Spironolactone Interactions and Risks

Starting a new prescription drug can be exciting, if you think about it.

When you’re at the point of taking a new medication, it’s because something isn’t quite right with your health. Whether a serious illness or minor infection, drugs can change your quality of life. 

But prescription medications come with risks, too. And spironolactone is no different. 

When you first discuss a new medication with your healthcare provider, it’s crucial you tell them about all other medications you’re taking — either regularly or just once-in-a-while, prescription or over-the-counter. 

It’s also important to discuss your medical history including current and past diagnoses that could affect your health now. 

For women suffering from abnormal hair growth, hair loss and acne (three off-label uses of spironolactone), the medication can dramatically improve quality of life. 

But only if you’re thorough in weighing the risks and appropriate medical advice beforehand. 

How Is Spironolactone Used 

Spironolactone is approved by the FDA for the treatment of congestive heart failure and edema, low potassium levels, hyperaldosteronism (the overabundance of the hormone aldosterone) and high blood pressure. 

Spironolactone is the generic name, though it is also sold under the name Aldactone®. 

It is also used off-label for acne, hair loss, abnormal hair growth, acne in early puberty and as an androgen blocker in transgender women.

It is a prescription drug, so you must get it through a healthcare professional. 

Dosing instructions vary based on your diagnosis, though your healthcare provider  may begin you with a low dose and slowly increase, to minimize potential side effects.

Spironolactone Drug Interactions

As with all prescription drugs, you have to be cautious about what you take in conjunction with spironolactone. 

There are several different drugs that can interact negatively with it, so it’s important to tell your healthcare provider about all medications — even over-the-counter — you take, and read the drug information and instructions that come with all of your medications.

Drugs to be particularly cautious of include: 

• ACE inhibitors, or certain heart medications

• Potassium supplements

• Drugs known to cause hyperkalemia such as heparin, aldosterone blockers, and angiotensin II antagonists

• Alcohol and illicit drugs including narcotics 

• Corticosteroids 

• Tubocurarine or other muscle relaxants 

• Lithium 

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

• Digoxin

• Cholestyramine 

Your healthcare provider may adjust your dosage to minimize potential reactions between drugs, or may suggest an alternative to either spironolactone or another current drug you’re on.

Side Effects of Spironolactone

The list of potential side effects with nearly any prescription drug is long, but just because the side effects are possible doesn’t mean you’ll suffer with them all. Talk with your healthcare provider  if any of these side effects are particularly concerning, or if you experience them with no relief while on spironolactone. 

Side effects of spironolactone may include:

• Vasculitis

• Ataxia

• Confusion

• Dizziness

• Lethargy

• Drowsiness

• Headache

• Nipple and/or breast pain

• Alopecia

• Toxic epidermal necrolysis

• Erythematous maculopapular rash pruritus

• Stevens-Johnson syndrome

• Urticaria

• Chloasma

• Electrolyte disorder

• Amenorrhea

• Asymptomatic hyperuricemia

• Decreased libido

• Hypocalcemia

• Hyperglycemia

• Hyperkalemia

• Hypomagnesemia

• Hyponatremia

• Hyperuricemia

• Hypovolemia

• Abdominal cramps

• Gastritis

• Diarrhea

• Gastrointestinal ulcer

• Gastrointestinal hemorrhage

• Nausea

• Vomiting

• Gout

• Menstrual irregularities

• Agranulocytosis

• Leukopenia

• Thrombocytopenia

• Postmenopausal bleeding

• Metabolic acidosis

• Hepatotoxicity

• Anaphylaxis

• Renal insufficiency

• Lower limb cramp

• Renal failure syndrome

• Fever

• Drug reactions with eosinophilia and systemic symptoms

Other Spironolactone Risks 

Spironolactone has a Category C rating from the FDA, which means you should not take spironolactone if you’re pregnant or intend on becoming pregnant.

Spironolactone may potentially affect the hormones of an unborn child leading to endocrine dysfunction into adulthood. 

However, there is limited understanding of the full potential effects  of spironolactone in pregnant women, so talk to your healthcare provider before taking spironolactone if you’re considering children. 

Breastfeeding women should also exercise caution, as spironolactone can appear in breast milk with unknown potential effects. If the use of this drug is deemed essential by your healthcare provider you should discuss alternative methods of feeding your baby. 

People with Addison’s disease, high potassium levels, and some kidney and liver diseases should not take spironolactone, so be sure to discuss your medical history with your healthcare provider before beginning treatment.