How Long Does Spironolactone Take to Work for Acne?
Medically reviewed by Lindsay Cook, PharmD
The approach to treating acne will depend on many factors, including age, lifestyle, the type and severity of acne experienced, and genetics.
Mild or moderate acne may be treated with topical products (those that you apply to the skin)—while more severe acne may require oral medications, such as antibiotics, hormones (for females only), or retinoids, such as Accutane (isotretinoin).
One notable hormonal treatment option for acne is spironolactone—a drug that has been used for decades to treat acne in adult females. It may be used when other treatments have not been effective.
When using spironolactone for acne, it may start to work within several weeks; however, in some cases, it can take up to five months to see its full effects.
This article will analyze the role of spironolactone in the treatment of acne.
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What Is Spironolactone?
Spironolactone is an orally administered hormonal therapy often identified by its brand-name formulations, such as Aldactone (oral tablet) and CaroSpir (liquid suspension).
This medication can be further classified as an aldosterone receptor antagonist, a diuretic (water pill) that encourages water loss in the body.
For treating acne, spironolactone is only prescribed off-label to adult females, not males. "Off-label" refers to the prescribing of drugs for uses or at dosages not approved by the Food and Drug Administration (FDA).
Spironolactone is not used in adult men because it can impact a male's physical and sexual health, including causing breast growth and tenderness and sexual dysfunction, including erectile dysfunction (ED).
How It Works
Spironolactone works by reducing excess oil and helping to clear acne.
In doing so, it causes the kidneys to eliminate unnecessary fluids and sodium from the body while reducing the loss of potassium.
Traditional Uses
Spironolactone is FDA-approved to treat the following:
Hyperaldosteronism (a condition in which the body makes too much of the hormone aldosterone)
Edema caused by certain conditions, such as liver or kidney disease
Spironolactone for Acne Relief
When other treatments, such as topical or certain oral medicines, are ineffective for acne relief, a healthcare provider may prescribe hormonal therapy.
Hormonal therapy may include oral contraceptives, such as birth control pills, and/or spironolactone.
Females who take spironolactone must also use birth control to prevent pregnancy since the drug can lead to severe disabilities in the infant.
Consult with your provider on which birth control pills are safe and effective for you.
How Effective Is Spironolactone?
For acne, spironolactone is considered a safe and effective treatment for adult females as a monotherapy treatment option (treating a condition with a singular medication).
Studies that reflect this include the following:
One small study showed that one-third of the females who took spironolactone had a complete clearing of acne, and one-third reported noticeably less acne.
Another study looked at 395 females who took spironolactone and found that 66% had a complete response, while 85% had a complete or more significant response than 50%.
One study found that spironolactone completely cleared acne in many females who took the medication. Females reported over 70% improvements on the face, chest, and back, showing that spironolactone works on multiple body parts, not just the face; 85% reported improvements, with 55% saying their acne was noticeable and 26% were almost transparent.
Dosing Guidelines
Guidelines for spironolactone use in acne include:
The dosing is generally between 50 and 200 milligrams (mg) by mouth daily.
Doses of 150 to 200 mg daily may be more effective for acne. However, lower doses (50 to 100 mg daily) may be effective and have fewer side effects. The healthcare provider will prescribe a lower dose to start, even as low as 25 mg daily, and gradually increase the dose to an effective dose.
Spironolactone is generally prescribed for at least one or two years, with some time off occasionally to see if the drug is still needed.
How Long Does Spironolactone Take to Work for Acne?
Results may differ, but general guidelines include:
You may see a decrease in breakouts and oiliness as soon as a few weeks.
It can take up to three months to see an initial response, and it may take up to five months to get the full effect of this medicine.
Take your medicine daily, as directed, even if you don't see results immediately.
Keeping appointments with your healthcare provider can also increase your chances of successful acne treatment.
This will help your provider assess how well the treatment is working and allow them to adjust the dose of medication if needed.
Continue following your healthcare provider's other recommendations, such as using certain cleansers or other treatments if recommended or prescribed.
Guidelines for Safe Use
Tips for safely taking spironolactone are:
Before taking spironolactone, tell your healthcare provider about all preexisting conditions and current medication regimens.
