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Drug Info

Best spironolactone alternatives and what to know before switching

Used to treat acne, PCOS, and heart conditions, this generic diuretic doesn’t work for everyone—but there are other options available.

Key takeaways

  • For heart-related medical conditions, options like ACE inhibitors, ARBs, beta-blockers, and other diuretics are available.

  • Spironolactone is often used off-label for hormonal acne and hirsutism, especially in women with PCOS.

  • Common alternatives include birth control pills, anti-androgens, and oral antibiotics.

Spironolactone, commonly known by its brand name Aldactone, is a prescription medication that works as a potassium-sparing diuretic. Though it’s approved for treating high blood pressure (hypertension), heart failure, and fluid buildup (edema), many dermatologists prescribe it off-label for hormonal acne and excessive hair growth (hirsutism), especially in women with polycystic ovary syndrome (PCOS). 

For those seeking other options, there are several spironolactone alternatives that might be just as effective. Many patients look for alternatives when spironolactone doesn’t work or causes problems like irregular periods, breast tenderness, or increased potassium levels. The alternatives range from prescription drugs to natural supplements. However, it’s best to consult a doctor or healthcare provider when choosing the most appropriate option. 

What can I take instead of spironolactone?

If you’re experiencing bothersome side effects and high costs, or if spironolactone isn’t working well for you, it may be worth considering other alternative treatments. Your healthcare provider can help you explore options based on your overall health and the specific reasons you used spironolactone.

Spironolactone alternatives for cardiovascular problems

There are several alternatives to spironolactone for managing cardiovascular issues, such as high blood pressure and heart failure. Potassium-sparing diuretics that might be similarly effective to spironolactone include eplerenone and amiloride. Other diuretics like furosemide or hydrochlorothiazide can also be used to eliminate excess fluid and salt, lowering blood pressure and alleviating swelling. 

Other options include ACE inhibitors, such as lisinopril and enalapril, which relax blood vessels to ease the heart’s workload, and angiotensin II receptor blockers (ARBs) like losartan and valsartan that help lower blood pressure while protecting kidney function. In addition, beta-blockers, including metoprolol and carvedilol, slow the heart rate, while calcium channel blockers like amlodipine and diltiazem relax blood vessels to manage blood pressure.

Spironolactone alternatives for PCOS and other hormonal problems

PCOS and other hormonal issues can lead to symptoms like irregular periods, hirsutism, and severe acne due to imbalances in hormones such as estrogen, progesterone, and androgens (like testosterone). Spironolactone is commonly used to help manage these symptoms by blocking the effects of androgens. However, other treatment options may also help manage these problems:

  • Birth control pills: These oral tablets can help balance estrogen and progesterone levels, regulate the menstrual cycle, and reduce androgen levels. Brands like Yaz and Ortho Tri-Cyclen are commonly used contraceptive pills.
  • Antibiotics: If you’re living with acne related to hormonal changes, oral antibiotics like doxycycline and minocycline may help reduce skin inflammation.
  • Insulin sensitizers: Medications like metformin may help improve insulin sensitivity, which can lower insulin levels and indirectly reduce androgen production.
  • Anti-androgens: These medications directly target and reduce the effects of male hormones in the body. Finasteride and flutamide are examples that may be effective.
  • Topical treatments: For acne, creams or gels with ingredients like tretinoin can be effective when applied directly to the skin, helping to reduce clogged pores and inflammation.

Compare spironolactone alternatives

Drug name Uses Dosage Savings options
Aldactone (spironolactone)
  • Hypertension
  • Heart failure
  • Edema
  • Acne (off-label)
  • Hirsutism (off-label)
25 to 100 mg daily Spironolactone coupons
Inspra (eplerenone)
  • Hypertension
  • Improved survival after heart attack in people with heart failure
25 to 50 mg once daily Inspra coupons
Midamor (amiloride)
  • Hypertension
  • Heart failure
5 mg once or twice daily Amiloride coupons
Lasix (furosemide)
  • Hypertension
  • Edema
40 mg twice daily or 20 to 80 mg once Lasix coupons
Zestril (lisinopril)
  • Hypertension
  • Heart failure
  • Acute heart attack
5 to 40 mg once daily Zestril coupons
Winlevi (clascoterone)
  • Acne
1 g to the affected area twice daily Winlevi coupons
Casodex (bicalutamide)
  • Prostate cancer
  • PCOS symptoms (off-label)
25 to 50 mg daily Casodex coupons
Eulexin (flutamide)
  • Prostate cancer
  • PCOS symptoms (off-label)
250 mg three times daily Eulexin coupons
Oracea (doxycycline)
  • Bacterial infections
  • Rosacea
  • Acne
40 mg once daily Oracea coupons
Propecia (finasteride)
  • Androgenic alopecia
  • PCOS symptoms (off-label)
1 mg once daily Finasteride coupons
Accutane (isotretinoin)
  • Acne
0.5 to 1 mg/kg daily given in two divided doses  Accutane coupons
Yaz (drospirenone/ethinyl estradiol)
  • Prevention of pregnancy
  • Premenstrual dysphoric disorder
  • Moderate acne in women 14 years and older
1 tablet by mouth daily Yaz coupons

Other alternatives to spironolactone

  • Minocin (minocycline)
  • Sumycin (tetracycline)
  • Cardizem (diltiazem)
  • Hyzaar (losartan/hydrochlorothiazide)
  • Diovan (valsartan)
  • Norvasc (amlodipine)
  • Lopressor (metoprolol tartrate)
  • Toprol XL (metoprolol succinate)
  • Loestrin (norethindrone/ethinyl estradiol)
  • And many more.

