4 months on Retin-A and Spironolactone and I have dizziness and fainting my doctor says is a vasovagal reaction. Thoughts?

Sorry you are having trouble with your medication!  I would definitely go back to your dermatologist and see if there's an alternative, or if maybe just the topical retin-a would be enough to keep your acne at bay.  You are right, spironolactone can cause some dizziness and low blood pressure in sensitive individuals, and you would not want that to happen at critical moments such as driving!  We generally have a lot of good improvement in acne with spironolactone, but sometimes the side effects outweigh the benefits.  See your dermatologist and best of luck!

Thank you for your question. Spironolactone is a diuretic and can lower blood pressure, even at a low dose. If the dizziness or fainting spells continue, then alteration to your treatment should be considered, such as lowering the spironolactone dose, etc. I highly recommend you consult with a board certified dermatologist regarding your questions and concerns about treatment. Take care and good luck.