I. What is Spironolactone (Prescription Drug)?

Spironolactone belongs to a class of drug known as antiandrogens. Antiandrogens inhibit the biological effects of androgens (sex hormones) by blocking the androgen receptors on specific tissues. This class of drug is used to treat hypersexuality, hormonal therapy for prostate cancer, prostate enlargement, acne, hirsutism and male patterned baldness. Antiandrogens when administered in males would result in slow reversal of male secondary sexual characteristics. Spironolactone is also used as a diuretic drug or "water pill" which means that it increases the rate of urine excretion. The increase in urine excretion reduces the water and sodium in the body. This drug is also used to lower the blood pressure, in the treatment of edema or fluid retention and for increasing the potassium levels of the body.

II. How does Spironolactone works on acne?

The main cause of acne is of course increased production of sex hormones. Over the course of time the sudden increase in hormone levels off, that is why acne subsides after teenage years. For some adult people, hormonal imbalances and high testosterone levels still trigger the oil glands to pump out lots and lots of sebum or oil. Overactive oil glands cause acne and inflammation due to bacterial growth. When taken orally, Spironolactone blocks the androgen receptors of the oil glands so that it will not be triggered by high testosterone levels. Blocking of androgen receptors cuts down the oil production of the oil glands and thus reduces the growth of P. acnes bacteria and the formation of comedo.

Advantages

This acne medication can clear blackheads, whiteheads and oily skin. It does not kill bacteria but prevents the excessive growth of bacteria by reducing their food source which is sebum. Blackheads and whiteheads will not develop if there is a reduced sebum output in the oil gland.

Disadvantages

This acne medication is not designed for the treatment acne. ( "OFF LABEL USE" of anti-androgen is usually done by dermatologists to treat acne.)
Not everyone can use this drug. Your dermatologist and doctor should evaluate your health condition first if your body can tolerate this drug.
This drug SHOULD NEVER BE USED BY MALES because it can affect the secondary sex characteristics of males.

Efficacy

Spironolactone is very very effective for the treatment of hormonal acne but not everyone can take this medication.

Records were reviewed from 85 women with acne treated consecutively with spironolactone 50 to 100 mg/day, administered either as single-drug therapy or as an adjunct to standard therapies. The maximum length of treatment was 24 months. RESULTS: Clearing of acne occurred in 33% of patients treated with low doses of spironolactone; 33% had marked improvement, 27.4% showed partial improvement, and 7% showed no improvement. The treatment regimen was well tolerated, with 57.5% reporting no adverse effects. CONCLUSION: Spironolactone can be used in low doses as a single drug or as an adjunct to standard acne therapies in women with adult acne. When used in this fashion, treatment outcomes are favorable, and the drug is well tolerated.
( Source: J Am Acad Dermatol. 2000 Sep;43(3):498-502. Links Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients.)

The mean age of the patients was 21.4 +/- 3.5 years. Two patients discontinued the study due to side-effects. Five patients were lost in the follow-up. Clinically significant improvement was noted in 24 patients (85.71%). No response was seen in four patients. All of the nonresponding patients had received previous unsuccessful therapies. Mean number of lesions and mean DHEAS levels of the 24 patients with clinical improvement decreased significantly after treatment (P < 0.01 and P < 0.05, respectively). There was no change in the mean total testosterone levels before and after treatment (P > 0.05). CONCLUSION: Spironolactone is a safe and effective medication for women with acne vulgaris. Although its side-effects seem to be high, they are in the majority of cases not a reason to stop treatment.
( Source: J Eur Acad Dermatol Venereol. 2005 Mar;19(2):163-6. Links Effects and side-effects of spironolactone therapy in women with acne.Yemisci A, Gorgulu A, Piskin S. Department of Dermatology, Kesan State Hospital, Edirne, Turkey. )

RESULTS: Most of the female patients who completed the 20-week regimen exhibited excellent improvement (evaluated by a photographic grading scale), although some discontinued treatment because of menstrual disturbances or other reasons. The treatment was less efficacious for the males than for the females, and because gynecomastia developed in three male patients, spironolactone treatment for males was stopped. Examination of the serum of 25 patients did not identify any toxicity associated with the treatment. Drug eruptions and edema in the lower extremities were each seen in three patients. CONCLUSION: Oral spironolactone is effective and safe for the treatment of acne in Asian females, and can be a good option for severe, recurring, and widespread types of the condition.
( Source: Aesthetic Plast Surg. 2006 Nov-Dec;30(6):689-94. Links Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians.Sato K, Matsumoto D, Iizuka F, Aiba-Kojima E, Watanabe-Ono A, Suga H, Inoue K, Gonda K, Yoshimura K. Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. )

III. Forms, Dosage and Administration

Aldactone is supplied as 25mg tablets. For the treatment of acne, the typical dose is 25 to 150 mg per day. Full acne reduction would be seen after 2 to 4 months of use.

IV. Precautions

People with allergy to this medication. Signs of allergy include rash, itching, swelling, dizziness, breathing trouble.
This medicine can raise potassium levels in the body. High potassium levels can be fatal. If you notice that you have muscle weakness or irregular heartbeat contact your doctor immediately.

V. Side Effects

This prescription drug can cause blurred vision and dizziness. Dehydration is also another side effect and early symptoms include dry mouth and thirst. Nausea, vomiting, fatigue or nasal congestion may persist for a few days as the body adjust to this medication. If any other side effects mentioned persists and worsens please contact your doctor immediately.

Brand Names

Aldactone, Novo-Spiroton, Spiractin, Spirotone, Verospiron or Berlactone

References

http://www.drugs.com/spironolactone.html (Micromedex data last updated 30 October 2007. Multum data last updated 21 November 2007).
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682627.html (American Society of Health-System Pharmacists, Inc. Disclaimer Last update- 05/01/2007
http://www.medicinenet.com/spironolactone-oral/article.htm ( Last Editorial Review: 3/2/2005 )

Page last modified: January 07, 2008