Top 5 spironolactone alternatives

The following are some of the most common alternatives to spironolactone.

1. Inspra (eplerenone)

Eplerenone is a diuretic that blocks similar receptors in the body as spironolactone. However, it may cause fewer hormonal side effects, such as breast enlargement in men and changes in menstrual cycles for women. In addition, one study found that patients with chronic heart failure who took eplerenone had better heart function than those who took spironolactone, with their heart’s ability to pump blood improving from around 38% to 40%. Those taking eplerenone also had a 47% lower chance of dying from heart-related issues than those on spironolactone.

2. Midamor (amiloride)

Amiloride is another potassium-sparing diuretic that can be used in people who are unable to take spironolactone. One study found that amiloride effectively lowers blood pressure, resulting in significant reductions of around 15 mmHg in systolic blood pressure. Amiloride may also have a lower risk of causing high potassium levels than spironolactone. However, it’s typically combined with other diuretics like hydrochlorothiazide. 

3. Winlevi (clascoterone)

For acne, Winlevi is a newer topical cream that works similarly to spironolactone but without the systemic effects. It specifically binds to acne-producing hormone receptors in the skin, which helps reduce oil production and inflammation without affecting hormone levels throughout the body. It’s typically applied twice daily to affected areas. Most people see improvements within four to 12 weeks of consistent use. Side effects are usually mild and may include redness or irritation at the application site.

4. Casodex (bicalutamide)

Casodex contains bicalutamide, an anti-androgen medication approved to treat prostate cancer but sometimes prescribed off-label for conditions like hirsutism or androgenic alopecia. Like spironolactone, Casodex blocks androgen receptors, but it does so more selectively. This can make it effective for reducing excess hair growth and persistent acne in women with PCOS. The typical dosage for PCOS is around 25 mg daily, which is lower than doses used for cancer treatment. Side effects may include breast tenderness, hot flashes, and potential liver function changes. 

5. Oracea (doxycycline)

Oracea is a low-dose formulation of doxycycline, an antibiotic that’s used to treat various bacterial infections as well as skin conditions like rosacea and acne vulgaris. A 40 mg daily dose for acne is lower than the dosage for typical infections. Unlike spironolactone, Oracea doesn’t affect hormone levels. It’s an oral medication taken once daily for different types of acne, and most people see significant improvements within four to six weeks. Common side effects include sun sensitivity, digestive upset, and yeast infections in some women. 

Natural alternatives to spironolactone

Although prescription medications are effective treatment options for cardiovascular problems and PCOS, some people might look for natural alternatives to spironolactone. These alternatives can potentially help manage symptoms with fewer side effects and at a lower cost. However, they may not have strong scientific backing for their efficacy.

Lifestyle changes like regular exercise and stress management may naturally help balance hormones and are a key part of treatment regimens. Other alternatives to spironolactone may include dietary supplements, such as herbal products, vitamins, and minerals. For example, spearmint shows promise as a natural anti-androgen to lower high androgen levels. 

Natural supplements for high blood pressure and heart failure might include:

  • Omega-3 fatty acids
  • Coenzyme Q10 (CoQ10)
  • Magnesium
  • Hawthorn
  • L-arginine
  • Beetroot extract

Natural supplements for PCOS may include:

  • Spearmint tea
  • Saw palmetto
  • Vitex agnus-castus (chasteberry
  • Myo-inositol
  • Berberine
  • Vitamin D
  • Vitamin E
  • Selenium

Natural options don’t come without potential side effects, drug interactions, and other warnings. Therefore, it’s best to consult a healthcare professional before relying on a natural alternative to manage symptoms. 

How to switch to a spironolactone alternative

Switching from spironolactone to an alternative treatment requires some planning and medical supervision. Although the spironolactone dosage isn’t known to cause withdrawal symptoms, stopping it suddenly could cause rebound effects, such as increased acne and hair loss. 

Once a new treatment option is in place, the transition might follow these steps:

  • Reduce the spironolactone dosage gradually according to a doctor’s instructions
  • Start the alternative treatment while still on a reduced dose of spironolactone
  • Monitor for possible side effects or changes in symptoms during the transition period
  • Schedule follow-up appointments to check progress and adjust treatment if needed
  • Be patient, as most alternatives take several weeks or months to show full results

Before making any changes, schedule an appointment with your healthcare provider or a board-certified dermatologist to discuss potential options. During this visit, a healthcare provider will review your medical history and current symptoms, as well as order blood tests to check potassium levels and other important biomarkers. They can help determine which alternative might work best for your specific situation.