4 foods to avoid while taking spironolactone

In this article:

• How spironolactone works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects
• Maximizing spironolactone benefits

In this article

• How spironolactone works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects
• Maximizing spironolactone benefits

Spironolactone (brand name: Aldactone, CaroSpir) is a potassium-sparing diuretic, also known as a “water pill.” It is FDA approved to treat hypertension (high blood pressure), heart failure, and edema (excess fluid buildup caused by medical conditions such as kidney or liver disease). It is also commonly prescribed off-label to treat hormonal acne, female pattern hair loss, and hirsutism often associated with polycystic ovarian syndrome (PCOS).

Spironolactone use can cause electrolyte imbalance (especially high serum potassium levels), so it’s important to monitor potassium and sodium levels while on this drug. Your provider may choose to monitor your blood work while you are on this medication. You might also need to limit potassium-rich foods such as bananas and dried fruit. Consuming too much salt may also impact spironolactone’s effectiveness.  

How spironolactone works

Spironolactone blocks the hormone aldosterone, which tells the kidneys to hold on to water and sodium. Eliminating excess fluid through urination ultimately decreases fluid in the bloodstream, lowering blood pressure, according to Troy Alexander-El, MD, a board-certified internal medicine physician in Chicago, Illinois. As for spironolactone off-label uses? “By decreasing the amount of hormones, it improves insulin resistance [and] decreases facial hair and acne, all of which are associated with conditions like PCOS,” says Dr. Alexander-El.

Spironolactone can take a couple of weeks to noticeably lower blood pressure. How fast it works may vary depending on the form, dosage, and condition being treated.

4 foods to avoid with spironolactone

Good news: There are no foods that must be completely avoided on spironolactone. The prescribing information lists no direct food-drug interactions. However, increased urine output from spironolactone can lead to electrolyte imbalance and dehydration. 

Given that, many healthcare professionals recommend limiting the following when taking spironolactone.

1. Potassium-rich foods

Potassium is an essential mineral, but Dr. Alexander-El says too much potassium can cause irregular heartbeat, respiratory depression, and cardiac arrest. Spironolactone increases the risk of hyperkalemia (high blood potassium). Hyperkalemia is often caused by kidney disease, but in this case, high potassium levels develop because spironolactone causes water and sodium elimination while retaining potassium. In one study, 2% of spironolactone users experienced severe hyperkalemia compared to 1% of those taking a placebo. 

While it’s unnecessary to completely eliminate dietary potassium while taking spironolactone, Dr. Alexander-El emphasizes the importance of monitoring how much potassium you consume. 

“Some foods especially high in this mineral include dried apricots, prunes, lentils and other pulses (dried seeds from a pod), yams, acorn and butternut squash, and Swiss chard,” says Elizabeth Harris, RDN, a registered dietitian nutritionist in Annapolis, Maryland. She also suggests eliminating salt substitutes like Nu-Salt from your diet since they contain potassium chloride.

2. High-sodium foods

If you take spironolactone to combat high blood pressure or fluid retention, fast food and salty processed foods will only undermine your efforts. “Too much sodium can cause the medication to not be effective because the spironolactone is essentially competing with your body’s natural propensity to retain water,” says Dr. Alexander-El. 

Research also clearly links regular consumption of ultra-processed foods to high blood pressure, heart disease, and obesity. Harris suggests that while it’s okay to occasionally enjoy pizza and fast food, the important thing is to treat them like a treat and focus more on filling your plate with whole foods. 

3. Excess caffeine

Common side effects of spironolactone include dry mouth and increased thirst. The drug also increases urine output, which increases the risk of dehydration. Caffeine is a well-known diuretic, so consuming caffeine while on spironolactone is likely to have a compounding effect, exacerbating urinary output and associated side effects.

Bottom line: Stay hydrated while taking spironolactone. There’s no drug warning to avoid caffeine altogether, but drinking less tea or coffee than usual might be a good idea until you determine how spironolactone affects you.

4. Excess alcohol

Like caffeine, alcohol has a diuretic effect. Combining spironolactone with alcohol can increase the risk of dehydration. Research suggests that wine and spirits present a higher risk of dehydration than beer. 

When working to avoid excess alcohol, it may be helpful to review the Centers for Disease Control and Prevention’s definitions of heavy drinking and binge drinking. The CDC defines heavy drinking as eight or more drinks per week for women and 15 or more drinks per week for men. Binge drinking is defined as four or more drinks at a time for women and five or more drinks at a time for men.

What should you eat while taking spironolactone?

Spironolactone lowers blood pressure, but it is not a one-size-fits-all cure for hypertension, heart failure, or edema. People taking spironolactone can support the drug’s effectiveness—and potentially reduce long-term dependence on the drug—by eating a balanced diet of healthy whole foods. For instance, the DASH diet is known to lower blood pressure. Plus, low-glycemic index foods and zinc-rich foods are known to help with acne. 

As a rule of thumb, Harris suggests focusing on eating more lean proteins, whole grains, and lower-potassium fruits and vegetables while on spironolactone. 

Gastrointestinal side effects of spironolactone

Like many drugs, spironolactone can cause gastrointestinal side effects, although it is usually well tolerated. Common gut-related side effects of spironolactone include: 

• Stomach pain
• Vomiting
• Diarrhea

Anyone experiencing diarrhea from spironolactone should eliminate coffee and alcohol until the gastrointestinal problems have resolved. Caffeine has a known laxative effect, and diarrhea has been linked to alcohol consumption. 

Tips for maximizing spironolactone benefits

It’s essential to follow the spironolactone dosage instructions that come with your prescription refill. Generally, this medication is taken once or twice daily and can be taken with or without food.

Tell your healthcare provider about any prescription drugs, over-the-counter medications, and supplements you take before using spironolactone. This will prevent dangerous or efficacy-related drug interactions. For instance, while taking spironolactone, you should not take potassium supplements, heparin, digoxin, eplerenone, amiloride, lithium, or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. Seek individualized medical advice if you are concerned about the medications you are taking.

The best way to maximize spironolactone benefits is to make lifestyle choices that support your overall health. These may include:

• Eating a diet full of healthy, unprocessed foods, such as fruits, vegetables, whole grains, and lean protein
• Exercising regularly 
• Reducing stress or practicing relaxation techniques like meditation and mindfulness
• Prioritizing good sleep hygiene 

Finally, seek urgent medical attention if you develop signs of an allergic reaction or high potassium levels while on spironolactone.