Spironolactone, also known as aldactone, is a diuretic drug used to treat hormonal acne, along with other conditions such as polycystic ovary syndrome (PCOS), high blood pressure and congestive heart failure.Â
Women with persistent hormonal acne often have recurring inflammation along the jawline and neck area, caused by increased sebum. The sebum can be traced back to excess levels of or sensitivity to androgen (testosterone). Spironolactone blocks these androgens to reduce sebum and clogged pores.
The drug works by minimizing the excess testosterone that can lead to breakouts, according to San Ramon, California dermatologist Dr. William Ting. âThis is not like Accutane, where weâre talking about a âcureâ for acne,â Dr. Ting says. âSpironolactone temporarily pauses the effects of hormonal triggers. For a lot of women, acne does slowly become less noticeable, but for others, the hormonal triggers can unfortunately persist [despite the drug].âÂ
If something other than hormones is responsible for your blemishes, spironolactone wonât be an effective solution for you.
âSpironolactone needs to be taken under the supervision of a dermatologist,â Dr. Ting says. âYou should not be blindly asking for it from your primary care doctor, because we often need to adjust the dose, depending on efficacy and patient satisfaction.â
Unlike with Accutane, you will not need to undergo monthly blood tests while taking spironolactone. However, you should meet with your dermatologist on a regular basis to monitor your progress.
Pros
Cons
Because it's treating a medical condition, spironolactone is usually covered by health insurance.
Dr. Emmy Greber, a dermatologist in Boston, Massachusetts, told the American Academy of Dermatology (AAD) that ideal candidates for spironolactone are female patients with hormonal acne that flares before or after menstrual cycles. If youâve tried other topical and internal medications (like antibiotics and isotretinoin) and still have persistent acne, spironolactone can be added to your regimen or taken alone.
Because spironolactone decreases testosterone, donât take the drug if you identify as male. You run the risk of impotence, gynecomastia, and loss of libido.Â
If you have liver or kidney diseases (including hyperkalemia or Addisonâs, among others), or diseases that may affect the kidneys (diabetes), spironolactone may cause severe complications.
It can take at least six to eight weeks before improvements in your skin will be noticeable, but because hormonal acne is a chronic condition, itâs tough to predict if and when breakouts will stop. âI typically see results from spironolactone in two months, but it can take longer to get the full effect,â says Dr. Melissa Chiang, a Spring, Texas, dermatologic surgeon.
If you arenât seeing enough change after the three-month mark, talk to your doctor. You may need to adjust the dosage. When you do see results, youâll need ongoing treatment. In a RealSelf Q&A, Nashville dermatologic surgeon Dr. Michael Gold says, âMost women who start on spironolactone for their acne will remain on it for an extended period of time, with proper monitoring.âÂ
Once you stop taking the drug, you can expect the improvements to taper off, though you may be able to extend your results with other acne-fighting treatments, such as medicated creams or oral antibiotics. âYour dermatologist will adjust those, depending on how you do,â Dr. Ting says. âPerhaps your topical medication will kick in nicely, allowing you to slowly come off spironolactone. Itâs really at the discretion of your dermatologist, depending on how your skin reacts.â
Spironolactone is FDA-approved for a variety of conditions, including the treatment of acne, and low doses are considered safe if youâre an appropriate candidate. Yet, it does come with side effects and risks that can range from uncomfortable to serious.Â
Because spironolactone interacts with many medications and shouldnât be taken by patients with a number of diseases, be up-front with your physician about all the medications youâre taking and share your complete medical history.Â
Formal contraindications include sleeping pills, opioids, muscle relaxers, or prescriptions for anxiety, depression, or seizures.
One of the main side effects of spironolactone is that your potassium levels can increase, resulting in muscle cramps or heart palpitations. While some doctors log your baseline potassium levels and keep checking over the following months, that practice is changing. A study from 2015 that had tracked women from 2000 to 2014 concluded that if youâre healthy, with regular potassium levels, you donât need routine monitoring.
However, your doctor may want you to avoid consuming too many high-potassium foods and beverages, such as sports drinks, bananas, kiwis, avocados, mangos, and coconut water. You may also be counseled on how to spot signs of hyperkalemia.
Drinking alcohol or taking narcotics while taking spironolactone can exacerbate the side effects and leave you dangerously lightheaded, to the point that you may faint when you stand. It's safest to avoid alcohol and recreational drugs while you're taking spironolactone, to avoid the possibility of injury from a fall.
It is safe to take spironolactone in addition to a birth control pill. In a RealSelf Q&A, Dr. Paul says, âBoth medications work well together to help control acne. Birth control pills do not interact with spironolactone, so you arenât at higher risk of pregnancy by taking both.â In fact, some doctors strongly recommend using some kind of birth control while taking spironolactone, if thereâs a chance you could get pregnant. Â
Another benefit to taking birth control pills: âThey keep your cycle regular, so that minimizes one side effect of spironolactone for acne,â Dr. Ting says.
Because spironolactone is a diuretic, you may actually lose âwater weightâ while taking the drug.
However, many people say theyâve actually gained weight from spironolactone. It increases cortisol levels, which is clinically proven to add adipose fat to the belly, so you may experience spironolactone weight gain.
It also has a side effect of breast enlargement.
âTypically, hormonal acne results in cystic-type acne lesions, and topicals do very little for this type of acne alone. An alternative to spironolactone for this type of acne would most likely be oral antibiotics plus a topical regimen,â says Dr. Peter Malouf, a Fort Worth, Texas, dermatologist. âFor women who take hormone replacement therapy that includes testosterone, treating acne in these situations can be an uphill battle.â
Depending on the severity of your situation, your dermatologist might recommend one of these alternatives.
Bowser A., Spironolactone for hormonal acne (2018)
Ghelani R., Spironolactone (Aldactone): diuretic medicine used in heart failure (2019)
Stimson R., et. al., Cortisol Release From Adipose Tissue by 11β-Hydroxysteroid Dehydrogenase Type 1 in Humans (2009)
U.S. Food and Drug Administration, Aldactone - Spironolactone (2008)
Updated February 21, 2024