Rosen M.P., Breitkopf D.M., Nagamani M. A randomized controlled trial of second- versus third-generation oral contraceptives in the treatment of acne vulgaris. Make sure to discuss your current medication list with your pharmacist and healthcare provider. It can treat conditions like heart failure and high blood pressure. Without the need for regular blood testing or the risk of severe teratogenicity, spironolactone is an attractive alternative to treatment with isotretinoin. The study was limited in its retrospective nature and lack of a control group. Potential association between the oral tetracycline class of antimicrobials used to treat acne and inflammatory bowel disease. You and Your Hormones. (15) In addition, there is no clinical evidence to suggest that antihypertensive medications or spironolactone have a meaningful negative effect with respect to SARS-CoV-2 and guidance from the American Academy of Dermatology recommends continuing spironolactone for patients who are currently on treatment or indications in which spironolactone is known to be beneficial (16, 17, 18). Possible side effects include the following. Ofloxacin may also cause a false positive result for amphetamine or methamphetamine. When taking spironolactone as a part of GAHT, this is an intended side effect. About 6 out of every 7 patients (85.1%) experienced either a CR or a partial response greater than 50% (PR>50) . It is often used in motion sickness. Hyperkalemia in women with acne exposed to oral spironolactone: A retrospective study from the RADAR (Research on Adverse Drug Events and Reports) program. Of the 108 patients, 94 patients acne improved (65 of which were completely clear) and 14 patients did not. Kapur G, Valentini RP, Imam AA, Mattoo TK. To see the most updated information available, check out our latest updates on current COVID-19 treatments. Similar to high potassium, low sodium is a common side effect that can become serious. Duration of oral tetracycline-class antibiotic therapy and use of topical retinoids for the treatment of acne among general practitioners (GP): A retrospective cohort study. Note: Percentages are calculated from a total of 42 patients with initial chest CASS scores greater than 0. View interaction reports for spironolactone and the medicines listed below. There are potential adverse events, such as dizziness or lightheadedness, and this usually goesaway pretty quickly if you have it. spironolactone, along with There were 110 patients that met all eligibility requirements. If this could be a problem, let your dermatologist know. In fact, the risk of developing blood clots is greater during pregnancy and just after having a baby than when taking the pill. what should Ido? Practical considerations in real world practice.Dermatol Clin. Taking this medication causes higher amounts of water and sodium to be eliminated, thereby reducing water retention. Your healthcare provider might ask you to take a lower dose or stop the medication if you experience side effects. Most significantly, there were no women in this study who relapsed when treated with spironolactone unless they were weaned to lower doses (five patients) or their concurrent treatments were altered (one patient relapsed after receiving a medroxyprogesterone acetate injection). Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne.JAMA Dermatol. Of these 104 patients, 15 patients were prescribed systemic antibiotic medications concurrently either as a tapering of existent antibiotic use or as an adjunct therapy due to a lack of response to treatment with spironolactone. [12] Spironolactone has been considered as a possible alternative to the guideline-based recommendation of a three-month course of oral antibiotics, specifically the tetracycline class of antibiotics, for chronic treatment of moderate to severe acne because it may reduce the risk of antibiotic resistance in patients on very long periods of antibiotics and provide clinically relevant improvement in acne. There is 1 alcohol/food interaction with spironolactone. If you are a Mayo Clinic patient, this could Spironolactone is also a diuretic, or water pill. Muhlemann M.F., Carter G.D., Cream J.J., Wise P. Oral spironolactone: an effective treatment for acne vulgaris in women. When taken alone, spironolactone can be quite effective. eHealthMe is studying from 1,225 Dramamine users for its effectiveness, alternative drugs and more. She agreed to taking spironolactone (100 mg daily) and planned a return visit in 3 months. Best of luck! The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. Its also prescribed for people who are retaining too much fluid. Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, Ford I, Cruickshank JK, Caulfield MJ, Salsbury J, Mackenzie I, Padmanabhan S, Brown MJ., British Hypertension Society's PATHWAY Studies Group. This study reaffirms the results of previous studies in terms of effectiveness and safety but adds to the literature by showing the low rate of relapse. Although the study by Roberts et al. You can unsubscribe at any time. