Spironolactone for Acne: Benefits, Side Effects, and More

Acne is a common skin condition for many people—up to 50 million in America, in fact.

It can cause frustration, self-consciousness, and social isolation in some people.

While teenagers are most associated with acne concerns, people of all ages can be affected.

Improving acne may or may not require a personalized care plan for your skin. Everyone’s skin type will respond in different ways to different treatments.

Your dermatologist will decide treatment options based on the cause of the acne, your skin type, and a variety of other factors. 

One common treatment for acne is spironolactone (Aldactone).

This is a medication most commonly used for treating blood pressure, heart failure, and other conditions, including acne.

In this article, I’ll cover what spironolactone is, how it’s used and how it works for acne. I’ll also discuss the benefits and potential side effects, as well as who shouldn’t take this drug.

Finally, I’ll cover alternatives to spironolactone and highlight when it’s time to see a professional.

What is Spironolactone (Aldactone)?

Spironolactone (Aldactone) is a medication classified as a diuretic and an aldosterone antagonist.

Also called “water pills,” diuretics remove excess water from your body by triggering more urine production.

Spironolactone and other diuretics are most commonly prescribed to treat fluid retention for some health concerns.

Spironolactone is considered a potassium-sparing diuretic, meaning your potassium levels won’t drop significantly if you take it.

Uses of Spironolactone

Spironolactone is most commonly used as a hormonal acne treatment in feminine-presenting patients.

It’s not often prescribed to male-presenting patients due to its effects on testosterone and other androgens. 

Using spironolactone for acne is an off-label use of the medication, meaning it has not been officially approved by the Food and Drug Administration (FDA), although medical professionals widely accept it.

Other research has studied the use of spironolactone for acne, alopecia, hirsutism, medication-induced rash, scar prevention associated with top surgery, and skin atrophy. 

The literature review of eight studies states that spironolactone is not recommended for treating hirsutism.

More research is recommended to confirm the use of spironolactone for acne, alopecia, medication-induced rash, and scar prevention associated with top surgery.

There was no conclusion on the use of spironolactone for skin atrophy. 

Occasionally, spironolactone is prescribed as a fourth-line treatment for high blood pressure, meaning multiple other medications are typically tried first.

As a potassium-sparing diuretic, spironolactone causes the body to flush out excess water and sodium (salt), which in turn lowers blood pressure. 

It is also prescribed for patients with heart failure and to prevent further cardiovascular events.

How Does Spironolactone Work for Acne?

Spironolactone is an aldosterone antagonist, meaning it slows the production of androgen hormones in the body, such as testosterone.

Androgen hormones promote masculine characteristics, so reducing these hormones may not be desirable for masculine-presenting patients.

Reduced androgen hormones mean fewer hormones will be present to bind to oil glands, preventing stimulation of oil production.

Since acne can be caused by increased oil production that clogs pores, reducing oil production may improve hormonal acne. 

While spironolactone is not a first-line treatment for severe acne, it may be prescribed after trying topical medicines and treatments such as retinol, antibiotics, or a combination of these.

Benefits

The greatest benefit of taking spironolactone is its credibility as a long-term treatment for acne in people with menstrual cycles. 

Generally, spironolactone offers the following benefits regarding acne:

• Fewer inflamed spots, such as cysts
• Fewer comedones, which are bumps that become inflamed
• Less greasiness and oil production in the skin

Since spironolactone is an oral medication, not a topical one, all areas of the body that produce oils due to hormone levels will be affected.

This may result in a reduction in acne not only on the face, but also on the back, chest, and/or other areas.

Possible Side Effects

Possible side effects for patients taking oral spironolactone include:

• Dry mouth
• Increased potassium levels
• Stomach cramping, diarrhea, vomiting
• Dizziness
• Headaches
• Lowered blood pressure
• Frequent urination

Spironolactone is also known to cause side effects of irregular periods and breast soreness, tenderness, and/or enlargement for patients who menstruate. 

Interactions and Warnings

Spironolactone affects potassium levels, hormone levels, and blood pressure.

Patients taking other medications for concerns regarding these should speak with a medical professional before taking oral spironolactone.

Spironolactone has negative interactions with drugs such as:

• Potassium supplements
• Angiotensin-converting enzyme (ACE) inhibitors 
• Angiotensin II receptor blockers
• Lithium
• Non-steroidal anti-inflammatory drugs
• Digoxin (Lanoxin)
• Cholestyramine
• Acetylsalicylic acid
• Salt substitutes
• Cyclosporine (Sandimmune)
• Triamterene (Dyrenium)

The FDA label for oral spironolactone (Aldactone) does have a black box warning, as high doses have caused tumors in experiments involving rats.

You should limit your alcohol consumption when taking spironolactone, as alcohol may increase your risk of orthostatic hypotension.

This is sudden dizziness and a drop in blood pressure after you stand up too quickly, which can be dangerous.

When taking spironolactone, patients should monitor their blood pressure regularly to ensure no adverse effects occur.

How Quickly Does Spironolactone Work for Acne?

Initial doses of spironolactone start at 25-100mg per day and increase in a stepwise fashion every 6-8 weeks until there is a noticeable improvement in the acne.

Most people notice a therapeutic effect within 4-8 weeks. 

The average dose for someone taking spironolactone for acne and other skin concerns is 50-150mg per day. 

Taking spironolactone does not guarantee you will not experience any acne.

It may completely clear the skin, or you may need to combine it with other treatments.

Who Shouldn’t Take It

Generally, patients should not take oral spironolactone if they are:

• Taking eplerenone
• Planning for pregnancy
• Pregnant or breastfeeding
• Being treated for kidney disease

Patients diagnosed with hyperkalemia (high potassium levels) or Addison’s disease should not take oral spironolactone.

Spironolactone Alternatives

If spironolactone is not an option, some alternatives exist for acne treatment and prevention.

Oral contraceptives or birth control pills are a common alternative for treating hormonal acne.

The Cochrane Collaboration, an international research group, explored studies on birth control and acne and found that all oral contraceptives improved acne in participants.

The researchers cautioned that no one pill was found to be more effective than another, so be aware of this when looking for an oral contraceptive for acne.

Some patients turn to spironolactone after trying topicals and cream medications.

Your dermatologist may prescribe you alternative medications such as retinol, benzoyl peroxide, and topical antibiotics for treating skin concerns.

Some alternatives for spironolactone can be purchased over-the-counter. Speak with a medical professional or dermatologist to learn if spironolactone or one of its alternatives is right for you.

When to See a Medical Professional

There are signs and symptoms you should be aware of when taking spironolactone – they signal the need for a visit with a medical professional. 

Orthostatic hypotension is a sudden drop in blood pressure after you stand that causes dizziness and sometimes fainting.

About 6% of Americans experience orthostatic hypotension. Medications can occasionally cause orthostatic hypotension, or it may be genetically inherited.

If you suspect you have orthostatic hypotension, consult a medical professional to see if you should switch your medications.

Hyperkalemia occurs when a patient’s potassium levels are too high.

This can be life-threatening if not treated properly.

Often there are no symptoms, but some hyperkalemic patients experience nausea, an irregular heartbeat, numbness or muscle weakness, abdominal cramping, or sudden collapse. 

Signs of a medical emergency when taking spironolactone include:

• Sudden collapse
• Seizure
• Sudden decrease in urine output

These may be signs of a cardiac event or kidney problem that could be life-threatening. Call for emergency medical attention immediately if you experience one or more of these symptoms.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app?

Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a healthcare provider in minutes. 

K Health’s AI-powered app is based on 20 years of clinical data.