Spironolactone for Acne (Women)

What is spironolactone, and how does it work?

Spironolactone is a medicine often used to treat heart problems, high blood pressure and fluid buildup. It can also affect hormones by blocking male hormones (called androgens), which women naturally produce in small amounts. If a woman has too much of these hormones or is sensitive to them, it can cause skin disorders such as acne.

Using Spironolactone for acne

Spironolactone is a widely-used safe medicine that is sometimes used “off licence” for the treatment for acne. “Off licence” means that the treatment is not specifically used for this condition in the UK government prescribing licence. However, it is available on the NHS and is a good alternative to antibiotics. A 2022 study showed it works well and is safe for women with ongoing acne. For more information on this study, please use the link at the end of the page to view a short video. Spironolactone is not usually used for men to treat acne.

Will spironolactone cure my acne?

Spironolactone does not cure acne, but it can help manage and even clear it over time. It works slowly, so you will need to take it for several months to see the full effect. Most women notice improvement after three months, but treatment needs to be continued for the full six months. It may take up to 6 months to see the full benefit.

What dose should I take?

The usual dose for acne is between 50 micrograms (mg) and 150mg per day. You will usually start with 50mg a day for one month. If you had no side effects and your blood tests are normal, your doctor may increase your daily dose to 100mg a day. Spironolactone tablets should be swallowed whole with a glass of water after food.

What are the common side effects of spironolactone?

Side effects of spironolactone may depend on the dose which is taken.

Common side effects

• Sore or swollen breasts
• Irregular menstrual periods, which may improve if you take the pill or use a hormonal device within the uterus (IUD).
• Drop in blood pressure (Postural hypotension) can make you feel dizzy, lightheaded or faint.

Uncommon side effects

• Skin rashes
• Drowsiness
• Fatigue
• Headache
• Loss of sex drive

Rare side effects

• Confusion
• Loss of coordination
• Increased urine production, this medicine is a diuretic (water tablet).

Very rare side effects

• High potassium levels in the blood (more likely if you’re over 45 or have heart/kidney problems)
• Changes in blood tests for your kidneys or liver (these usually go back to normal if you stop or lower the dose)
• Cancer, animal studies showed a possible link to cancer at very high doses, but this hasn’t been seen in people using regular doses.

Important precautions

• Do not take spironolactone if you are pregnant or trying to get pregnant.
• Do not take spironolactone if you have Addison’s disease or serious kidney problems.
• Drinking alcohol may increase some of the side effects of spironolactone, such as dizziness. We advise decreasing the amount of alcohol you consume.
• Take reliable contraception while using spironolactone.
• The combined pill can help reduce side effects and improve acne.
• It’s usually safe to try for a baby one month after stopping spironolactone.

How will I be monitored for the side effects of spironolactone treatment?

Your doctor will recommend a blood test to check your potassium level before starting treatment and may also monitor your bloods during treatment. These checks may be needed more frequently if you have heart or kidney problems, or if you take other medications that affect potassium levels.

Can I take other medicines with spironolactone?

Let your doctor know if you are taking any medication from the following groups;

• Angiotensin-converting-enzyme (ACE) inhibitors (e.g. Quinapril, Captopril, Perindopril)
• Anti-inflammatory painkillers (e.g. Aspirin, Ibuprofen, Diclofenac)
• Antibiotics (e.g. Trimethoprim, trimethoprim-sulfamethoxazole)
• Diuretics (e.g. Furosemide, Indapamide, Bumetanide)
• Heart conditions (e.g. Digoxin)
• High blood pressure (e.g. Candesartan, Losartan, olmesartan)
• Potassium supplements

If you are taking a medication that is not listed above, please inform your doctor. There may be other medications or supplements that can interact with spironolactone and cause problems.

Further information

For further information, use the links below to go to other internet sites:

• Spironolactone for Adult Female Acne (SAFA) study: https://youtu.be/c03E_R9Rcgw
• https://www.medicines.org.uk/emc/product/12015/smpc
• https://dermnetnz.org/topics/anti-androgen-therapy

This page has been minimally adapted from the British Association of Dermatologists Patient Information Leaflet on Spironolactone (2022), found here: https://www.bad.org.uk/pils/spironolactone/