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). For exhibitors, advertisers, sponsors & media, Running Your Dermatology Practice During COVID-19. StatPearls Publishing, Treasure Island (FL). Charny JW, Choi JK, James WD. (13) In addition, while use of spironolactone has been increasing, oral antibiotics are still prescribed 3 to 5 times more often than spironolactone for women with acne. Additional urine studies to assess kidney function may also be a requirement. This means that this study, on its own, isnt enough to say if spironolactone could prevent COVID-19. Yang CT, Kor CT, Hsieh YP. This combination has another advantage. (For the study, monotherapy was defined as no concomitant oral acne treatments; for patients taking a concomitant OCP, they were considered to be on spironolactone monotherapy if the OCP was started greater than 6 months before spironolactone.). Other possible side effects of taking spironolactone include fatigue, headache, and dizziness. In the treatment of acne vulgaris, spironolactone may reduce sebum production by blocking the binding of dihydrotestosterone to its androgen receptors, thereby inhibiting sebocyte proliferation.[12]. This can cause males to develop feminine characteristics, like breast growth and hair loss. Ko DT, Juurlink DN, Mamdani MM, You JJ, Wang JT, Donovan LR, Tu JV. In one study, 1,475 patients prescribed spironolactone were followed for 3 to 7 years. Federal government websites often end in .gov or .mil. Spironolactone may worsen kidney function in patients with low to no salt in their body or in those who take other blood pressure medicines (eg, ARB, ACE inhibitor). Minocycline, for example, has been studied with various methods of outcome measurement and has been found to show improvement in 51% of cases (Ozolins et al., 2004) and completely or mostly clear acne in 23.6% of cases (Stewart et al., 2006). Save with patient assistance programs. Efficacy of low-dose spironolactone in subjects with resistant hypertension. By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx. One early study showed that there was no reduction in sebum excretion (Walton et al., 1986). J Clin Aesthetic Dermatol. One study found that almost 1 in 8 split pills were off by more than 20%. Usually avoid combinations; use it only under special circumstances. If none of these patients had taken spironolactone, it is expected that about 8 of them would have developed breast cancer during that time. If you have what feels like razor bumps or acne on the back of your neck or scalp, you may have acne keloidalis nuchae. Sometimes these side effects can happen from taking spironolactone on an empty stomach. If youre 35 years of age or older, the pill may not be an option for you and only spironolactone may be prescribed. Spironolactone, with a similar side effect profile regardless of the duration of treatment, may be a safer treatment option than oral antibiotic medications for chronic acne treatment. Of the total drug interactions, 50 are major, 288 are moderate, and 23 are minor. Spironolactone was well tolerated. Hormonal therapy is an option for many women with stubborn acne, but its not always the only option. The content represents the opinions of the authors and should not be interpreted as the official AAD position on any topic addressed. Aldosterone antagonist therapy and mortality in patients with ST-segment elevation myocardial infarction without heart failure: A systematic review and meta-analysis. Find out why dark spots appear and what can fade them. Spironolactone works by affecting certain hormones in your body. Feeling tired or low in energy. Greenblatt DJ, Koch-Weser J. Additionally, a recent study investigated hyperkalemia as a potential complication of this potassium-sparing diuretic in healthy young women with acne who are the typical demographic for off-label spironolactone use (Plovanich et al., 2015). This survey is being conducted by the WebMD marketing sciences department. About 6 out of every 7 patients (85.1%) experienced either a CR or a partial response greater than 50% (PR>50) . Concurrent treatments were similarly represented in both those patients who experienced improvement and those who did not. Spironolactone may also be prescribed without the pill. This is called off-label use. doi:10.1056/NEJMoa2008975. These patients medical records were thoroughly reviewed with data points inputted into a data collection sheet. Of these, 34 patients saw a reduction in their CASS score by the time of their first follow-up visit, an additional 5 patients saw a reduction by the second follow-up visit, and an additional 1 patient by the fourth follow-up visit (Table 3). (10, 11) Although it is always important to individualize treatment regimens to the specific needs of the patient, spironolactone is a great medication to have in our armamentarium to help our patients achieve clear skin. Things to remember when you fill your prescription. Call your doctor for medical advice about side effects. Careers, Unable to load your collection due to an error, Department of Dermatology, University of Pennsylvania, Philadelphia, PA. Physiol Rep. 2019;7(11):e14105. The women saw an average improvement in their acne by 73.1% for the face, 75.9% for the chest, and 77.6% for the back. 2009; 2(12): 1622. 