What is the Most Effective Dosage of Spironolactone to Fight Acne?

I typically start at 100 mg per day, and I check back with the patient in 2 months.  if the patient is doing well, without any outbreaks, we start decreasing the dose.  However, if the patient continues to have acne and is not having side effects, we continue at 100 mg per day.  50 mg per day may be adequate.  The best advice is to wait a couple months and see what happens...

The usual starting dose is 50 mg/day of spironolactone for most women with “hormonal” acne. There are potential adverse events, such as dizziness or lightheadedness, and this usually goesaway pretty quickly if you have it. As a standalone treatment, this can take up to 3 months for effectiveness, and some patients may need the dose of 100 mg to get them better. Many of us will use spironolactone with a topical medication or two if needed, so make sure you connect with a board-certified dermatologist to see it is appropriate for you and that you are monitored with your acne and your progress regularly.

Spironolactone is an excellent medication for treating hormonal acne in females. Unfortunately, at higher doses it can have side effects (including dizziness and lightheadedness). I start nearly all of my patients on 50mg daily.  Spironolactone takes up to 3 months to have its full effect, at which point I will sometimes decrease the dose or may increase the dose of Spironolactone if necessary.  If you are currently taking 50mg daily, that is a great dose for most women with hormonal acne.

 

It works, particularly when a woman finds antibiotics both topical and systemic aren't working for that predictable perimenstrual flare.  You don't need large doses and often can take it only around your menstrual period..  I always suggest two weeks on and two weeks off.  I often start women on 25mg twice a day to see if that low dose is enough to block the hormonal hit.  I rarely have to take them to 50 mg twice a day.  Give the initial dosing at least one menstrual cycle to see if it works.  Two cycles are even better.

Hope that helps!