Two medicines, side by side
Hydrochlorothiazide vs spironolactone
Hydrochlorothiazide and spironolactone are both labeled for high blood pressure, heart failure and edema (fluid retention). Drugs@FDA records approvals of hydrochlorothiazide since 1959 and of spironolactone since 1960. Pharmacies paid $0.0115 per hydrochlorothiazide 25 mg tablet and $0.0426 per spironolactone 25 mg tablet (NADAC, October 7, 2026). Hydrochlorothiazide's other strengths are brand-only: $4.46 per mL (Inzirqo 10 mg/mL oral suspension). In FDA's classes, hydrochlorothiazide is a thiazide diuretic and spironolactone an aldosterone antagonist.
Check it at the source: the hydrochlorothiazide FDA label on DailyMed (effective June 12, 2026); the spironolactone FDA label on DailyMed (effective November 28, 2025).
Highlights of the hydrochlorothiazide record
Hydrochlorothiazide (Inzirqo) · label of June 12, 2026
Used for
From the label: indicationsHydrochlorothiazide tablets USP are indicated as adjunctive therapy in edema associated with congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy. Hydrochlorothiazide tablets USP have also been found useful in edema due to various forms of renal dysfunction such as nephrotic syndrome, acute glomerulonephritis, and chronic renal failure. […]
On the market
- Earliest approval on file
- February 12, 1959
- Generic labelers
- 43 labelers
- Pharmacy cost
- $0.0115 per tablet
Supply and safety
- Shortage
- A presentation being discontinued
- Recalls
- 7
Highlights of the spironolactone record
Spironolactone (Aldactone) · label of November 28, 2025
Used for
From the label: indicationsALDACTONE is an aldosterone antagonist indicated for: • The treatment of NYHA Class III–IV heart failure and reduced ejection fraction to increase survival, manage edema, and to reduce the need for hospitalization for heart failure ( 1.1 ). • Use as an add-on therapy for the treatment of hypertension, to lower blood pressure. […]
On the market
- Earliest approval on file
- January 21, 1960
- Generic labelers
- 38 labelers
- Pharmacy cost
- $0.0426 per tablet
Supply and safety
- Shortage
- A presentation being discontinued
- Recalls
- 6
Source: FDA drug labels via openFDA (Hydrochlorothiazide label of June 12, 2026, Spironolactone label of November 28, 2025); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do hydrochlorothiazide and spironolactone differ on the record?
In FDA's classes, hydrochlorothiazide is a thiazide diuretic and spironolactone an aldosterone antagonist.
Half-life, in each label's words: Hydrochlorothiazide, “When plasma levels have been followed for at least 24 hours, the plasma half-life has been observed to vary between 5.6 …”; Spironolactone, “The mean half-life values of its metabolites including canrenone, 7-α-(thiomethyl) spirolactone (TMS), and …”
Generics: hydrochlorothiazide since 1973; spironolactone since 1980 (Drugs@FDA).
| Hydrochlorothiazide | Spironolactone | |
|---|---|---|
| Labeled for | Heart failure, High blood pressure, Edema (fluid retention) | Heart failure, Edema (fluid retention), High blood pressure |
| Pharmacologic class | Thiazide Diuretic | Aldosterone Antagonist |
| How it works (label) | n/a | Spironolactone and its active metabolites are specific pharmacologic antagonists of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted … |
| Half-life (label) | When plasma levels have been followed for at least 24 hours, the plasma half-life has been observed to vary between 5.6 and 14.8 hours. | The mean half-life values of its metabolites including canrenone, 7-α-(thiomethyl) spirolactone (TMS), and 6-β-hydroxy-7-α-(thiomethyl) spirolactone (HTMS) are 16.5, 13.8, and 15 hours, respectively. |
| Earliest approval on file (Drugs@FDA) | February 12, 1959 | January 21, 1960 |
| First generic approved | January 12, 1973 | May 7, 1980 |
| Generic labelers (NDC) | 43 labelers | 38 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.0115 per tablet (Hydrochlorothiazide 25 mg tablet) | $0.0426 per tablet (Spironolactone 25 mg tablet) |
| 12-month price change | -7% | -14% |
| Boxed warning | No | No |
| Shortage now | A presentation being discontinued | A presentation being discontinued |
| Recalls recorded | 7 | 6 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 144,413 | 139,757 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What next?
- Alternatives to hydrochlorothiazide
- every medicine labeled for the same conditions