Medication Overview Spironolactone
The following provides a medication overview of Spironalactone and how to effectively and safely use it to support hair loss. You will also receive a physical document called a medication guide or patient drug information in the package with your medication when it arrives from the pharmacy which contains full information about Spironalactone — you should read all of the information that comes with your prescription shipment before taking your medication and at each refill. It’s important to take your medication as directed by your provider and to review the directions on your prescription label. This medication overview reviews the risks and benefits of spironolactone for the treatment of female pattern hair loss (androgenic alopecia). Please make sure to read it in addition to the manufacturer’s pamphlet that comes with the medicine.
What is spironolactone?
Spironolactone is an aldosterone antagonist. It is FDA-approved for the treatment of heart failure, hypertension, edema, and primary hyperaldosteronism. Spironolactone is also known as a potassium-sparing diuretic. This means that it promotes the loss of sodium and water through the urine and the retention of potassium in the blood. Although it is not FDA-approved for hair loss, spironolactone is used off-label as an effective treatment for hormonally-activated hair loss in women. In the treatment of female pattern hair loss, spironolactone works by blocking androgen receptors in hair follicles. This prevents the shortening of the hair growth phase and miniaturization of the hair follicle, both of which can lead to hair loss. Spironolactone is not used in males for the treatment of hair loss due to its side effects. Spironolactone is only available with a healthcare provider’s prescription.
Age Range: Through the Hers platform, spironolactone is only available to premenopausal women, born female, between the ages of 18-45.
How should I take spironolactone?
Spironolactone can be taken with or without food. Taking spironolactone with food may reduce stomach upset. It’s important to stay well-hydrated to avoid feeling light headed or dizzy. You should drink plenty of water throughout the day. Taking the medication at night can also help reduce symptoms. Taking spironolactone after dinner is one way to minimize side effects.
How long does it take for spironolactone to work?
It may take between 6-12 months for improvement to be seen.
Are there any dietary restrictions that I should follow while taking spironolactone?
While taking spironolactone, excessive potassium intake should be avoided. This includes avoiding potassium-containing supplements in addition to salt substitutes that contain potassium. Coconut water contains high amounts of potassium and should be avoided. Most other foods, including bananas, are safe to consume in moderation.
Drinking alcohol may increase certain spironolactone side effects, such as headache or dizziness.
You are not a candidate for treatment with spironolactone through the Hers platform if any of the following apply to you. You should speak with a healthcare provider in-person about treatment for your female pattern hair loss if:
You have a hypersensitivity or allergy to any of the ingredients in spironolactone:
Active ingredient: spironolactone
Inactive Ingredients: lactose monohydrate, dibasic calcium phosphate, povidone, peppermint oil, purified talc, pregelatinized starch, colloidal anhydrous silica, magnesium stearate, hypromellose, polyethylene glycol 400, titanium dioxide, iron oxide yellow, iron oxide red
You are taking any of the following medications:
Eplerenone
Cholestyramine
Daily use of acetylsalicylic acid (aspirin) or NSAIDS (e.g., ibuprofen, advil, aleve, naproxen)
Potassium supplements
Drugs that increase serum potassium levels (e.g., ACE-inhibitors, angiotensin-receptor blockers, Heparin or low molecular weight heparin)
Lithium
Digoxin
You have any of the following conditions:
Hyperkalemia (elevated potassium levels)
Addison’s disease
Kidney or liver disease
Electrolyte imbalances
Heart disease
Gout
Adrenal gland disorder
Irregular menstrual periods that have not been evaluated by a healthcare provider in-person
Recent onset of excessive hair growth on the face or body, enlargement of the clitoris, and/or deepening of the voice
Can I take spironolactone if I am pregnant, breastfeeding, or planning to become pregnant?
No, spironolactone is contraindicated during pregnancy. You must tell your provider if you are pregnant, breastfeeding, or planning to become pregnant. Spironolactone is not available to pregnant or breastfeeding women through the Hers platform. If you are breastfeeding, please speak to a healthcare provider in-person to see if spironolactone is an appropriate treatment for you.
What are some of the more common side effects of spironolactone?
Headache, dizziness, drowsiness, confusion
Nausea, vomiting, diarrhea
Abdominal pain
Irregular menstrual periods
Breast tenderness/enlargement
Decreased libido
Hyperkalemia (elevated potassium level in your blood) is a reported serious side effect of spironolactone. Hyperkalemia is rarely seen in young, healthy individuals under 45 without underlying kidney or heart disease. Contact your healthcare provider right away if you experience any of the following symptoms of hyperkalemia:
Confusion
Fatigue
Muscle pain or weakness
Difficulty with breathing
Irregular heartbeat
Nausea
Tingling or numbness in the arms, hands, legs, or feet
These are not all of the possible side effects of spironolactone. For more information, ask your healthcare provider or pharmacist.
Contract your healthcare provider for medical advice about side effects. You can message a healthcare provider through your Hers account if you have any questions about your treatment, including any side effects you may be experiencing. You may report side effects to FDA by calling 1-800-FDA-1088 or visiting http://www.fda.gov/MedWatch.
If I am sexually active, is it important to use an effective form of contraception while taking spironolactone?
