Stacks Image 2236


This prescription medication is the go-to drug for treating adult onset female hormonal acne that is refractory topical medication. This drug blocks androgens – male type hormones, which all women make in small quantities – from stimulating the oil glands in the androgen-sensitive areas of the face: the chin, jawline, cheeks, and neck. Although it works well, there are some important considerations. Firstly, this drug is only for women. Secondly, women taking this medication should never become pregnant while taking it because of the risk of birth defects. After a few weeks off the drug, it is safe to conceive. Most women taking spironolactone experience no side effects. About one-third of women taking this medication may experience increased urinary frequency, such as urinating one extra time per day. This happens because this drug is a weak diuretic. Additionally, 1 out of 5 women taking the medicine can experience spotting between menstrual periods and breast tenderness; concomitant use of birth control will prevent these effects. Rarely, nausea can occur if the medication is taken on an empty stomach. This medicine can also lower blood pressure, but it is usually only lowered by a tiny amount. If her blood pressure runs low, a patient may experience symptoms of dizziness or weakness, especially when she stands up rapidly from a seated or reclined position.

I often recommend that women who are sexually active with men use
acne-friendly birth control pills while taking spironolactone. The birth control pills can help acne, but not to the same degree that spironolactone can. However, the combination is superior to spironolactone alone. And obviously, the use of birth control pills decreases the risk of the undesirable situation of unintended pregnancy in a patient taking spironolactone and blocks the potential side effects of spotting and breast tenderness.

As a bonus, for women with female pattern hair loss or excess body hair, or for women going through peri-menopausal symptoms (hot flashes), this drug can really help. Be sure to tell your doctor or other health care practitioner if you have disease of the kidney or are taking medication for high blood pressure in combination with spironolactone. Some health care providers will recommend to check a blood test to monitor your potassium level while taking this medication, as this medication can raise your potassium level. This becomes more important for patients with pre-existing disease of the kidney as well as for patients who are taking certain medications for treatment of high blood pressure. In fact, a
2015 study has shown that it is not necessary to monitor potassium in young, healthy women with acne. I do recommend that potassium be monitored if the patient has kidney disease, heart disease, or takes medications that can raise potassium. Symptoms of rising potassium include pins & needles, muscle weakness, fatigue, and a slow heart beat.

Spironolactone works well to counter the effects of certain types of hormonal contraception that promotes acne. For example, for patients who have had a hormone releasing intrauterine device placed for contraception, some of these patients develop hormonal acne. This happens because the hormones released by the intrauterine device are able to stimulate the androgen receptors on the oil glands in the androgen sensitive areas of the face. By taking spironolactone, hormonal acne can be treated without the removal of the intrauterine device.

For most patients, I recommend a starting dose of 50mg twice a day. I recommend taking it with food, as it enhances the absorption of the drug. I recommend waiting 8-12 weeks to judge the effectiveness of the drug at a given dose.

Spironolactone should not be used in patients taking lithium salts, typically used to treat psychiatric conditions, as it can increase the concentration of lithium. Similar considerations apply for patients taking the cardiac drug digoxin.