Medically reviewed by Leah Millheiser, MD
Written by Our Editorial Team
Last updated 2/26/2022
Spironolactone is an increasingly popular medication prescribed by dermatologists to help fight acne. However, like all prescription drugs, spironolactone side effects are a thing.
Although Spironolactone was initially utilized in clinical practice as a potassium-sparing diuretic, it’s been used off-label for acne since the 1980’s.
In this article, we’re going to break down for you what makes Spironolactone unique — how and why it’s effective in combating acne, its side effects, as well as other skin care options for you, should you want to expand your skin care game a little bit more to get healthier, brighter skin.
It can also be referred to as a potassium drug of sorts — a potassium-sparing diuretic.
Spironolactone can help patients with low levels of potassium and serve as a potassium supplement of sorts.
Originally, a potassium-sparing diuretic like spironolactone was developed to treat high blood pressure, and it’s still prescribed for that very purpose.
Another purpose spironolactone serves is helping people who retain too much fluid, making it commonly referred to as a water pill.
Like other medications, however, in the process to target one dilemma (how to assist people with high blood pressure, for example), researchers found that spironolactone was quite effective in assisting women with acne problems.
However, the effects of spironolactone doesn’t just show in helping women who experience problematic acne. Spironolactone also assists women who experience excessive hair growth.
Since spironolactone is a form of hormonal therapy — and consequently more potent than your typical over-the-counter medications — it’s usually employed by dermatologists and other health care providers to treat female patients with severe acne after other alternatives have been exhausted.
Acne is a skin condition in which hair follicles under your skin get clogged.
Oil and dead skin cells crowd and stop up the pores, plugging them if you will, resulting in the outbreaks of lesions — you might know them as zits.
While acne most commonly rears its head (get it?) on the face, it can also show up on your shoulders, back and chest.
Acne is extremely common. Further, acne can show itself going into your forties and fifties.
Most people, however, see their acne go away far sooner than middle age.
While acne can cause scarring and disfigurement, one of its most profound effects on anyone is its psycho-sociological impact.
When it comes to adverse effects — side effects of any kind — the effects of spironolactone have been rigorously studied.
In one eight-year study, the data showed that, although there were side effects to taking this medication, the side effects typically didn’t cause discontinued use of the medication itself.
According to the American Dermatological Association, the most common side effects of spironolactone are:
Side effects are always worth being concerned about. Some folks may fear they’ll develop congestive heart failure, improper kidney function, heart disease, have a heart attack — shoot, have multiple heart attacks.
Look, any time you’re taking a serious medication like this, it’s only natural to be concerned.
But, to sum it up, while there are known side effects to taking this specific drug, spironolactone has been studied since the ‘70s.
Researchers now have decades worth of data to find connections between the risks or lack thereof, and they feel confident in stating that the drug is safe.
Other known side effects of spironolactone include:
Irregular menstrual period
Deepening of the voice
Post menopausal vaginal bleeding
Increased hair growth in parts of the body
One potential side effect of Spironolactone that has caused serious concern, however, is whether women who use it have a higher risk of breast cancer.
That concern stems from a 1975 study that found a correlation. Since then, the connection between taking spironolactone and breast cancer has been studied rigorously.
However, there has not been sufficient data to suggest there’s a solid, incontrovertible link between breast cancer and the taking of spironolactone.
Further, in the aforementioned eight-year study, there were no cases of breast cancer. It’s worth nothing, however, that four patients in that study underwent breast biopsies.
The good news: the outcomes of all those biopsies were benign.
And if all of that still doesn’t put your concerns to rest, it’s also worth noting that spironolactone is approved by the Food and Drug Administration (FDA), which means it went through the same rigorous trial and testing periods as every other drug that gets their stamp of approval.
Either way, the best thing to do if you have any questions about medications you’re thinking about taking is have a talk with your healthcare provider.