Yes, spironolactone can potentially cause birth defects in a developing fetus (e.g., feminization of a male fetus). You should use a reliable form of birth control while taking spironolactone. If you are concerned that your birth control method was ineffective or failed, over-the-counter emergency contraception is available but must be taken within 72 hours (3 days) following the sexual act. Prescription emergency contraception (ella®) is also available through a healthcare provider and must be taken within 5 days following the sexual act.
Oral contraceptive pills are often prescribed with spironolactone as a form of birth control and to help maintain regular menstrual periods while preventing side effects, such as breast tenderness.
If you become pregnant while taking spironolactone, you should immediately stop taking spironolactone and inform a medical professional.
Use & Storage
Store the medicine in a closed container at temperatures below 77 degrees Fahrenheit (25 degrees Celsius). Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed.
Accurate Information
Your provider has evaluated the specific health information you provided and is making recommendations based on it. If you forgot to provide or incorrectly provided any information, your provider may misdiagnose or fail to diagnose conditions that you may have which could affect their recommendation for treatment. If you need to clarify or update any information about your health, please message a provider through the Hers platform.
Treatment Failure
This treatment is not 100% effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If you do not see any signs of improvement or if you are experiencing new or worsening symptoms, message a provider through the Hers platform anytime or contact your regular healthcare provider. If it is an emergency, call 911 or seek immediate help in-person.
Misdiagnosis or Delayed Diagnosis
There is also a risk that your provider will misdiagnose or fail to diagnose conditions that you may have which could affect the recommendation for treatment. The healthcare providers providing treatment through the Hers platform use evidence-based guidelines as well as clinical decision-making to try to minimize these risks.
Accepting or Declining The Recommendation
Your provider is recommending this treatment for you because the potential benefits outweigh the risks in their estimation. You should evaluate this information and any input from your in-person healthcare team, and any other relevant information to decide if this treatment plan is appropriate for you. You are free to not follow the recommendations you received from the provider through the Hers platform.
Share with Your In-Person Healthcare Team
You can request access to your records anytime. We strongly recommend that you update your in-person healthcare team about any new medicines that you are taking or other changes in your health.
You can also ask questions anytime by messaging a provider through the Hers platform, and we are happy to help you share any information about your health with your in-person healthcare team.
FAQ:
Is it normal to see an increase in hair shedding when starting new hair loss treatment?
Shedding is a fairly common side effect when starting a new hair loss medication. It can occur with any treatment but is most common with minoxidil. While it can be a cause for alarm, it is part of the process and means the medication is working. Typically we don’t recommend adjusting therapy except for intolerable shedding or shedding that lasts longer than 2 months. If you have continued shedding after the first 2 months of treatment, please let us know so we can connect you with your provider who can go over the next steps. You can find more information about this here: https://www.hims.com/blog/how-long-before-minoxidil-starts-working#minoxidil-and-hair-shedding https://www.hims.com/blog/finasteride-is-working-now-how-to-keep-that-new-hair
When can I see results from hair loss treatment?
All hair loss medications take about 4-6 months to see results. If you are not seeing results after 6 months of treatment, or if you are experiencing any side effects, then please reach out for re-evaluation. Since hair growth is gradual it may be helpful to take a progress photo each month. Try to take photos in the same lighting at the same angle. If you always get the same haircut then right afterwards is a great time to take a progress photo so your hair is the same length. You can find more information about this here: https://www.hims.com/blog/finasteride-results-timeline https://www.hims.com/blog/how-long-before-minoxidil-starts-working
Can I use a dermaroller with my topical treatment?
You may opt to use a dermaroller to increase the efficacy of your topical formulation. Follow the instructions specific to the device. Make sure to apply the dermaroller with light pressure to minimize bleeding on your scalp for 2-5 minutes at night, preferably after showering, and before you apply your topical formula. It is recommended to wait a few weeks after starting your topical formula to let your skin adjust before trying a dermaroller. While dermarollers come in different needle sizes, starting with 0.25mm is the best to start with. Disinfecting the dermaroller after use by soaking in 70% isopropyl alcohol is very important to prevent infection. Most studies involve using a dermaroller one night a week. Be sure to avoid using a dermaroller if your skin feels irritated or swollen. You can find more information about this here: https://www.hims.com/blog/dermaroller-and-minoxidil
Is it safe to drink alcohol while taking hair loss medications?
It’s safe to drink alcohol in moderation while taking your hair loss medications, however heavy alcohol consumption can affect your nutrient absorption to the point where you may develop nutritional deficiencies that can cause hair loss. Furthermore, drinking alcohol while taking oral minoxidil can potentially cause a decrease in blood pressure causing light-headedness, dizziness, or fainting. You can find more information about this here: https://www.hims.com/blog/alcohol-and-hair-loss https://www.hims.com/blog/finasteride-and-alcohol https://www.hims.com/blog/minoxidil-interactions
Does wearing my hair in tight hairstyles cause hair loss?
If you wear your hair in tight hairstyles this puts a lot of strain on your hair follicles. With continued use, it will eventually lead to scarring and permanent loss of hair, which we call traction alopecia. In order to prevent further hair loss, it’s important to avoid wearing tight hairstyles and give your hair breaks between artificial hair use or braiding. If it hurts while your hair is being styled, you should ask the stylist to stop and redo it since pain signals damage at the hair root. Combining tight hairstyles with chemically treated hair increases the risk of traction alopecia and should be avoided. Hair loss treatments will help the hair that you have to grow thicker, but it will not regrow hair where scarring has already occurred.