Spironolactone: What it is, How it Works, Side Effects & More

    Dr. Leah Millheiser, MD Headshot
    Medically reviewed by Leah Millheiser, MD Written by Our Editorial Team Last updated 5/16/2020

    If you’ve searched online for products to treat acne, you may have heard of a medication called spironolactone. 

    Spironolactone is a prescription medication. Sold under the brand name Aldactone®, as well as several others, it’s prescribed to treat a variety of different conditions including:

    • Hyperaldosteronism (a condition in which the body produces too much of the hormone aldosterone)
    • Heart failure
    • Low potassium levels
    • Hypertension (high blood pressure)
    • Edema

    It’s also used to treat certain forms of acne in women, including the hormonal acne that can develop and affect your skin during your menstrual cycle.

    If you have hormonal acne, your healthcare provider may recommend spironolactone on an “off-label” basis either on its own or in combination with other medication to reduce breakouts and improve your skin. 

    Below, we’ve explained exactly what spironolactone is and how it works to treat both acne and other conditions. We’ve also looked at the advantages and disadvantages of spironolactone in comparison to other acne medications, as well as its potential side effects. 

    What Is Spironolactone?

    Spironolactone is a prescription medication that’s used to treat a wide range of diseases and health conditions. 

    Spironolactone belongs to two medication classes. First, it’s a diuretic — a type of medication that increases your body’s excretion of excess fluids, causing you to expel more water.

    Second, it’s an antiandrogen — a type of medication that reduces the effects of androgens such as testosterone in the body. 

    Spironolactone was developed throughout the 1950s and first received approval from the FDA in 1960. Today, it’s a widely used medication with millions of prescriptions written for it every year.

    You may have seen spironolactone for sale under the brand name Aldactone®. It’s also available as a generic medication under a variety of different brand names. 

    As a diuretic, spironolactone is used to treat fluid retention in people with liver disease, kidney diseases such as nephrotic syndrome, and heart diseases such as congestive heart failure. 

    It’s also used as an effective treatment for people with high blood pressure and those with hypokalemia, a condition in which the blood has too little potassium. 

    As an antiandrogen, spironolactone is sometimes prescribed to treat hormonal acne in women, particularly cases of acne that don’t respond to other medications. Although spironolactone is not FDA-approved for the treatment of hormonally-activated acne in women, it is widely accepted by the medical community as an effective treatment for this type of acne.

    How Does Spironolactone Work

    Spironolactone works by blocking the action of a hormone called aldosterone, which is used by the body to retain water and sodium. 

    Aldosterone is produced in the adrenal glands. People with high blood pressure, low potassium levels and other health conditions often have overly high levels of aldosterone. Aldosterone can also contribute to water retention in people with conditions such as kidney failure. 

    By reducing the effects of aldosterone, spironolactone can force the body to excrete extra fluid and lower blood pressure, reducing the level of strain on the heart, kidneys and other organs. 

    Spironolactone for Hormonal Acne

    As a treatment for hormonal acne, spironolactone’s role in the body is a little more complicated.

    A range of factors can contribute to the development of acne. There are generally four big ones, and certain hormones (androgens) are one of them.

    Despite its reputation as a “male” hormone, both men and women produce testosterone. Men produce testosterone in much larger quantities than women, along with very small amounts of “female” hormones such as estrogen.

    Likewise, women produce a larger amount of sex hormones such as estrogen, plus a smaller amount of testosterone.

    As a woman, testosterone also plays an important role in maintaining well-being, cardiovascular function, bone strength and influencing pain perception.

    Unfortunately, it can also be a serious annoyance for your skin. When your body produces more testosterone than normal, such as before your period, it can also produce more sebum — a type of natural oil that your body uses to lubricate and moisturize your skin.

    When sebum levels get too high, they can clog pores and trigger an acne breakout, leaving you with whiteheads, blackheads and, in some cases, even painful cystic acne.

    We’ve gone into more detail on this process in our full guide to hormonal acne, which covers the role of testosterone in the development of acne and the most common symptoms of a hormonal acne breakout. 

