse
  • increased breathing rate and/or effort

Drug sensitivities can develop over time with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment.

Are there any risk factors for this medication?

DO NOT give this drug to dogs who:

  • have heart failure caused by aortic valve or pulmonary valve problems 
  • have Addison’s disease (hypoadrenocorticism) 
  • have low sodium blood levels and/or high potassium blood levels 
  • have known allergies to any component 
  • have kidney disease and taking nonsteroidal anti-inflammatory medications (NSAIDs)  
  • are pregnant or nursing 

This medication should be USED WITH CAUTION in dogs who:

  • have kidney disease or liver disease
  • are young
  • are used for breeding
  • have uncontrolled conditions where electrolytes or blood sugar can be out of balance (e.g., diabetes mellitus)

Are there any drug interactions I should be aware of?

Certain medications should be USED WITH CAUTION when given with spironolactone + benazepril, including but not limited to:

  • other medications used to treat heart conditions and/or control blood pressure (e.g., aspirin, beta-blockers, calcium channel blockers, ARBs, digoxin, diuretics, heparin)
  • insulin, glipizide
  • histamine H1 receptor antagonists (e.g., diphenhydramine)
  • immunosuppressants (e.g., azathioprine, cyclosporine)
  • anticonvulsants (e.g., phenobarbital, pregabalin)
  • benzodiazepines
  • corticosteroids (e.g., dexamethasone, prednisone)
  • mirtazapine
  • mitotane
  • pain relievers and muscle relaxants (e.g., NSAIDs, opioids, methocarbamol)
  • polyethylene glycol 3350 (e.g., Miralax®)
  • supplements (e.g., potassium, iron)
  • prazosin
  • sulfa-/trimethoprim
  • trazodone
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine)

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

  • Baseline blood work (including electrolytes, BUN, creatinine) is required before starting treatment, followed by recheck bloodwork as recommended by your veterinarian.
  • Your veterinarian may schedule follow-up visits for monitoring and/or do additional testing (blood pressure check, chest X-rays, heart ultrasound, etc.) to ensure the medication is working. In this case, follow your veterinarian’s directions.

How do I store spironolactone + benazepril?

  • Store at room temperature in the original container. 
  • Keep medication out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

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