2-6. There were 16 patients who did not improve and six who relapsed after initial improvement. Have you taken an antibiotic to treat your acne and been disappointed with the results? The studies had only 36 and 21 subjects, respectively, but showed a statistically significant improvement in acne (Goodfellow et al., 1984, Muhlemann et al., 1986). Data sources include IBM Watson Micromedex (updated 2 Apr 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Sulfonamide medications that may be OK. Certain diabetes medications glyburide (Glynase, Diabeta) and glimepiride (Amaryl), for example. doi:10.14814/phy2.14105. Dahal, K., et al. A CASS score of 0 (no or barely visible acne lesions) to 5 (highly inflammatory lesions with nodules and cysts) is assigned separately for the face, chest, and back on the basis of the severity of the acne in that area. They want to take me off doxy bc not a good long term solution. Randomized Aldactone Evaluation Study Investigators. Skip the coconut water and supplements that contain potassium. Research Fellow, Department of Dermatology Over the last decade, experiences like these prompted me to spearhead a retrospective review of our Mayo Clinic experience regarding spironolactone for the treatment of adult female acne. Yes, spironolactone is a super safe, and effective drug to treat female hormonal acne. That's not exactly top precision. 2-6. Highly clinically significant. All rights reserved. The topical retinoids can be really useful for maintenance after clearing up the active and cystic acne. I typically see results from spironolactone in two months, but it can take longer to get the full effect. Zouboulis C.C., Akamatsu H., Stephanek K., Orfanos C.E. You may opt-out of email communications at any time by clicking on But you may be familiar with it for other off-label uses, like acne and hair problems. Advertising revenue supports our not-for-profit mission. Spironolactone works by blocking aldosterone. This is because theyre more likely to develop severe high potassium. N Engl J Med. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Spironolactone is FDA approved to treat a few health conditions: Heart failure with reduced ejection fraction (HFrEF), Swelling caused by fluid buildup (edema), often due to liver or kidney damage, Primary hyperaldosteronism, a condition where the body makes too much of the hormone aldosterone. Only used in women2. Spironolactone is a mineralocorticoid receptor antagonist that is currently indicated for the treatment of primary hyperaldosteronism, congestive heart failure, cirrhosis, nephrotic syndrome, essential hypertension, hypokalemia, and edema of pregnancy (FDA, 2014). Avoid combinations; the risk of the interaction outweighs the benefit. This study looked at people who were already taking spironolactone for another condition. Point to Remember: In the unsettling times of the COVID-19 pandemic, we need commonplace dermatologic heroes to inspire us. Of the 15 patients who were prescribed systemic antibiotic medications while treated with spironolactone, 4 patients were tapered off of the preexisting antibiotic regimens, 10 patients initiated antibiotic medications after a trial of spironolactone alone was not effective, and 1 patients was both tapered off of a preexisting antibiotic regimen and initiated a new regimen. Several clinical pearls emerged from this article which can be used with patients to decide whether spironolactone may be helpful for their acne: Two-thirds of patients (66.1%) experienced a complete response (CR) . No uniform blood pressure or potassium testing was conducted because this generally young, healthy patient population was screened by history to have no hypertension, cardiac, or renal disease. Notably, in a 2019 survey of acne patients and their parents, nearly 75% responded that they would prefer an effective, antibiotic-free prescription rather than an oral antibiotic for acne. There were 4,621,497 patients in the PennSeek database of which 464 patients had the terms acne, CASS, and spironolactone in their medical records. However, for spironolactone, empirically it may be the case that it instead decreases ACE2 expression. Check with your doctor immediately if any of the following side effects occur: Get emergency help immediately if any of the following symptoms of overdose occur: Some side effects may occur that usually do not need medical attention. Shaw J.C. Low-dose adjunctive spironolactone in the treatment of acne in women: A retrospective analysis of 85 consecutively treated patients. Wrenger E, Mller R, Moesenthin M, Welte T, Frlich JC, Neumann KH. Adverse reactions to spironolactone. International Journal of Women's Dermatology, http://www.fda.gov/downloads/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm234639.pdf, http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf, Irregular menses (varied duration between periods), Oligomenorrhea (periods greater than 35 days apart). Get prescription saving tips and more from GoodRx Health. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Find out what may be causing the itch and what can bring relief. U.S. Food and Drug Administration Risk evaluation and mitigation strategy (REMS). Spironolactone helps the body get rid of fluid. However, only 32% of antibiotic users in the survey responded that they were aware of non-antibiotic treatments, such as spironolactone.