Read the prescription label and the patient information leaflet carefully. Ask your healthcare provider or pharmacist any questions you have about taking spironolactone.
Take spironolactone exactly as directed. Do not take more or less than prescribed. If you miss a dose, take it as soon as you remember. However, skip the missed dose if it is almost time for the next dose. Do not take extra doses to make up for a missed dose.
You can take spironolactone with or without food.
Take spironolactone at about the same time every day. If taking two doses, for example, take one at 8 a.m. and the second at 8 p.m. each day.
Your healthcare provider may recommend dietary changes, including avoiding salt substitutes that contain potassium. Your provider may ask you about your dietary potassium intake.
If you drink alcohol, consult your healthcare provider. Combining alcohol with spironolactone can increase the risk of dizziness and fainting.
Store spironolactone at room temperature (68 to 77 degrees F), away from direct light, heat, and moisture. Do not store it in the bathroom. As with all medications, keep it out of the sight and reach of children and pets.
Potential for Interaction
Before taking spironolactone, tell your healthcare provider about all of the medicines you take, including:
Prescription medications
Over-the-counter (OTC) medicines
Vitamins
Supplements
While taking spironolactone, do not start any new medications without approval from your healthcare provider.
Categories of drugs that may negatively interact with spironolactone include:
Medications that increase potassium, such as potassium supplements, or angiotensin-converting enzyme (ACE) inhibitors such as Altace (ramipril)
Antidepressants, such as Lithium
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen) or Aleve (naproxen sodium)
Blood pressure support medications, such as Lanoxin (digoxin)
Medications used to lower cholesterol levels, such as Questran (cholestyramine)
This is not a complete list of drug interactions. Other types of drugs may negatively interact with spironolactone.
Therefore, ask your healthcare provider for more information about the possibility of spironolactone's interacting with other medications you take.
Side Effects
Like all drugs, spironolactone carries the potential for side effects of varying severity.
Monitor yourself or a loved one closely for the emergence of side effects that fail to go away or that worsen over time.
Call your healthcare provider right away if you experience severe side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.
The following lists common, less severe, rare, and more severe side effects of spironolactone.
Common Side Effects
Common side effects of spironolactone may include:
Stomach problems, including vomiting, diarrhea, and stomach cramps
Breast enlargement or pain
Vaginal bleeding in postmenopausal females (who have ended their monthly menstrual periods)
Excess hair growth on parts of the body
Severe Side Effects
Serious side effects of spironolactone may include:
Anaphylaxis (severe allergic reaction), which includes symptoms such as urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat, requiring immediate medical care
Weakness, pain, or cramps in the muscles
Pain, burning, numbness, or tingling in the hands and/or feet
Not being able to move your arms or legs
Lethargy
Appetite loss
Urinating less frequently
Dehydration (symptoms may include excess thirst, dry mouth, dizziness, headache)
Low platelet levels (symptoms may include unusual bleeding or bruising, vomiting blood, blood in the stools)
Liver problems (symptoms may include upper right stomach pain, flu-like symptoms, or jaundice, which is yellowing of the skin or whites of the eyes)
Alternative Treatment Options
Consult your healthcare provider for professional medical advice and a treatment plan for nondrug options.
Nondrug options may include:
Dietary changes (such as eating foods low on the glycemic index, meaning they won't raise your blood sugar quickly)
A regular skin-care regimen using gentle, nonirritating products
Laser and light treatments
Summary
Spironolactone is an orally administered hormonal therapy that, in addition to its standard usage for high blood pressure and fluid retention, can be used off-label for the treatment of acne in adult females.
When using Spironolactone for acne, you may see initial results in several weeks (but it can take up to three months) and up to five months to see the full benefit of this medication.
Ask your healthcare provider for more information about spironolactone to see if it is right for you.
Frequently Asked Questions
Can pregnant or breastfeeding people take spironolactone?
No. Because it can cause birth defects, spironolactone should not be taken if you are pregnant or planning to become pregnant.
If you already take spironolactone and find out you are pregnant, stop the medication and contact your healthcare provider right away.
If you are breastfeeding, check with your healthcare provider for medical advice.
Can spironolactone affect period cramps during use?
Spironolactone may cause stomach pain or cramps in general. It may also make your menstrual cycle irregular.
Read the original article on Verywell Health.
