Aldactone (Spironolactone) for Hormonal Acne

An Acne Treatment for Females With 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

Possible side effects of aldactone
Verywell / Cindy Chung

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:

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.

Frequently Asked Questions

  • How quickly does spironolactone work for acne?

    It can take three to four months before skin improvement becomes noticeable. Keep in mind that spironolactone works best when paired with other conventional acne treatments, such as topical retinoids, topical antibiotics, or benzoyl peroxide.

  • Is spironolactone safe for long-term use?

    The long-term use of spironolactone in the treatment of acne appears to be safe. This is evidenced by a study involving 210 females who received spironolactone for up to eight years for the treatment of acne.

  • Does spironolactone for acne make you gain weight?

    Spironolactone is actually sometimes prescribed for weight loss, though it isn't considered an effective option. There are no scientific studies that have studied its effects on weight. Although it may remove some water weight from the body, it does not directly cause fat loss.

  • What foods should I avoid while taking spironolactone?

    Since spironolactone is a potassium-sparing diuretic, you may need to reduce or avoid high-potassium foods like asparagus, bananas, Brussels sprouts cantaloupe, honeydew melons, kiwis, mangoes, oranges, papaya, potatoes, prunes, sweet potatoes, and tomatoes.

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3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  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.

  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

  3. Bhatt DL. Ask the doctor. The June 2013 issue states on page 3 that "it's important to increase potassium intake, particularly if you take a diuretic." But on page 5, it says that if you take spironolactone (which I do), you should avoid high-potassium foods. I'm confused--should I be eating bananas and other potassium-rich foods or not? Harv Heart Lett. 2014 Mar;24(7):2.

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