Treating Acne With Aldactone (Spironolactone)

An Acne Treatment for Women With Hormonal Acne

Aldactone (spironolactone) is a medication that's used to treat many different disorders, from high blood pressure to fluid retention. Although the U.S. Food and Drug Administration doesn't officially recognize Aldactone as an acne treatment, it is often prescribed off-label to treat hormonally-influenced breakouts in women.

This medication isn't used as ​a first line of defense against acne breakouts. Aldactone is only effective against acne caused by hormonal fluctuations, for example, women who consistently break out around the time of their monthly cycle. It's especially helpful for women with hormonal disorders that trigger acne, or who have acne along with other problems like unwanted facial hair.

This is an acne treatment option for adult women only. It's not prescribed for men with acne or for young teens and tweens. Aldactone is only available by prescription from your doctor.

How Aldactone Works

Aldactone is in a group of drugs called anti-androgens. Hormones, specifically androgens, have been linked to the development of acne. Aldactone works by limiting hormonal fluctuations that can trigger breakout development.

Androgen hormones, like testosterone, are typically thought of as male hormones. But androgens are also present in the female body, although in lower levels. Some women produce more androgen hormones than needed. Anti-androgens like Aldactone block androgen receptors in the body, preventing cells from absorbing androgen hormones.

Simply, Aldactone limits specific hormonal fluctuations that can contribute to acne breakouts.

Because of the way Aldactone works, only women whose acne is greatly influenced by hormonal fluctuations will see results with this medication. But for those women who have hormonal acne, the drug can do a good job in helping to manage breakouts.

Usage Directions

Unlike most acne treatments, Aldactone isn't applied to the skin. Instead, it's taken orally.

When using Aldactone as an acne treatment, the most common dosage is between 50 to 100 mg daily. Many dermatologists start off prescribing 25 mg and work up to the target dosage over the course of several weeks. Your doctor will determine the most appropriate dosage for you, depending on your personal situation.

If your breakouts only appear around the time of your monthly cycle, your dermatologist may have you use Aldactone for the week just prior to your period only. This can help even out androgen spikes that might be triggering your acne.

Aldactone is often prescribed along with oral contraceptives. It can also be used in conjunction with other topical acne medications. It tends to work best as an additional acne treatment, rather than the sole treatment.

You'll probably continue using topical acne treatments while using Aldactone. It isn't always effective when used on its own, but works well when used in conjunction with conventional acne treatment medications.

Possible Side Effects

Possible side effects of aldactone
Verywell / Cindy Chung

Side effects with low dose spironolactone aren't as common as with higher doses, but most often include:

  • Irregular menstrual cycle
  • Breast tenderness

Other side effects can include:

  • Thirst or dry mouth
  • Stomach cramps, vomiting, and/or diarrhea
  • Headache
  • Dizziness
  • Increased blood potassium levels
  • Low blood pressure

Both blood potassium levels and blood pressure should be checked periodically while you're taking this medication. However, women younger than 45 years old do not need to have their serum potassium checked while taking spironolactone.

Also, you shouldn't get pregnant while taking this drug. In addition, this medication isn't a good choice for you if you have kidney problems, or a history (or family history) of breast cancer, uterine cancer, or ovarian cancer.

Take your pill with a meal if it upsets your stomach. And make sure to drink plenty of water daily as Aldactone acts as a diuretic.

A Word From Verywell

Aldactone isn't a first-line treatment for acne, so your dermatologist will likely have you try the conventional acne medications first: topical retinoids, topical antibiotics, benzoyl peroxide or a combination of these medications. If those aren't clearing your skin sufficiently, and your physician thinks that your acne breakouts are exacerbated by hormonal fluctuations, she may then decide to prescribe Aldactone as well.

No matter what treatment plan your dermatologist creates for you, try to be patient while waiting for results. It can take three to four months before you really notice a big improvement in your skin. So, don't give up on your treatments too soon, and let your dermatologist know about any side effects you experience.

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  1. Kim GK, Del Rosso JQ. Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris: Practical Considerations for the Clinician Based on Current Data and Clinical Experience. J Clin Aesthet Dermatol. 2012;5(3):37–50. PMID: 22468178

  2. Hassoun LA, Chahal DS, Sivamani RK, Larsen LN. The use of hormonal agents in the treatment of acne. Semin Cutan Med Surg. 2016;35(2):68-73. doi:10.12788/j.sder.2016.027

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