What are the aims of this leaflet?
This leaflet has been written to help you understand more about the drug spironolactone. It explains what it is, how it works, how it is used to treat skin conditions, and where you can find out more about it.
What is spironolactone and how does it work?
Spironolactone is a drug usually prescribed for patients with heart problems, high blood pressure and fluid retention. It can also have hormonal effects by blocking the action of androgens (male hormones), that are normally produced by all women in low levels. Some women have raised levels of androgens or increased sensitivity to normal levels of androgens, and this can lead to skin and hair disorders. Spironolactone can be used in the management of these conditions.
What skin conditions are treated with spironolactone?
Spironolactone is used ‘off licence’ to treat women with acne, female pattern hair loss and hirsutism (male pattern hair growth which is excessive hair growth, including chin and upper lip areain women). “Off licence” means that the treatment is not specifically indicated for these conditions in the UK government prescribing licence. However, it is still usually available on the NHS. Spironolactone is also used in the management of polycystic ovarian syndrome (PCOS) and is not usually given to men to treat skin problems.
Will spironolactone cure my condition?
Spironolactone is not a cure but taken long-term it can help control and sometimes clear acne. It can help reduce excess facial and body hair and improve the thickness of scalp hair in women with certain types of hair loss. The treatment works slowly over several months.
What dose should I take?
The usual daily dose for skin complaints is between 50-200mg per day. Typically, higher doses are required for hair conditions. Your doctor will advise you on what dose to take.
How should I take spironolactone?
Spironolactone tablets should be swallowed whole with a glass of water after food.
How long will I need to take spironolactone before I see an effect?
Most women find that their acne starts to improve after about 3 months of treatment. Hair conditions take longer, and treatment usually needs to be continued for up to six months before the benefit can be seen.
What are the common side effects of spironolactone?
Side effects of spironolactone may depend on the dose which is taken. Common side-effects in women who are before the menopause include breast tenderness/enlargement and irregular menstrual periods. These symptoms usually settle with continued treatment and may be helped by taking spironolactone with the oral contraceptive pill or a hormonal device within the uterus (IUD).
Spironolactone can cause a drop in blood pressure when going from sitting to standing (postural hypotension) which can cause dizziness, a lightheaded feeling or fainting. Uncommon side effects include skin rashes, drowsiness, fatigue, headache, loss of libido (sex drive) and very rarely, confusion and loss of co-ordination. As this medication is a diuretic it can increase the amount of urine produced by the body.
What are the rare side effects of spironolactone?
Raised levels of potassium in the blood may occur during treatment with spironolactone. This is more common in patients over 45 years and those with heart or kidney problems and in people who take other drugs that affect potassium levels. It may very rarely cause abnormal blood counts and rashes. It may affect the kidney and liver function which will be seen on blood tests done to monitor. These tend to improve after stopping the drug or reducing the dose.
Animal tests with very high doses of spironolactone showed a possible association with cancer, but this has not been observed in normal use of this medication in humans.
Are any other precautions necessary?
You do not need to use contraception while taking spironolactone, but you should stop the medicine if you become pregnant. Spironolactone is not known to cause serious harm to an unborn baby. However, it may affect the development of a male baby’s sex organs during pregnancy.
If you are planning to get pregnant, or might be pregnant, speak to your healthcare professional. It is usually safe to conceive a month after stopping the spironolactone treatment.
People with Addison disease or significant kidney problems should not take spironolactone.
How will I be monitored for the side effects of spironolactone treatment?
Your doctor may recommend a blood test to check your potassium level before starting treatment and occasionally during treatment. These checks may be needed more frequently if you have heart or kidney problems or if you take other medication that affects potassium levels.
May I drink alcohol while taking spironolactone?
Drinking alcohol may increase some of the side-effects of spironolactone such as dizziness. It would be advisable to moderate your alcohol consumption in accordance with recommended guidelines by the NHS.
Can I take other medicines at the same time as spironolactone?
If you are taking any of the following medications, please inform your doctor (you can check with your doctor or pharmacist):
- Diuretics (“water tablets”)
- Potassium supplements
- ACE Inhibitors (e.g. quinapril, captopril)
- Tablets for high blood pressure
- Aspirin, indomethacin (an anti-inflammatory/analgesic drug)
- Digoxin (used to treat heart conditions)
- Trimethoprim and trimethoprim-sulfamethoxazole (types of antibiotics)
There may be other medicines or supplements that can produce problems with spironolactone so make sure that your doctors know about everything you are taking.
Where can I get more information about spironolactone?
dermnetnz.org/topics/anti-androgen-therapy
www.aad.org/dw/dw-insights-and-inquiries/2020-archive/july/spironolactone
www.medicines.org.uk/emc/product/5920/smpc
patient.info/medicine/spironolactone-aldactone
This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS PATIENT INFORMATION LEAFLET
PRODUCED | OCTOBER 2018
UPDATED | NOVEMBER 2022
NEXT REVIEW DATE | NOVEMBER 2025
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