    Enter spironolactone. As an antiandrogen, spironolactone reduces the effects of androgens like testosterone in your body. This can lower the amount of sebum that’s secreted from your skin, resulting in fewer and less severe acne breakouts.

    Although the effects of spironolactone on acne aren’t immediate, most studies show that it’s an effective treatment for hormonal acne.

    One study from 2017 found that the majority of women with acne who received spironolactone as a treatment saw a “dramatic improvement” in their acne. 

    A separate four-year study found that 86.9 percent of people who had previously been treated for acne and 93.2 percent of people who had never been treated before using spironolactone experienced improvements in their skin. 

    Spironolactone may be particularly effective at treating stubborn acne that doesn’t respond to other treatments, including deep-seated acne on the jawline, neck and lower face

    Spironolactone Dosages

    Spironolactone is available in a range of dosages to treat different conditions. Depending on the condition for which you’re prescribed spironolactone, your age, your general health and several other factors, your healthcare provider may prescribe a different dosage from those listed below.

    Spironolactone typically comes in tablet form at strengths of 25, 50 or 100mg per tablet. It’s also available as an oral solution. Carefully check the strength of your spironolactone tablets and use them as prescribed by your healthcare provider. 

    For hormonal acne, spironolactone is typically prescribed at a dosage of 50 to 200mg per day in one or two doses. In some cases, such as if you have mild acne or if use spironolactone as well as another acne medication, your healthcare provider may recommend a dosage of 25mg per day. 

    Depending on the severity of your acne and other factors, your healthcare provider may prescribe a relatively low starting dosage of spironolactone and adjust your dosage over time.

    If you’re prescribed spironolactone, closely follow the instructions provided by your healthcare provider. You should not adjust your dosage of spironolactone or stop taking this medication without talking to your healthcare provider.  

    Spironolactone Side Effects and Interactions

    Like other medications, spironolactone can cause side effects. The frequency and severity of these side effects can vary based on the dosage of spironolactone you’re prescribed. 

    Side effects of spironolactone may include:

    • Gynecomastia in men
    • Vasculitis
    • Ataxia
    • Confusion
    • Dizziness
    • Drowsiness
    • Headache
    • Lethargy
    • Nipple pain
    • Alopecia,
    • Chloasma
    • Erythematous maculopapular rash pruritus
    • Stevens-Johnson syndrome
    • Toxic epidermal necrolysis
    • Urticaria
    • Amenorrhea
    • Asymptomatic hyperuricemia
    • Decreased libido,
    • Electrolyte disorder
    • Gout
    • Hyperglycemia
    • Hyperkalemia
    • Hyperuricemia
    • Hypocalcemia
    • Hypomagnesemia
    • Hyponatremia
    • Hypovolemia
    • Abdominal cramps
    • Diarrhea
    • Gastritis
    • Gastrointestinal hemorrhage
    • Gastrointestinal ulcer
    • Nausea
    • Vomiting
    • Erectile dysfunction
    • Irregular menses
    • Breast pain
    • Postmenopausal bleeding
    • Agranulocytosis
    • Leukopenia
    • Thrombocytopenia
    • Hepatotoxicity
    • Anaphylaxis
    • Drug reaction with eosinophilia and systemic symptoms
    • Lower limb cramp
    • Renal failure syndrome
    • Renal insufficiency
    • Fever
    • Metabolic acidosis

    Some of these side effects may be temporary. If you experience persistent side effects after you start using spironolactone, or if any of the side effects listed above become severe, talk to your healthcare provider. 

    If you experience any of the serious side effects listed above after using spironolactone, either on its own or with other medications, call your healthcare provider as soon as possible. 

    Interactions Between Spironolactone and Other Medications

    Spironolactone may interact with other over-the-counter or prescription medications, as well as health supplements and herbal products.

    Some interactions between spironolactone and other medications may increase the side effects of either medication, or prevent either medication from working properly. Others may potentially cause harmful side effects. 

    Medications that can interact with spironolactone include ACE inhibitors, angiotensin II receptor blockers (ARBs), potassium supplements, anticoagulant medications such as heparin and low molecular weight heparin (LMWH) and other potassium-sparing diuretics.

    These medications can cause a dangerous increase in your potassium levels, increasing your risk of experiencing severe side effects when used with spironolactone. 

