What Is It?

Spironolactone has been widely used for over 50 years to treat fluid retention, mild high blood pressure, and a few rare hormonal problems. It was subsequently found to be highly effective in the treatment of certain hormonally-related conditions in women, including (1) Adult acne, (2) unwanted facial or body hair, and (3) "pattern" hair loss of the scalp. It is common for a woman to have two or even all three of these (hormonal) problems. They are almost never caused by abnormally high or low hormone levels. In fact, hormone levels are usually normal. The problem is not with how much hormone is made, but how much hormone is used at its destination; in this case your oil glands and hair follicles. If your oil glands and/or hair follicles are too sensitive to normal fluctuations in your hormones, you "overreact" to those fluctuations.

THREE IMPORTANT POINTS:

• Adult acne is NOT the same as teenage acne, and does not usually respond to teen acne treatments
• "Pattern" hair loss is as common in women as baldness is in men. However, women do NOT go bald the way men do; their hair just becomes thin in the same, central area of the scalp.
• The same hormones can cause hair loss on the scalp and Abnormal Hair Growth elsewhere. How can that be? Because different hair follicles have different hormone receptors.

Spironolactone does not change your hormone levels because hormone levels are not the problem. It works by preventing hormones from binding to your hair follicles and oil glands, blunting the unwanted effect. Since your hormone levels remain the same, hormone-associated side effects are avoided. Of course, no drug is completely free of side effects, but in our years of experience with this therapy, side effects have been quite rare, and those we have seen have been quite mild. Less than 5% have noticed irregular or frequent menstrual periods, which can be easily controlled with birth control pills or other methods. Breast Tenderness, Mood changes and Fatigue are other possible side effects.

The package insert also mentions reports of "tumors in laboratory animals." This is outdated and misleading information. Spironolactone has been prescribed for over 50 years, with many people taking it daily for years at a time, yet there is no evidence that it has caused a single tumor in a human, even after many years of continuous treatment. The present consensus is that any such risk is negligible.

If your blood pressure is normal, spironolactone will not affect it. If you are being treated for high blood pressure now, please tell us. However, if you are taking any other blood pressure medicines, spironolactone may increase their effect. You may have to substitute spironolactone for one or more of your present medicines. Please ask your physician about any potential problems with blood pressure medicines (or any other medication you are taking).

Do not take Spironolactone if you are pregnant.

Spironolactone should NOT be taken with drugs known as ACE inhibitors. Most people must take spironolactone regularly for a minimum of 4 months to have a beneficial effect. If it proves to be effective, you can count on remaining on spironolactone for 6 to 12 months. While taking spironolactone, do not eat LARGE AMOUNTS of whole-grain cereals, chickpeas (hummus), bananas, potatoes, tomatoes, carrots, celery, orange or grapefruit juices, clear broths, or salt substitutes such as "Nu-salt". REASONABLE AMOUNTS of any of these foods is not usually a problem.

The only adverse effect seen with any sort of regularity -- is irregular menses, and that's easily rectified with oral contraceptives. (Spironolactone + OrthoTricyclin or OrthoCyclen is an excellent combination treatment for androgenic acne.) The only other adverse effect listed in the insert as "relatively common" is breast tenderness, it is only rarely of any concern. Mood issues have been listed as a problem. Acne itself causes significant mood issues, especially when you are 35 or 40 and wondering what you did to deserve it!

Spironolactone 25 mg by mouth 2 times a day

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