At Live Oak Dermatology in Roswell, we frequently prescribe spironolactone for a variety of skin concerns. It was developed as a diuretic ( a type of blood pressure medication) but actually has excellent anti-androgen activity which makes it very useful for a variety of female dermatologic concerns including hair loss (alopecia), acne (especially hormonal acne), and unwanted hair growth (hirsutism). It is considered safe for long-term use if needed but may take several months to see improvement.
Side effects are typically rare and mild. Common side effects may include increased frequency of urination (thanks to the diuretic effect), menstrual irregularities, breast tenderness, breast enlargement and headache. Some patients experience fatigue and dizziness. If this does occur, please let us know and we can adjust how you take the medication.
Stop this medication if you become pregnant. This medication can theoretically result in the feminization of a male fetus although it may be less likely then previously thought. Regardless you should stop the medication if you are pregnant or planning on becoming pregnant.
Spironolactone is NOT compatible with the following medications:
This medication can increase potassium levels. Avoid potassium supplements or excessive ingestion of K+ rich foods. Routine monitoring of K+ levels is no longer standard of care in healthy young patients. However we often do monitor K+ in patients with age over 40 years old, history of kidney disease, history of cardiac disease and those on certain medications such as ACE inhibitors, ARBs, aldosterone blockers, NSAIDS such as ibuprofen, naproxen, indomethacin, potassium supplements.
If you are taking an SSRI (citalopram, escitalopram, fluoxetine, paroxetine, sertraline) we may also monitor your sodium levels.
Of note, spironolactone is sometimes abused by competetive athletes for its diuretic effect (to rapidly lose weight from water loss) or to mask other illegal drugs by diluting urine. Therefore it is banned by the U.S. Anti-doping agency for use highly competetive athletics goverened by the USADA (https://www.usada.org/substance-profile-spironolactone/ ).
There have been concerns in the past that spironolactone may increase the risk of breast cancer due to its hormonal influences. It is not a pro-estrogen like some oral contraceptive pills (which do increase breast cancer risk), but it is an anti-androgen which could increase un-opposed estrogen theoretically increasing risk. Also, some animal studies, demonstrated an increased risk of benign (noncancerous) tumors in rats. These risks have not been demonstrated in humans, in fact, a large study of 2.4 million woman did NOT demonstrate an increased risk of cancerous or noncancerous breast tumors (https://www.ncbi.nlm.nih.gov/pubmed/24189467 ). However, people with a personal history or strong family history of breast cancer will sometimes avoid as a precaution even though there is no evidence of increased risk in humans.
Moderate intake of High-Potassium Foods (avoid excessive consumption
Bananas, oranges, cantaloupe, honeydew, apricots, grapefruit (some dried fruits, such as prunes, raisins, and dates, are also high in potassium)