The lists of side effects rattled off on television commercials for prescription drugs can be laughable — they’re the inspiration for many memes and Saturday Night Live skits.

But when you experience these unpleasant side effects, the joke suddenly stops. 

As with other prescription drugs, spironolactone comes with a lengthy list of potential side effects.

However, just because these effects are possible doesn’t make them all likely. But knowing what you risk by taking spironolactone may help you make a better-informed decision  about whether it’s right for you. 

TL;DR: What You Need to Know About Spironolactone 

• Spironolactone is a prescription medication approved by the FDA to treat edema, congestive heart failure, high blood pressure and hyperaldosteronism. 
• It is also used off-label in the treatment  of acne in women. 
• The most common side effect experienced among men on spironolactone is gynecomastia, or the enlargement of the breast tissue. 
• As with all prescription drugs, the use of spironolactone should be decided after close discussion with a healthcare provider about the benefits versus risks. 

What Is Spironolactone?

Spironolactone is a prescription drug sometimes sold under the brand names Aldactone® and Carospir®.

It is known as an aldosterone antagonist, which means it reduces the effect of aldosterone  within the body.

Aldosterone is a hormone produced by the adrenal gland that plays a role in cardiovascular and renal health. 

Spironolactone is approved by the Food and Drug Administration to treat several conditions, but is also used “off-label” for the treatment of acne in women.

“Off-label” means that the FDA has not specifically approved spironolactone for the treatment of acne, although it is frequently used for this purpose in dermatologic healthcare.

According to the drug’s label, spironolactone is used to treat: 

• Hyperaldosteronism (when the body produces too much aldosterone), resulting in low potassium levels
• Hypertension, or high blood pressure 
• Edema or fluid retention
• Heart failure

Possible Spironolactone Side Effects

As with all prescription drugs, using spironolactone comes with risks of side effects. Because the drug alters the hormone balance within your body, many of the side effects are hormonal in nature. 

For men: The most common side effect of spironolactone is gynecomastia, or the enlargement of breast tissue in men, according to the drug’s manufacturer. In men, the drug may also cause erectile dysfunction.

Additional possible side effects of spironolactone include: 

• Stomach ache and cramping
• Diarrhea
• Vomiting
• Drowsiness
• Restlessness
• Irregular menses
• Breast pain

Rare, but serious possible side effects include: 

• Changes in heartbeat
• Confusion
• Muscle pain, weakness, and cramping
• Signs  of dehydration
• Flu-like symptoms
• Difficulty breathing or swallowing
• Rash, hives and/or itching
• Bloody stools or vomit
• Fainting
• Appetite changes
• Unusual bruising or bleeding 

If you experience serious side effects while taking spironolactone, contact your healthcare provider for medical advice immediately. 

Spironolactone Drug Interactions 

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
• Digoxin
• Lithium
• Cholestyramine
• Acetylsalicylic Acid 
• Eplerenone

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.

Other Spironolactone Precautions 

Some people should not take spironolactone, including those with Addison’s disease or  hyperkalemia.

Drinking alcohol while on spironolactone can cause exaggerated effects like dizziness, but also lightheadedness and fainting upon standing. If you drink regularly, tell your healthcare provider before beginning spironolactone.