    Other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen, acetylsalicylic acid and psychiatric drugs such as lithium, may interact with spironolactone and should not be used at the same time as this medication. 

    To avoid interactions, inform your healthcare provider of all other medications that you currently use or have recently used before discussing spironolactone. 

    Spironolactone and Pregnancy

    Spironolactone has a category C rating from the FDA, meaning that animal studies have found that it may have adverse effects on the fetus. Although there isn’t enough human data to make any certain statements, this medication may have negative effects on the genitalia of a  male fetus. 

    If you’re prescribed spironolactone for hormonal acne or any other condition and think that you may be pregnant, talk to your healthcare provider as soon as possible. 

    You should not take spironolactone during pregnancy. 

    You should also talk to your healthcare provider if you’re planning to become pregnant in the near future and currently use spironolactone.

    Certain byproducts of spironolactone, such as the metabolite canrenone, can pass into breast milk. If you’re currently breastfeeding or plan to breastfeed, make sure you talk to your healthcare provider about this before discussing spironolactone. 

    Learn More About Treating Hormonal Acne

    If you frequently get acne breakouts, especially before and during your period, your healthcare provider may recommend spironolactone as a treatment option.

    Spironolactone is an effective treatment for acne. However, it’s not the only option that you can use to improve your skin. From topical creams to other oral medications, a variety of treatments are available that can help you stop acne breakouts and enjoy smoother, pimple-free skin.

    Our guide to hormonal acne goes into more detail on how and why acne breakouts happen, as well as the most effective acne treatments that are currently available. 

    Frequently Asked Questions About Spironolactone

    How and When Should You Take Spironolactone?

    Spironolactone comes in tablet and liquid solution form. If you’re prescribed spironolactone to treat fluid retention caused by heart failure, kidney disease, liver issues or any other non-acne health condition, closely follow your healthcare provider’s instructions regarding dosage and usage. 

    For treating hormonal acne, spironolactone is typically prescribed in tablet form, either as one dose or two tablets per day. 

    Spironolactone can be taken on its own or with food. You may prefer to take spironolactone in the morning, as this medication’s effects on fluid retention can cause you to urinate frequently, potentially interfering with your ability to sleep. 

    How Long Does it Take Spironolactone to Work for Acne? 

    After you start using spironolactone, it may take several weeks to see a reduction in acne and improvements in your skin. This is both because the medication requires time to start working and because you may need to gradually increase your dosage after starting treatment.

    According to the American Academy of Dermatology, you should see a decrease in breakouts and oiliness within a few weeks of starting spironolactone. 

    If you don’t notice improvements after six to eight weeks of starting spironolactone, don’t stop taking this medication suddenly. Instead, talk to your healthcare provider. Depending on the severity of your acne, they may recommend adjusting your dosage of spironolactone. 

    Is it Safe to Use Spironolactone and Hormonal Birth Control?

    Yes. Unless you have an existing health condition that prevents you from using the birth control pill or other forms of hormonal contraception, it’s safe to use spironolactone with the pill. In fact, spironolactone and birth control pills are often prescribed together to treat hormonal acne.

    If you have severe or persistent hormonal acne, your healthcare provider may recommend using a combined birth control pill and spironolactone for improved effectiveness. 

    Our guide to the birth control pill and acne goes into more detail about how certain types of the birth control pill can help to treat hormonal acne breakouts, either on their own or when used in combination with medications like spironolactone.

    How Long Does Spironolactone Stay in Your Body?

    Spironolactone has a relatively short half-life of approximately 1.4 hours, meaning a standard dosage will exit your system relatively quickly. However, some metabolites of spironolactone have a significantly longer half-life and may stay in your body for several days before being fully eliminated. 

    I Compete in Sports. Can I Use Spironolactone?

    Spironolactone is a diuretic that may have performance-enhancing properties. It’s included in the World Anti-Doping Agency list of banned diuretics and masking agents. If you compete in drug-tested sports, using spironolactone to treat acne or another condition could cause you to fail a drug test. 

    If you’re an athlete with concerns about using spironolactone, it’s best to contact your sports governing body for more information. 

    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.