Spironolactone and Alcohol: Risks & Side Effects

If you’ve been prescribed spironolactone for hair loss or hormonal imbalances, your healthcare provider may have told you not to drink while using the medication. But is combining spironolactone and alcohol truly risky?

Like many medications, spironolactone doesn’t mix well with alcohol. If you drink alcohol on spironolactone, it can lead to a range of uncomfortable side effects.

Spironolactone is often prescribed for hormonal acne and female pattern hair loss. It’s also used for certain cardiovascular issues.

Below, we’ll explain why you shouldn’t drink heavily (if at all) on spironolactone, plus address other common questions about the risks of mixing alcohol and spironolactone.

Here’s the truth: Taking spironolactone with alcohol can cause side effects, especially if you drink alcohol regularly or in large amounts.

The combination of spironolactone and alcohol isn’t necessarily lethal — as long as you’re not drinking excessively and don’t participate in dangerous behavior like drinking and driving.

But still, the side effects can be very unpleasant.

When you mix spironolactone and alcohol, you may develop orthostatic hypotension, a form of low blood pressure that can occur if you stand up too quickly from sitting or lying down. This can make you feel woozy, ill, and confused.

Drinking alcohol with spironolactone can increase your risk of other side effects, including:

• Lightheadedness

• Dizziness

• Fainting

Spironolactone is a diuretic (a water pill) as is alcohol. This means that they both make you need to urinate more. So, combining the two can lead to excessive urination. If you do drink alcohol while on spironolactone, be sure to increase your water intake to avoid dehydration.

Drinking alcohol while on spironolactone may also lead to a higher risk of hyperkalemia (elevated potassium levels), which can cause heart-related complications, especially in those with kidney disease. 

Also, spironolactone is often prescribed to  manage fluid build up associated with liver disease. If you have a health condition that affects your liver, your healthcare provider has likely advised that you stay away from alcohol altogether. It’s always important to follow the recommendations of your healthcare provider.

How Alcohol Affects Your Body

Alcohol is a central nervous system depressant, meaning that it slows down your cognitive functions and reaction time. When consumed, alcohol is absorbed into your bloodstream, distributed throughout your body, and then metabolized primarily by your liver. 

Your liver breaks down alcohol into a toxic substance called acetaldehyde, which, if it accumulates, can cause damage to your organs (including your liver, leading to conditions such as cirrhosis). Acetaldehyde is then converted to acetic acid, which ultimately breaks down into carbon dioxide and water before leaving your body. 

The brain-related effects you feel when drinking are caused by altered levels of brain chemicals (neurotransmitters), which act as chemical messengers between  nerve cells. When alcohol is present, it impacts the balance of these neurotransmitters, affecting brain activity.

For example, alcohol increases the effects of an inhibitory neurotransmitter called gamma-aminobutyric acid (GABA). One of GABA’s jobs is to slow down brain activity, so when you add in alcohol effects, this leads to sedative effects. 

Alcohol also prevents an excitatory neurotransmitter called glutamate from doing its job (of promoting brain activity). 

Mix all of these interactions together, and you get the characteristic depressant effects of alcohol.

To help you better understand the risks of mixing spironolactone and alcohol, let’s do a quick breakdown of what spironolactone is.

Often marketed under the brand name Aldactone®, spironolactone is available in tablet and liquid form. It belongs to a class of medications called mineralocorticoid receptor antagonists.

Spironolactone is used to treat:

• Hormonal acne 

• Female pattern hair loss (androgenic alopecia)

• Fluid retention (edema) in people with kidney or liver disease

• Heart problems, including heart failure

• Hyperaldosteronism (excessive levels of the hormone aldosterone)

• Hypertension (high blood pressure)

• Hypokalemia (low potassium levels)

The medication is also an anti-androgen, which means it blocks certain male hormones (like testosterone). For this reason, it’s not usually recommended for men, especially when other treatments are possible.

Spironolactone is not recommended for people who already have high potassium levels (hyperkalemia), who use eplerenone (a diuretic used to treat high blood pressure and heart failure), or who have Addison’s disease, a rare disorder that occurs when the adrenal glands do not produce enough of the hormones cortisol and aldosterone.

Alcohol and spironolactone have a unique relationship: Interestingly, recent research published in the journal Molecular Psychiatry suggests that spironolactone may have potential as a treatment for alcohol use disorder (AUD).

In a cohort study, people with AUD who were on spironolactone seemed to reduce their  alcohol intake based on self-reported data. Studies done on mice and rats also suggest that spironolactone reduces alcohol consumption. 

