Yet, for many years evidence-based literature regarding the efficacy of spironolactone has lagged behind our day-to-day experience with spironolactone in the dermatology clinic. The frequency of administration and adjustments in the dose are based on the clinical indication and presence of renal impairment. Today, the pill contains less estrogen. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Women who answer yes to any of these questions may want to consider hormonal therapy for acne. doi:10.14814/phy2.14105. Ozolins M., Eady E.A., Avery A.J. Spironolactone works by blocking aldosterone. fast or irregular heartbeat fever with or without chills general feeling of tiredness or weakness headache heartburn hives, itching, or skin rash hoarseness increased thirst indigestion inverted nipple loss of appetite loss of consciousness lower back or side pain lump in the breast or under the arm muscle pain or cramps muscle spasms or twitching Spironolactone specifically works by competitively blocking aldosterone receptor-mediated action. Men have developed breasts while taking this medication to treat acne. Spironolactone [package insert]. Kim GK, Del Rosso JQ. 3. These side effects usually lessen or go away if your dose is lowered. Cureus. GoodRx is not sponsored by or affiliated with any of the third-party brands identified. Spironolactone is not prescribed to treat acne in men due to side effects. Common side effects. Guidelines of care for the management of acne vulgaris. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Save with GoodRx. 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. Pitt B., Zannad F., Remme W.J., Cody R., Castaigne A., Perez A. And hes gotta be larger than life (1), These lyrics recently reminded me of a hero in dermatology: spironolactone for the treatment of acne in adult women. Inclusion criteria for the study were (1) diagnosis of acne by a dermatologist, (2) treatment with spironolactone for at least 3 months, and (3) dermatologic follow-up for at least 3 months after initiation of spironolactone. This content does not have an English version. From this group, patients who were over the age of 12 years, treated with spironolactone for acne after January 1, 2007, and evaluated with CASS scores at both the initial and follow-up appointments by one of two specific dermatology providers were selected as eligible for the study. Moderately clinically significant. Does Sprycel interact with other medications? [3]This medication is not yet generally recommended for end-stage renal disease patients either on or not on dialysis; even though more large randomized controlled trials are needed, some reports do suggest that it would be well tolerated in chronic kidney disease patients if clinicians carefully manage the risk of hyperkalemia. 2020;NEJMoa2006923. Even though her facial dermatitis was the impetus for the video consultation, spironolactone became the anticipated hero of the visit! These medications may interact and cause very harmful effects. You may opt-out of email communications at any time by clicking on Kelidari H.R., Saeedi M., Hajheydari Z., Akbari J., Morteza-Semnani K., Akhtari J. Spironolactone loaded nanostructured lipid carrier gel for effective treatment of mild and moderate acne vulgaris: A randomized, double-blind, prospective trial. Of the remaining patients, an additional 20 patients improved and 12 patients cleared their acne when treated with 150-mg/day doses, and 10 patients improved and 3 patients cleared with 200-mg/day doses. Charny JW, Choi JK, James WD. [4][5] The definition of resistant hypertension is elevated blood pressure above the goal despite a patient being on optimal doses of three different antihypertensive agents of which one is a diuretic is another condition for which clinicians can prescribe spironolactone. Kim, G. K., et al. On the basis of this finding, a patient should maintain a dose that is effective for at least 2 months. October 2018. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. This combination has another advantage. The large sample size and encouraging results in terms of efficacy, relapse rate, and safety make this an important study to promote more widespread use of spironolactone in the treatment of women with acne. In fact, the pill has proven so effective that the US Food and Drug Administration (FDA) has approved some oral contraceptives for treating acne. PennSeek software training was provided by Yevgeny Jesse Zlatsin of the Data Analytics Center, Corporate Information Services, University of Pennsylvania in Philadelphia, PA. Funding sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. If your potassium levels rise too much, your spironolactone dose may need to be changed or stopped. Ofloxacin may also cause a false positive result for amphetamine or methamphetamine. These patients did not take trimethoprim-sulfamethoxazole as an adjunctive treatment to spironolactone because this antibiotic medication can potentially cause hyperkalemia. Accessed April 16, 2020. The type of oral contraceptive pill was unknown in 15 patients. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Aldosterone antagonist therapy and mortality in patients with ST-segment elevation myocardial infarction without heart failure: A systematic review and meta-analysis. Effect of spironolactone on COVID-19 in patients with underlying liver cirrhosis: A nationwide case-control study in South Korea. Some mixtures of medications can lead to serious and even fatal consequences. The site is secure. Average before and after CASS scores and percentage of improvement for women who initiated treatment with CASS score greater than 0 for the face, chest, and back. Routine blood work is necessary to evaluate serum potassium levels and any decline in renal function. 2012 May (Acne suppl). ), Spironolactone appeared to be effective as monotherapy, as 327 of the 395 patients (82.8%) were classified as receiving spironolactone monotherapy. (7) Using the data from our publication, I was able to provide her with clinically-relevant information about the drug. [10] Spironolactone was studied concurrently with metolazone in patients with cirrhosis and nephrotic syndrome and found to be effective adjunctively, and it mitigated the hypokalemia associated with metolazone use. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for theManagement of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Make sure to discuss your current medication list with your pharmacist and healthcare provider. Efficacy of low-dose spironolactone in subjects with resistant hypertension. (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.). Iwas prescribed 50mg Doxycycline and did not see an improvement. HHS Vulnerability Disclosure, Help There is a need for further research for spironolactone to gain legitimacy as a systemic acne medication. Practical considerations in real world practice.Dermatol Clin. This warning was included after researchers gave animals very high doses of spironolactone. Cumming DC. When hormonal therapy helps to clear acne, a patient may stay on it for a long time. Common off-label uses for spironolactone include: Hirsutism (male-pattern hair growth in females), Part of estrogen-based gender-affirming hormone therapy (GAHT), Part of a medication regimen some people take after having a heart attack. 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). If youre uninsured or underinsured, you may be eligible for Aldactones patient assistance program, which offers the medication free of cost. Portions of this document last updated: April 01, 2023. Usually avoid combinations; use it only under special circumstances. National Library of Medicine Spironolactone is generally well tolerated in women and its potentially most worrisome side effects, hyperkalemia and increased risk of cancer, are not sufficiently supported by evidence. Note: Percentages are calculated from a total of 45 patients with initial back CASS scores greater than 0. High potassium levels are also more likely to happen if you take certain medications. 2016;74:945-73. Improvement ranges from a 50% to 100% reduction in acne. These medications must be prescribed by a doctor. Barbieri JS, James WD, Margolis DJ. Talk to your doctor if you have concerns about this. Hormonal therapy can be used alone to prevent new breakouts. Shaw J.C., White L.E. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney. Philadelphia chromosome positive acute lymphoblastic leukemia, chronic phase Philadelphia chromosome positive chronic myelocytic leukemia, lymphoid blast phase Philadelphia chromosome positive chronic myelocytic leukemia, myeloid blast phase Philadelphia chromosome positive chronic myelocytic leukemia, accelerated phase Philadelphia chromosome positive chronic myelocytic leukemia. The most common non-electrolyte and electrolyte adverse effects of spironolactone are breast complaints and hyperkalemia, respectively. Possible side effects include the following. http:/www.google.com. An additional 17 patients were excluded from the study due to medication non-compliance (12 patients), running out of medication (4 patients), or lack of timely follow-up (1 patient). If we combine this information with your protected Concurrent treatments may confound the observed efficacy of spironolactone. High potassium can cause heart rhythm problems. 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). Advertising revenue supports our not-for-profit mission. These actions make this medication helpful for certain health conditions such as heart failure. 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). Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, clear or bloody discharge from the nipple, decrease in urine output or decrease in urine-concentrating ability, dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position, persistent crusting or scaling of the nipple, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue, sore on the skin of the breast that does not heal, sores, ulcers, or white spots on the lips or in the mouth, swelling of the face, fingers, feet, ankles, or lower legs, swollen, painful, or tender lymph glands in the neck, armpit, or groin, unsteadiness, trembling, or other problems with muscle control or coordination, vomiting of blood or material that looks like coffee grounds, numbness or tingling in the hands, feet, or lips, rash with flat lesions or small raised lesions on the skin, loss in sexual ability, desire, drive, or performance, swelling of the breasts or breast soreness in both females and males, unusual dullness or feeling of sluggishness. 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