Derm Tips from Dr. Fitz - Spironolactone for Acne

Spironolactone for Acne

Spironolactone is sometimes used off-label to treat women with persistent adult acne due to increased androgen levels, because the drug is able to inhibit the activity of sebaceous glands (small skin glands that releases an oily, lubricating substance called sebum). The development of acne lesions is associated partly with increased sebum secretion, which can be stimulated in women by androgen excess.

Spironolactone for Hair Loss and Hirsutism

Because of its anti-androgen activity, spironolactone is also used off-label to treat female-pattern hair loss and hirsutism. Women with certain endocrine disorders produce more androgens than normal, leading to hair loss on the top or front of the scalp, and increased hair on the face and other (generally hair-free) body areas. Spironolactone helps by slowing down the production, and blocking the action of androgens.

Pregnancy and Spironolactone

Spironolactone may pose risks to a developing fetus. Some research suggests that spironolactone has the potential to feminize male fetuses during early pregnancy and cause endocrine problems in late pregnancy by inhibiting the activity of male hormones (androgens). In general, diuretics such as spironolactone aren't recommended for pregnant women. Unless the drug is absolutely necessary, it's not recommended for women who are breastfeeding because canrenone, a byproduct of spironolactone, is excreted in breast milk.

Common Side Effects of Spironolactone

• Vomiting, diarrhea, and stomach pain or cramps.
• Dry mouth and thirst.
• Dizziness, unsteadiness, and headache.
• Gynecomastia (enlarged breast tissue) in men, and breast pain in women.
• Irregular menstrual periods and post-menopausal vaginal bleeding.
• Erectile dysfunction.
• Deepening of the voice and increased hair growth.
• Numbness or tingling.
• Paralysis in the arms or legs.
• Arrhythmia.
• Confusion, extreme tiredness, and fainting.
• Unusual bleeding or bruising.
• Life-threatening skin reactions.
• Flu-like symptoms, pain in the upper right abdomen, loss of appetite, vomiting blood, or bloody stools.
• Difficulty breathing or swallowing.
• Decreased urination.

Severe Side Effects of Spironolactone

• Muscle pain or weakness.

Spironolactone Can Have a Negative Interaction with the Following Drugs:

• Lithium (Eskalith, Lithobid).
• ACE inhibitors, such as benazepril (Lotensin).
• Angiotensin II receptor blockers, such as azilsartan (Edarbi).
• Digoxin (Lanoxin).
• Cholestyramine (Questran, Cholybar).
• Steroids such as prednisone.
• Ibuprofin (Advil) and other non-steroidal anti-inflammatory drugs.
• Inspra (Eplerenone) and other aldosterone receptor antagonists.
• Heparin (Hemochron, Hep-Lock) and low-molecular-weight heparin (Lovenox).
• Skeletal muscle relaxers, including cyclobenzaprine (Amrix, Flexeril).
• Other diuretics, such as amiloride (Midamor).
• Norepinephrine.
• Potassium supplements.

Spironolactone Alcohol and Sedative/Narcotics

While taking spironolactone, consumption of alcohol, narcotics, or barbiturates (a sedative) can cause dizziness, lightheadedness, or fainting when you get up too quickly from a sitting or lying position. Therefore, it may be best to avoid drinking alcohol when taking spironolactone.