While we can’t extrapolate findings from animal studies to humans, it’s promising to see similar effects observed in both human and animal studies. 

However, much more research is needed on the topic — particularly placebo-controlled human studies. From there, experts can assess whether spironolactone could be a viable treatment option for AUD.

Spironolactone is a safe and effective medication for most women and may be acceptable to use during breastfeeding. However, like all prescription medications, it can potentially cause adverse effects.

Side effects of spironolactone may include:

• Breast pain or breast enlargement

• Changes in body hair growth

• Muscle or leg cramps

• Dehydration

• Diarrhea

• Dizziness

• Drowsiness or fatigue

• Electrolyte imbalances

• Frequent urination

• Headaches

• High potassium levels

• Low blood pressure

• Changes in menstrual cycle

• Nausea and vomiting

• Postmenopausal vaginal bleeding

• Restlessness

• Skin rash or hives indicating a potential allergic reaction

• Stomach cramps or pain

Do any of these sound familiar? Many of these common side effects can also be caused or worsened by drinking (especially drinking in excess).

When you combine spironolactone and alcohol, you may be more likely to experience:

• Nausea

• Vomiting

• Impaired coordination and balance

• Low blood pressure

• Drowsiness or fatigue

• Dehydration

• Dizziness and confusion

Long-Term Side Effects of Spironolactone and Alcohol

In the long run, mixing spironolactone with alcohol can have potentially dangerous effects that last beyond one moment or night. For instance, regularly drinking alcohol while on spironolactone increases the risk for serious conditions like liver disease and heart problems, since alcohol can strain the liver and negatively impact heart health over time. 

Furthermore, mixing these two together can amplify the conditions you may be taking spironolactone to manage, such as high blood pressure, heart disease, or heart failure. 

Bottom line? It’s best to avoid mixing spironolactone and alcohol. If you’re going to drink, stick to one or two units of alcohol (e.g., one glass of wine or one cocktail). Be wary of the possible side effects, including how it may affect your balance and coordination.

It can be dangerous to suddenly stop drinking if you have alcohol dependence. If you frequently drink a lot of alcohol and your healthcare provider prescribed spironolactone, it’s important to let them know.

If you’re not sure if your alcohol intake is average or “too much,” you can learn more on the website Rethinking Drinking, which is run by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Sometimes, a healthcare provider might suggest stopping spironolactone. This could be because it successfully treated your acne and you’re done with it, you’re experiencing bothersome side effects, or you’ve decided to try another treatment option.

So, once you stop taking spironolactone, when can you start drinking again? How long does spironolactone stay in your system?

The short answer is that it’s a good idea to wait at least four days after your last spironolactone dosage before drinking alcohol again.

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 of 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.

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

Still, 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 have been moderating your alcohol consumption during treatment, you may have a lower tolerance for alcohol than before, so drink lightly until you get your sea legs back.

• Go slow and steady. Avoid drinking alcohol too quickly at first — no shots, no keg stands, no bar crawls, and definitely no binge drinking.

• Drink plenty of water (or other non-alcoholic drinks). Try to have one non-alcoholic drink (like a glass of water, soda, or fruit juice) between each serving of alcohol. There are lots of great mocktail recipes out there, too – try one!

• 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 (or suspect you have) an issue with alcohol misuse, tell your healthcare provider and ask for medical advice.

You can also get help at the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) or visit www.FindTreatment.gov to find help in your area.

So, can you drink alcohol while taking spironolactone? It’s best to avoid it — but if you are going to drink, do so in moderation and avoid excessive alcohol consumption.

Here’s what to keep in mind:

• Mixing spironolactone and alcohol can lead to side effects. This includes low blood pressure, dizziness, and difficulty with balance and coordination. If you have certain medical conditions, like liver disease, you might be advised to avoid alcohol altogether — and it’s imperative to comply.

• How long after taking spironolactone can you safely consume alcohol? 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.

• Speak with a professional. It’s important to talk to your healthcare provider about staying safe while using spironolactone. They might suggest reducing your alcohol intake or avoiding alcohol altogether.

If using spironolactone for hair loss doesn’t sound appealing to you, we have guides on other hair loss treatments for women, including oral minoxidil and minoxidil drops.

Self-care sometimes includes cutting down on alcohol, especially if it’s necessary for your health. And if you’re using spironolactone for hair loss, it’s a small sacrifice to make for strong, healthy hair.

Speaking of hair, want to learn more about getting the hair of your dreams? We can help connect you with a medical professional to discuss your goals and options.