What is oral spironolactone?

April 25 2024 5:11pm • Est. Read Time: 4 MIN

What is spironolactone?

Spironolactone is a prescription medication that may also be sold under the brand names such as Aldactone and CaroSpir. 

What does spironolactone treat?

Spironolactone can treat a variety of conditions including hypertension, heart failure, edema (fluid retention), hyperaldosteronism (a condition in which the body releases too much of the hormone aldosterone), and hypokalemia (low potassium). It can also be prescribed “off-label” to treat conditions such as acne in females and hirsutism (excessive hair growth in a male-like pattern) in females.1

How does spironolactone work?

Spironolactone belongs to the class of drugs known as aldosterone receptor antagonists. 


Aldosterone is a steroid hormone that regulates salt and water balance in the body. Its main function is in the kidney where it increases the absorption of salt and water and excretion of potassium.2  


Spironolactone works by blocking aldosterone. It was primarily developed as a potassium-sparing diuretic (water pill) and an antihypertensive, increasing the output of urine and lowering high blood pressure. 

How does spironolactone treat hormonal acne?

Spironolactone treats acne by decreasing testosterone production and blocking the effects of androgens (often referred to as male hormones).3 


Androgens (like testosterone) can enlarge sebaceous glands and increase sebum (oil) production. So, by blocking androgens’ effects, spironolactone decreases sebum production in the skin and can reduce breakouts. 


Multiple studies have shown spironolactone’s effectiveness in treating acne including this 4-year retrospective study that showed 86% of patients’ acne improved with spironolactone4 and this retrospective study at Mayo Clinic that showed 85% of patients’ acne improved by over 50%.5

What are the potential side effects?

Potential side effects from oral spironolactone can include:6 

  • Dehydration 

  • Electrolyte imbalance (e.g. high potassium, low sodium)

  • Nausea/vomiting/diarrhea 

  • Headache 

  • Drowsiness 

  • Men specifically may experience gynecomastia (enlarged breasts) and loss of libido 

  • Menstrual irregularities 


This is not a complete list, so please talk to the prescribing medical provider for more information. 

Who shouldn’t take spironolactone?

Spironolactone should not be taken by those with hyperkalemia (high potassium) or those at high risk of developing hyperkalemia. People with kidney impairment should also not take spironolactone.7 This is not a complete list, so please discuss your medical history with the prescribing medical provider before taking spironolactone.  

Does spironolactone interact with any other medications?

Drug interactions may occur with taking certain prescription and over-the-counter medications along with spironolactone. These include blood pressure medications such as ACE inhibitors, muscle relaxants, NSAIDs including ibuprofen, and lithium.8 It’s important to discuss your complete medical history, including any medications you might be taking, with the prescribing medical provider.

What dosages are normally prescribed for acne?

Spironolactone is typically prescribed in tablet form at dosages of 25, 50, or 100mg. The maximum dose for acne is 200mg/day. The exact dosage prescribed will vary depending on a variety of factors including age, general health, the severity of acne, and what other acne medications are being taken.    


At Curology we limit our spironolactone prescription strength to 100mg/day. For those patients who may benefit from higher strengths, we advise in-person provider care as doses above 100mg/day require close monitoring which may include blood tests.


How long is spironolactone prescribed for?

Most women take spironolactone for many months, or even years. The treatment duration is different for each person. Regular check-ins with your medical provider are important to tailor your treatment recommendations.

What time of day is spironolactone taken? 

Spironolactone may be taken in the morning or at night. Please be aware that this medication may cause you to urinate more frequently, potentially interfering with your ability to sleep if taken at night.

How long does spironolactone take to work for acne?

According to the American Academy of Dermatology, a decrease in oiliness and breakouts may be noticeable within a few weeks of taking spironolactone.9 Although, this can vary from person to person and results are typically seen within 2-3 months. 

Can males take spironolactone?

Males should not take spironolactone. Male patients who take spironolactone may experience gynecomastia (enlarged breasts), loss of libido, and general feminization.10

Is spironolactone safe during pregnancy?

Spironolactone is pregnancy category C, so it should not be taken by women who are pregnant, trying to become pregnant, or are sexually active and not using a reliable form of contraception. Based on data from animal studies, oral spironolactone may interfere with the development of primary sex characteristics in male fetuses.11 

Is it safe to take both spironolactone and birth control pills?

Birth controls pills and spironolactone are often used together to treat hormonal acne. However, not all birth control pills can be safely used with spironolactone without checking bloodwork, so please discuss your medication history with the prescribing medical provider before taking spironolactone.

Can spironolactone be taken by those who compete in sports? 

Spironolactone is included in the World Anti-Doping Agency's list of banned medications.12 If you are an athlete and are required to undergo drug testing prior to competing, please contact your sports governing committee for rules and regulations prior to using Spironolactone.

What foods should be avoided while taking spironolactone?

According to the FDA, patients who are taking spironolactone should generally avoid potassium supplements and foods containing high levels of potassium, including salt substitutes.13 Potassium-rich foods include but are not limited to bananas, salmon, beans, coconut water, and spinach. For further guidance, please speak to your in-person medical provider.



1. Patibandla, S., et al. Spironolactone. In StatPearls. StatPearls Publishing. (2022). 
2. Scott JH. et al. Physiology, Aldosterone. In StatPearls. StatPearls Publishing. (2022).
3. Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016).

4.Grandhi, R., & Alikhan, A. Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study. Dermatology (Basel, Switzerland). (2017).
5.Roberts, E. E., et al. Treatment of acne with spironolactone: a retrospective review of 395 adult patients at Mayo Clinic, 2007-2017. Journal of the European Academy of Dermatology and Venereology. (2020).
6.Patibandla, S., et al. Spironolactone. Ibid.
7.Patibandla, S., et al. Spironolactone. Ibid.
8. US Food and Drug Administration. Aldactone, spironolactone tablets, USP. (Revised 2014).
9. American Academy of Dermatology. Stubborn acne? Hormonal therapy may help. (.n.d.).
10.Charny, J. W., et al. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. International journal of women's dermatology. (2017)
11.Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid.
12. World Anti-Doping Agency. World anti-doping code international standard prohibited list 2022. (2022).
13. US Food and Drug Administration. Aldactone, spironolactone tablets, USP.


Sources:

  1. StatPearls - Spironolactone

  2. StatPearls - Physiology, Aldosterone

  3. JAAD - Guidelines of care for the management of acne vulgaris

  4. Dermatology - Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study

  5. FDA - Aldactone, spironolactone tablets, USP

  6. AAD - Stubborn acne? Hormonal therapy may help

  7. International journal of women’s dermatology - Spironolactone for the treatment of acne in women, a retrospective study of 110 patients

  8. World Anti-Doping Agency - World anti-doping code international standard prohibited list 2022