Spironolactone and Alcohol: Risks & Side Effects

Looking and feeling great sometimes requires medication. The older you get, the more prescription drugs you may need — and some have warnings that may change your life.

If you have hormonal acne, female pattern hair loss or polycystic ovarian syndrome (PCOS), your healthcare provider may prescribe spironolactone to help you gain control over your symptoms. But while looking and feeling great is the goal, you might need to forgo that cocktail, glass of wine or other alcoholic beverage.

Below, we’ll explain why you shouldn’t drink heavily (if at all) on spironolactone, the risks and dangers of mixing booze with this drug, and what safety precautions to take if you’re getting back to the bar after being on spironolactone for some time.

The antiandrogen medication spironolactone is an FDA-approved diuretic for the treatment of certain heart issues, including hypertension and heart failure. Available as a tablet and in liquid form, spironolactone belongs to a class of medications called mineralocorticoid receptor antagonists.

Often marketed under the brand name Aldactone®, it affects the hormone aldosterone to indirectly address heart problems. To do this, spironolactone works by helping your body to expel extra water and the electrolyte sodium. Due to its effects on reducing water retention and regulating body fluid levels, it’s often called a water pill.

Like other medications, spironolactone is often prescribed off-label to treat certain medical conditions. This includes hormonal acne, female pattern hair loss and other health issues caused by excessive levels of androgen hormones.

Side effects of spironolactone may include:

• Diarrhea

• Nausea and vomiting

• Dehydration

• Stomach cramps or pain

• Breast pain or breast enlargement

• Menstrual cycle changes

• Postmenopausal vaginal bleeding

• Changes in body hair growth

• Drowsiness, fatigue or confusion

• Changes in motor control

• Restlessness

• Headaches

Like many other prescription drugs, spironolactone should be used cautiously with alcohol, if at all.

Spironolactone is a safe and effective medication for most women. However, like all prescription medications, it can potentially cause adverse effects.

Spironolactone is a medication used to treat hypertension (high blood pressure) and heart failure. It’s also widely used to treat low potassium levels and edema (excessive fluid retention) caused by various medical conditions.

The problem is that when you drink alcohol with spironolactone, you may develop orthostatic hypotension. This form of low blood pressure occurs when you stand up after sitting down — it can be a side effect of both spironolactone and alcohol.

Drinking can increase your risk of other side effects, such as:

• Lightheadedness

• Dizziness

• Fainting

This sudden decrease in blood pressure can cause problems like those mentioned above. It can also significantly increase your risk of injuring yourself, especially when combined with the effects of alcohol on your balance and motor skills.

If you’re prescribed spironolactone for hormonal acne, female pattern hair loss or any other condition, it’s always important to follow your healthcare provider’s instructions and discuss all the pros and cons of use.

At least one study published by the National Institutes of Health (NIH) looked at this issue in detail. We need to be clear here — the research is preliminary, and substantial volumes of additional research are needed to make any of this information pass into “useful” territory.

But here’s what the experts found:

• A study of over 500 spironolactone users and 2,000 non-users examined regular alcohol consumption over six months.

• The study found that spironolactone users self-reported, on average, three-quarters of a drink less than non-users.

• The research suggested that the medication might block addiction-promoting channels in patients with AUD (alcohol use disorder).

• Safety and effectiveness need to be studied in more detail with additional human studies to decide whether this novel treatment has long-term and safe potential for treating AUD.

Assuming you’ve successfully dealt with your acne breakouts or prevented your pattern hair loss from becoming more severe, how long after taking spironolactone can you drink alcohol? It depends on a few things, including dosage.

Spironolactone has a relatively short half-life, the amount of time until it reaches half its original concentration in the body.

On average, the half-life of spironolactone is approximately 1.4 hours. This means a standard dose of spironolactone is “out of your system” within 24 hours of the time you took your medication.

However, certain metabolites in spironolactone can last significantly longer in your body, with some requiring 15 hours or longer to reach half their initial concentration. These metabolites can take three to four days to completely exit your body. 

Because of this, depending on your individual health status, you may need to wait several days before drinking alcohol or increasing your alcohol consumption after stopping spironolactone.

It’s also important to talk to your healthcare provider before making any changes to your alcohol consumption, especially if you’re using other medications to treat acne, hair loss or other health issues.

So how do you know when you’re good to go? One way is to simply ask your healthcare provider.

If you’re given the all-clear to start drinking after stopping spironolactone, it’s fine to get out and enjoy yourself in moderation. 

However, it’s best to take a few precautions to reduce your risk of experiencing any issues while drinking. Try to:

• Start with small quantities of alcohol. If you’ve been taking spironolactone for a long time and moderating your alcohol consumption during treatment, you may have a lower tolerance for alcohol than before, so drink light until you get your sea legs back.

• Take it slow and steady. Avoid drinking alcohol too quickly at first — no shots, no keg stands, no bar crawls. Try to make yourself have one non-alcoholic drink (like a glass of water, soda or fruit juice) between each serving of alcohol.

• Stop drinking alcohol if you notice any issues. We wish we could tell our younger selves this, too, but if you feel dizzy, lightheaded or like you’re going to faint, stop drinking alcohol right away and switch to a non-alcoholic beverage. Try again another night.

Those are the best marching orders we can give you, assuming you have a fairly healthy relationship with drinking. Not everyone does.

If you have an alcohol use disorder, tell your healthcare provider and ask for medical advice. Let your provider know if you’re alcohol-dependent before using spironolactone, as this may affect your ability to use this medication safely.

How long after taking spironolactone can you safely consume alcohol? Here’s what to keep in mind:

• Spironolactone is one of several medications used to treat hair loss and acne in women.

• It’s usually okay to have a drink once the medication and its metabolites have left your system. For most people, this is a few days to one week after your last dose.

• It’s important to talk to your healthcare provider about staying safe while using spironolactone.

• Your provider may suggest moderating your alcohol consumption or avoiding alcohol altogether while using spironolactone. 

• Closely follow your healthcare provider’s instructions regarding alcohol use to stay safe while taking spironolactone. 

• Ask your healthcare provider if drinking any amount of alcohol is okay, especially if you use other medications.

Want to know more about spironolactone? We’ve covered spironolactone for hair loss, as an acne treatment and how spironolactone might affect your weight.

We have answers to your biggest questions about hair loss in women and female pattern baldness. You can also explore hair loss treatments approved by the FDA, including oral minoxidil and minoxidil drops.

Hers offers several of these as part of our range of acne treatments and medications for female hair loss.

Drinking and taking care of yourself don’t always go hand in hand, but your health should be the priority. If you’re ready to address some health concerns, we can help — reach out today (you can have that drink later).