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Spironolactone is a kind of weak potassium-sparing diuretics, and is fine white or white-like crystalline powder with slightly bitter taste. It is odorless or with slight mercaptan odor. It is highly soluble in chloroform but insoluble in water and soluble in ethanol, and easily soluble in benzene or ethyl acetate. It has a similar chemical structure as aldosterone and can compete with aldosterone for the aldosterone receptors in the cytoplasm of the distal convoluted tubule and collecting tube duct cells, affecting the binding of the aldosterone to its receptor, thus preventing the synthesis of aldosterone-induced protein and further inhibiting the exchange between K+ and Na+ with reduced potassium excretion and plays potassium-sparing diuretic effect.

The strength of the diuretic effect of spironolactone is related to the in vivo secretion of aldosterone with increased secretion also causing stronger effect while lower secretion causing weaker effects. It has no diuretic effect on patients without aldosterone secretion. Because the drug only acts on the distal convoluted tubule and collecting duct while having no effect on the other segments of tubular, it only has a weak diuretic effect with slow onset but long duration time.

It is mainly used for treating refractory edema accompanied with higher amount of aldosterone such as cirrhosis, congestive heart failure, and nephrotic syndrome with excellent efficacy in treating the patients with hyperaldosteronism caused by the lack of sodium in the congestive heart failure. Single drug administration usually only give a poor diuretic and therefore, it is often used in combination with hydrochlorothiazide or dihydrochlorothiazide for enhancing the effect. In addition, it can also be applied to the treatment of primary hyperaldosteronism and hypertension. Patients of hyperkalemia or renal failure should be disabled.