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Should I take spironolactone for acne?

Sarah Bradley writer headshot By | April 29, 2020
Medically reviewed by Karen Berger, Pharm.D.

When you hear the word “acne,” you probably think of the facial variety—but acne can crop up in many different places all over the body, and the solution isn’t as simple as slathering yourself in your favorite OTC pimple cream or investing in expensive skincare.

If you have severe facial acne or acne that affects your back, chest, buttocks, or arms, you may need to see a dermatologist to get your breakouts under control. And if you’re female, you may be prescribed a common blood pressure medication called Aldactone (spironolactone) for treatment of acne.

What does a blood pressure medication have to do with treating acne…and why is it typically only prescribed to women? Here’s everything you need to know about using spironolactone for acne.

What is spironolactone?

Spironolactone is a prescription medication used to treat high blood pressure and fluid retention, but is frequently prescribed off-label for the treatment of acne. It’s usually sold under the brand name Aldactone. 

“Spironolactone is perhaps one of the most commonly prescribed medications in dermatology and has been used safely for over 60 years to treat acne in adult women,” says Joshua Zeichner, MD, director of cosmetic and clinical research at The Mount Sinai Hospital. 

The drug is a diuretic, commonly known as a water pill, which means it triggers your kidneys to filter out excess water from your body through increased urine production. Spironolactone belongs to a class of diuretics, called potassium-sparing diuretics, that prevents the loss of potassium during this process; for a patient with high blood pressure, spironolactone can be effective at flushing out excess sodium, a common source of hypertension, without lowering potassium levels.

How does spironolactone work for acne?

Though spironolactone has been approved by the Food and Drug Administration (FDA) for treatment of blood pressure, Dr. Zeichner says it does not affect blood pressure when given at a low dose. Instead, its side effects make it a good off-label treatment for acne: It blocks hormones from binding to oil glands and prevents stimulation of oil production, which can lead to pimples. 

It’s also often prescribed for women who suffer from cystic acne, a type of pimple that sits deep in the surface of the skin rather than on top of it. Cystic acne happens when skin pores become clogged, then infected. It’s common along the jawline and on the chin.

However, spironolactone can also block testosterone and cause breast development in men, which is why it’s only prescribed to women. 

Spironolactone might not be the right treatment for all women with acne. According to Dr. Zeicher, it can be a good fit for women who:

  • suffer from hormonal acne or breakouts related to their menstrual cycle;
  • need systemic acne treatment to address severe acne or acne affecting large parts of the body;
  • have acne that is not well-controlled by topical treatments alone;
  • want to avoid treating their acne with hormonal birth control;
  • and have recurrent acne once oral antibiotics have been discontinued.

Spironolactone is often prescribed to teenagers and adult women, though women who are pregnant, or who may become pregnant, should not take spironolactone. Its feminizing effects could reach the fetus, so the testosterone levels of a male fetus could be impacted by the mother’s spironolactone use during pregnancy. 

The typical dose of spironolactone for acne is 25 to 200 milligrams per day; according to a 2012 study published in the Journal of Clinical and Aesthetic Dermatology, patients should start with the lowest dose possible and increase slowly over time if needed. Patients often experience improvement of acne, as well as less side effects, at lower doses. It is important to note that it can take about three months for the drug to have a noticeable effect on acne, and it’s not a one-time treatment, says Dr. Zeichner.

“If you discontinue spironolactone, the skin slowly will return back to what it’s genetically programmed to do,” he explains. “Acne typically returns within a few months [after stopping the drug].”

Is it safe to take spironolactone for acne?

As with any drug, spironolactone may cause side effects in some patients and not in others. It’s important to discuss these side effects with your doctor—and inform them of any other medications you’re taking—before taking it. 

Potential side effects of spironolactone include:

  • breast tenderness
  • irregular periods
  • increased potassium levels
  • lightheadedness 
  • nausea and vomiting
  • fatigue
  • increased urination

Dr. Zeichner says many of these side effects are more likely when the medication is given at higher doses. It’s worth noting that there is a black box warning on the drug, but it may not be a cause for genuine concern if you are an otherwise healthy female.

“In one study in rats spironolactone caused solid organ tumors, however it has not been shown to be a problem in humans,” advises Dr. Zeichner. The amount of the drug given to rats in the study was significantly higher than the one prescribed to women.

Spironolactone does not typically cause depression or mood changes. If you do notice changes in mood while taking it, let your doctor know. Sometimes, spironolactone is prescribed to promote hair growth in women because it’s an antiandrogen—that means it blocks the male hormones that may lead to hair loss in women.

Because the drug decreases fluid retention, you may lose a small amount of weight while taking it. There isn’t any evidence that spironolactone works as a weight loss medication, but it may help with premenstrual bloating and is often prescribed to treat symptoms of PMS and premenstrual dysphoric disorder (PMDD). 

When it comes to actually taking spironolactone, Dr. Zeichner recommends taking it with food for better absorption. Because sodium and potassium levels are impacted by the drug, you should monitor your intake of both. There is a chance that your potassium levels could become fatally high while taking spironolactone (known as hyperkalemia), so you should avoid eating large amounts of potassium-containing foods such as bananas, avocados, and spinach.

Diuretics like spironolactone are processed through the renal system, so patients with kidney disease should avoid taking this drug. According to the Mayo Clinic, patients who take potassium supplements, other drugs containing spironolactone or diuretics (especially triamterene and eplerenone), and other blood pressure medications should also avoid taking spironolactone. Patients should also avoid potassium supplements as well as salt substitutes that contain potassium, while taking spironolactone.

Saving on spironolactone costs

For a one-month supply of 25 milligram generic Aldactone tablets, the average patient pays about $28. With a SingleCare discount card, you might be able to pay less than $7.

Other popular prescription topical antibiotics like clindamycin, topical retinoids such as tazarotene, and oral medications like doxycycline or Accutane (Accutane users cannot be pregnant or become pregnant, and must follow a strict protocol through a program called ipledge). Some dermatologists recommend birth control pills, especially if your breakouts revolve around your menstrual cycle. Oral contraceptives can regulate the flow of hormones that affect oil production in your skin; it’s often helpful for women with polycystic ovarian syndrome, or PCOS, which usually causes an overabundance in male hormones.

There are a few over-the-counter acne medications, too, like benzoyl peroxide (cleansers, creams, or gel), Differin Gel, and salicylic acid cleanser or moisturizer. Most prescription acne treatments come with some side effects and not all are compatible with every person’s lifestyle. If you’re struggling to win the war against acne, make an appointment with your dermatologist for advice on which treatment might be best for you.