Aldactone (Spironolactone) for Hormonal Acne

Spironolactone, sold under the brand name Aldactone and others, is an oral medication used to treat many different disorders, including high blood pressure and fluid retention. Spironolactone is also commonly used to treat hormonal acne in adult females.

People who break out around the time of their menstrual cycle may benefit from this drug. It can also be helpful for adult females who have acne with other problems like unwanted facial hair.

The U.S. Food and Drug Administration doesn't officially recognize spironolactone as an acne treatment. Still, it is often prescribed off-label for this purpose. It is only available by prescription.

This article discusses spironolactone as a treatment for hormonal acne. It also discusses how to take it and possible side effects.

How Spironolactone Works for Acne

Spironolactone is in a group of drugs called anti-androgens. Androgens are often thought of as male hormones, everyone has them.

Androgens like testosterone are present in the female body, but at lower levels. Still, some females produce more androgen hormones than needed.

Hormones, specifically androgens, have been linked to the development of acne. Spironolactone works by blocking androgen receptors in the body. This stops cells from responding to androgen hormones.

Simply, spironolactone limits the hormonal fluctuations that can cause breakouts. It is used in females only.

How Spironolactone Is Used

Unlike most acne treatments, spironolactone isn't applied to the skin. Instead, it's taken orally. When spironolactone is used as an acne treatment, the most common dosage is between 50 and 100 milligrams (mg) daily.

Your dermatologist may start you on a lower dose. It is common to start at 25 mg daily and work up to a target dose over several weeks. Your healthcare provider will base the dosage on your personal situation.

If your breakouts only happen around the time of your menstrual cycle, you may only need spironolactone during the week before your period. This can help even out the hormone spikes that trigger acne.

Spironolactone is often prescribed with oral contraceptives (a.k.a, birth control pills). You will probably keep using topical acne medications while using spironolactone. It tends to work best alongside other acne treatments, rather than as the sole treatment.

Possible Side Effects of Spironolactone

Side effects of low-dose spironolactone aren't as common as with higher doses. When they do happen, they 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

Blood pressure should be checked periodically while taking this medication. For some females, blood potassium levels should also be checked. Females younger than 45 years old do not usually need to have potassium levels checked when taking spironolactone.

If spironolactone upsets your stomach, take it with a meal. Because spironolactone acts as a diuretic, it is also important to drink plenty of water.

You should not get pregnant while taking this drug as it may harm a fetus.

Spironolactone Interactions

Spironolactone can interact with many drugs and increase the level of potassium in the body to unsafe levels, referred to as hyperkalemia. The drugs of greatest concern include:

• Tekturna (aliskiren), used to treat high blood pressure
• Angiotensin-converting enzyme (ACE) inhibitors, like Vasotec (enalapril) and Prinivil (lisinopril), used to treat high blood pressure
• Angiotensin II receptor blockers (ARBs), like Cozaar (losartan) and Diovan (valsartan), used to treat high blood pressure
• Heparin, used as an anticoagulant (blood thinner)
• Potassium-sparing diuretics, like Inspra (eplerenone) and Midamor (amiloride), used to treat high blood pressure
• Potassium supplements
  

Cost of Spirolactone

Spironolactone is a relatively affordable oral acne treatment retail at around $90 for a 30-day supply.

If you have health insurance, your provider may cover the cost in part or in full, depending on your plan.

Remember to factor in the cost of other acne solutions your healthcare provider recommends using along with spirolactone when considering your budget for treatment.

Summary

Spironolactone (brand name Aldactone) is sometimes prescribed to treat hormonal acne. It works by blocking androgen hormones. It is usually used alongside other acne treatments.

Spironolactone is taken orally. It may have side effects like breast tenderness and irregular periods.

This drug is only for adult females. People who want to become pregnant or have a history of kidney problems or certain cancers should not take spironolactone.

A Word From Verywell

Spironolactoneisn't a first-line treatment for acne. Your dermatologist will probably have you try conventional acne medications first. This includes topical retinoids, topical antibiotics, benzoyl peroxide, or a combination of these agents.

Your healthcare provider may prescribe spironolactone if your acne is hormonal and these medicines do not work well enough.

Try to be patient while waiting for results. It can take three to four months before you notice a big improvement in your skin. Do not give up on your treatments, and let your healthcare provider know about any side effects you may have.