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Spironolactone is one of a class of medications called aldosterone receptor antagonists.  It is used to treat patients with hyperaldosteronism (the body produces too much aldosterone, a naturally occurring hormone); patients with low potassium levels; and patients with edema (fluid retention) caused by various conditions, including heart, liver, or kidney disease. Spironolactone is also used alone or with other medications to treat high blood pressure.  It causes the kidneys to eliminate unneeded water and sodium from the body into the urine, but reduces the loss of potassium from the body.


Spironolactone also reduces the effect of testosterone in the body and increases estrogen levels.  For this reason, it is sometimes used to treat unwanted facial hair or loss of hair in the scalp in women.  It can also be used to treat acne in women.  Its effect in this regard is similar to some birth control pills, but it does not provide birth control.


Who Should Not Take Spironolactone for Acne?


People with kidney problems or high potassium.  People who are allergic to spironolactone.


What Medications Can It Interact with?


You should always check with your doctor or pharmacist when you take more than one medicine at a time, even over-the-counter ones.  With spironolactone, you have to be especially careful with other medicines for your heart or blood pressure; medicines for depression; steroids; or medicines for pain or fever like aspirin, ibuprofen or naproxen (NSAIDs).


What About My Diet?


Do not eat large amounts of foods with high levels of potassium.  This includes bananas, prunes, raisins, and orange juice as well as salt substitutes.  Avoid excessive alcohol since this can increase some of the side effects.


What Are Possible Side Effects?


The most common side effects are irregular periods, swelling and tenderness of the breasts, headaches, dry mouth, thirst and mild lightheadedness or nausea.


More serious, but rare side effects include:  numbness or tingly feeling; muscle pain or weakness; slow, fast, or uneven heart rate; feeling very drowsy, restless, or light-headed; urinating less than usual or not at all; shallow breathing; tremors, confusion; upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.


What About Pregnancy and Breast-Feeding?


Spironolactone can affect the fetus.  It is also secreted in breast milk.  For this reason, it should not be taken during pregnancy and breast feeding.  If you are sexually active, you must use a sure method of birth control.  If you wish, spironolactone can be taken together with the birth control pill – the two together may make your periods regular again and give you even better control of your acne.  Spironolactone is not stored in your body for very long, so it does not affect your ability to have a normal baby in the future.


Do I Need Blood Tests?


It's controversial.  Some people feel that healthy adults don't need to do blood tests while on spironolactone, others will ask you to do a blood test to check potassium levels every 2 months.  I ask patients to do a blood test 6 weeks after you start to check your potassium levels and kidney function, if they are normal, then you should not need to do further blood tests unless your health or your medications change.


How Much Do I Take?


From 50 mg once a day to 100 mg twice a day.  You will likely start at a lower dose and increase it gradually if you need to.  It may take 2-6 months to see improvement so you must be patient.

How Long Do I Take It For?

Spironolactone only helps your acne for as long as you take it.  That means you can continue it for as long as you are acne prone.  Usually, that means for as long as you continue to get the occasional pimple.  If your skin is completely clear for a long period of time, say 4 months or so, you could try stopping the medication to see if the acne comes back.  Spironolactone has been found to be safe in people who have taken it for up to 8 years.

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