6 Things Dermatologists Want You to Know Before Starting Spironolactone for Acne

If you struggle with chronic bouts of blemishes and breakouts, you may have heard about a prescription drug called spironolactone (Aldactone, Carospir) that can help with hormonal acne.

By blocking certain hormone receptors, the medication decreases your skin's production of sebum, an oily substance that naturally moisturizes your skin but can also clog your pores, leading to acne, explains Howard Sobel, MD, a clinical dermatologic surgeon at Lenox Hill Hospital in New York City.

Research has shown spironolactone to be extremely effective at treating acne.

But as with any drug, it comes with its share of side effects and precautionary notes.

Here’s what dermatologists want you to know before taking spironolactone for acne.

1. It’s Usually Best to Take It in the Morning

Many doctors recommend taking certain medications in the morning simply so you don't forget, but there's another reason it may be better to take spironolactone in the morning: It's a diuretic, meaning it helps remove excess fluid from the body (similar to the effects of caffeine).

In other words, if you take this medication close to bedtime, it may cause you to wake up to urinate.

There may be exceptions to this, of course, and you might want to tweak your timing based on other side effects you have. Be sure to talk to your doctor about the best timing for you.

To avoid dehydration or electrolyte imbalances, drink plenty of water while taking spironolactone, especially during exercise or in hot weather.

A good rule of thumb is to drink about half your body weight in ounces each day, but talk to your doctor about this if you have any underlying heart or kidney conditions.

2. Avoid Getting Pregnant While Taking It

Spironolactone is not recommended for anyone pregnant or planning to get pregnant, because the drug has been shown to cause birth defects in animal studies.

For that reason, you shouldn't take the drug if you're trying to conceive. And if you're ‌not‌ planning for a baby but are sexually active, your doctor may recommend you take some form of contraception to avoid an unplanned pregnancy.

In fact, doctors recommend that some people take this med along with hormonal contraceptives for reasons unrelated to pregnancy; spironolactone can cause side effects such as breast pain and irregular periods, and hormonal contraceptives can reduce these effects.

For people with polycystic ovary syndrome (PCOS), taking the two together can help reduce symptoms like acne, excessive hair growth, and high blood pressure.

3. It Is Not Often Prescribed to Men

Because spironolactone is an anti-androgen, it interferes with “male” hormones like testosterone.

This can be problematic for certain men, as it can result in something known as gynecomastia, or enlarged breasts, says dermatologist Kristina Collins, MD, cofounder and CEO of Austin Skin in Austin, Texas. It can also negatively affect sexual function.

Spironolactone is sometimes prescribed to reduce testosterone in trans women.

4. You'll Need to Watch Your Potassium Intake

Potassium is an important mineral that helps maintain normal fluid levels in the body, but too much can be dangerous.

Spironolactone can sometimes cause elevated potassium levels, and certain medications or foods can cause this side effect to be more likely, says Dr. Collins.

The risk is lower if you're young and healthy and higher if you have kidney disease or take medications that affect your blood pressure or electrolyte levels.

Either way, though, it's crucial to talk to your doctor about any medications or supplements you take or plan to take. And you should also keep an eye on the amount of high-potassium foods you eat, including bananas, oranges, spinach, broccoli, and sweet potatoes.

“One everyday risk is drinking too much coconut water because the coconut water in combo with the spironolactone can make the elevated potassium issue more likely,” Collins says.

Taking spironolactone puts you at risk for hyperkalemia (high potassium levels), which can be dangerous.

Call your doctor right away if you have any of the following symptoms while taking this medication:

Stomach pain
Confusion
Difficulty breathing
Irregular heartbeat
Nausea or vomiting
Nervousness
Numbness or tingling in the hands, feet, or lips
Weakness or heaviness of the legs

5. It Can Take Months Before You See Results

While many people want a quick fix when it comes to acne, it tends to take a while before you start seeing the full results of the treatment.

In fact, depending on the dosage and the severity of your acne, Dr. Sobel notes that the average amount of time to start seeing results is typically two to three months.

However, spironolactone is often used in combination with topical acne treatments like retinoids and benzoyl peroxide, or other oral medications like antibiotics or birth control pills, for potentially faster results.

6. You Can Stop Taking It Cold Turkey, but Proceed With Caution

Some medicines require you to taper off of them slowly but, if you abruptly stop taking spironolactone for acne, you are unlikely to experience traditional symptoms of withdrawal. You may, however, find that your acne returns.

Collins says you may want to make sure you have other acne-control mechanisms like oral contraceptives or topical acne treatments in place before stopping the medication, so you don't experience a recurrence of your acne.

Additionally, because spironolactone is a diuretic used to treat fluid buildup caused by a variety of conditions, stopping the medication may lead to fluid retention and associated complications. While you should be evaluated for any potential complications before starting the medication, it’s still important to discuss discontinuing any medication with your healthcare provider to ensure it's done safely.

The Takeaway

Spironolactone, originally a diuretic, treats hormonal acne by reducing sebum production through its action on testosterone receptors; research indicates the drug is highly effective in clearing skin.
Important considerations for use include taking the medication in the morning due to its diuretic properties, avoiding it during pregnancy, and monitoring potassium levels.
You should expect to see full results after two to three months of consistent use and, while the medication can be stopped abruptly, dermatologists recommend preparing alternative acne treatments to prevent recurrence.