Relatively mild-ish side effects profile, super effective… What’s not to like?
Well, it’s worth noting that spironolactone is not indicated for use in women who are pregnant or are trying to conceive, as it currently has a “C” pregnancy rating by the FDA.
Even though spironolactone doesn’t wind up present in breast milk, it does mean that spironolactone may have an adverse or harmful effect on a fetus.
It’s also worth noting that all this talk about potential spironolactone side effects are only in reference to folks who were assigned female at birth.
People who were assigned male at birth are prohibited from using spironolactone as the side effects are not only severe, but are extreme.
Aside from being a diuretic, spironolactone is also a type of drug called an antiandrogen, which means it reduces the effects of male sex hormones (like testosterone) in the body.
Men who take spironolactone may experience side effects gynecomastia, which is the enlargement of breast tissue, which is a fancy way of saying it’ll make you grow boobs.
Some drugs must not be taken with spironolactone due to the risk of adverse effects. Your healthcare provider will help you determine if the medications you’re on can cause an interaction.
Make sure you tell your them about everything you take, both prescription and over-the-counter, as even potassium supplements may interfere with spironolactone.
The following are a sampling of medications that should be avoided while taking spironolactone:
Drugs designed to increase potassium levels
Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen
Editor’s note: while the above medications may, in some circumstances, be taken while under the supervision of a healthcare provider, eplerenone can never be taken while using spironolactone.
So, you’ve read the research and you’re not entirely sure spironolactone is the right choice for you. Hey, that’s completely fair.
Luckily, there are plenty of other options out there to help women with acne woes.
Hormonal therapies are typically employed when topical treatments for acne prevention or diminishment just aren’t cutting the proverbial mustard.
When it comes to antibiotics, you have yourself an all-encompassing term. What are they exactly? Antibiotics are any kind of medicine used to fight a bacterial infection.
Some common antibiotics you could be taking, if that’s the route you want to go when it comes to acne prevention, are:
Retinoids have long been considered mainstays in the treatment of acne, mostly because they work.
They come in a variety of shapes and sizes, but generally, your three options — in order from least to most harsh — are products like retinol (which are available over-the-counter), tretinoin (which is available by prescription only) and isotretinoin (which is also available by prescription only).
Retinol is offered in plenty of over-the-counter cosmetics and skin care products because of its mild side effects profile. But it’s also designed for people who only have mild acne issues.
Tretinoin is a topical retinoid that’s applied directly to the skin and comes in several different concentrations. Because it’s prescription-only, you’ll generally work with a dermatology provider to determine what concentration is best for you.
Isotretinoin is another prescription-only medication. In fact, your dermatologist or healthcare provider will likely only prescribe you an isotretinoin if you have severe acne and if other treatments simply aren’t cutting it.
Isotretinoin is considered probably the most efficacious acne treatment available. However, this medication also comes with the risk of some pretty rough side effects.
Think of isotretinoin as a heavy hitter of sorts. You only want to bring out the heavy hitter when the job is absolutely necessary, right?
Now, you might ask yourself: how serious does the acne have to be in order for a dermatologist or other healthcare provider to prescribe an isotretinoin?
The answer: the kind of acne that can cause deep, painful cysts and nodules, often the size of a pencil eraser — or even larger.
The consequence of this kind of acne leaves scars.
Spironolactone was first developed as a heart medication. However, over the years, it’s also proven effective as a treatment for other issues — including acne.
Rigorous study has shown that spironolactone is a solid solution to combating acne — a solution that requires contacting a healthcare professional or dermatology practitioner and having a discussion.
However, like all prescription drugs, there are some side effects you should be aware of. From mild to wild, they include things like irregular menstruation and breast tenderness, to potential birth defects if it’s taken while you’re pregnant.
If you speak with your healthcare provider and decide spironolactone isn’t necessarily right for you, there are plenty of other options they’ll be able to recommend, including antibiotics and retinoids.