Oral spironolactone is a dermatologist-recommended treatment for acne. It has traditionally been used to treat hormonal acne or acne that has a predilection for the lower face such as the chin, jawline, and sides of the cheeks. Oral spironolactone is now increasingly used to treat all types of acne and is an alternative to oral antibiotics. It works by blocking the effects of testosterone at androgen receptors, which helps reduce oil production and inflammation, leading to clearer skin.

Oral spironolactone should be taken in the morning.

What conditions do dermatologists treat with spironolactone?

Spironolactone is used off licence to treat women with acne as well as female pattern hair loss and hirsutism (excessive hair growth, including chin and upper lip area in women). Spironolactone is also used in the management of polycystic ovarian syndrome (PCOS) and oily skin.

Who is it not suitable for?

Oral spironolactone is not suitable for men. It is also unsuitable for transgender individuals undergoing hormone therapy that includes testosterone.
It is not suitable for women who are pregnant, planning to conceive or breastfeeding.
We do not prescribe spironolactone to those who have Addison’s disease or significant kidney problems.

How should I take spironolactone?

Spironolactone tablets should be swallowed whole with a glass of water and they should be taken in the morning. This is because spironolactone is a diuretic which means if you take it at nighttime, you may find yourself getting up in the night to urinate!

How long will I need to take spironolactone before I see an effect?

Most women find that their acne starts to improve after 3 months of treatment. However, studies have shown that best results are often seen after six months. To continue spironolactone after your first course has finished, please message your prescriber via your dashboard. We may ask you to confirm that there have been no changes in your medical condition or medications.

Can I use spironolactone long term?

Spironolactone can be taken long term, together with an effective contraception method if you are of childbearing age. Other treatments for acne such as oral antibiotics are not usually recommended for long term use.

What are the common side effects of spironolactone?

Side effects of spironolactone often depend on the dose which is taken. The dosages that are prescribed for acne are usually well tolerated. Potential side-effects in women who are before the menopause include breast tenderness/enlargement and irregular menstrual periods. These symptoms usually settle with continued treatment and may be helped by taking spironolactone with the oral contraceptive pill or a hormonal device within the uterus (IUD). Spironolactone can cause a drop in blood pressure when going from sitting to standing (postural hypotension) which can cause dizziness or fainting. As this medication is a diuretic it can increase the amount of urine produced by the body so you should keep hydrated.

What are the rare side effects of spironolactone?

Raised levels of potassium in the blood may occur during treatment with spironolactone. This is more common in patients over 45 years and those with heart or kidney problems and in people who take other drugs that can affect potassium levels. These tend to improve after stopping the drug or reducing the dose. Blood test monitoring is not usually required in healthy females under the age of 45 years. Spironolactone may very rarely cause rashes. This is not an exhaustive list and as with any medications you should read the information leaflet supplied within your tablet box.

Are any other precautions necessary?

Do not take this medication if you are pregnant or planning to become pregnant. Women taking spironolactone should use effective contraception to prevent pregnancy. Taking combined oral contraceptive pills in combination with spironolactone can increase its effectiveness in treating acne as well as providing contraception and reducing hormonal side-effects such as menstrual irregularities. If you are planning pregnancy, speak to your prescriber.

We do not prescribe spironolactone to those who have Addison’s disease or significant kidney problems.

May I drink alcohol while taking spironolactone?

Drinking alcohol may increase some of the side-effects of spironolactone such as dizziness. It would be advisable to moderate your alcohol consumption in accordance with recommended guidelines by the NHS.

Can I take other medicines at the same time as spironolactone?

This is a list of common medications that can interact with spironolactone:

• Diuretics (“water tablets”)
• Potassium supplements
• Potassium supplements
• ACE Inhibitors (e.g. captopril)
• Tablets for high blood pressure
• Aspirin, indomethacin (an anti-inflammatory/analgesic drug), ibuprofen
• Digoxin (used to treat heart conditions)
• Trimethoprim and trimethoprim-sulfamethoxazole (types of antibiotics)
• Sertraline (this can lower blood pressure so your prescriber may suggest starting with a lower dose of spironolactone)
• Adderall (or similar stimulants used to treat ADHD)

There may be other less common medicines or supplements that can produce problems with spironolactone so make sure that your prescriber knows about everything you are taking.

A note about spironolactone, magnesium supplements and coconut water

Both magnesium and spironolactone can affect the balance of electrolytes in your body, particularly potassium. If you have been prescribed spironolactone you should skip the magnesium supplements whilst you are taking the medication. Coconut water can also contain high levels of potassium so avoid this whilst you are taking spironolactone.

More information can be found here:
bad.org.uk/pils/spironolactone