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Hi everyone!

Has anyone tried spironolactone 100 mg (50 mg twice a day) combined with natural licorice, to reduce the side effects? I appear to have adrenal problems which are exacerbated by the side effects of spiro. - to the point that they are intolerable - but the spiro. is the only thing that seems to help my acne (have tried literally every kind of treatment except light therapy), so I don't want to get off of it.

I've read that research/study indicates that licorice counteracts the bad side effects of spiro. in women with PCOS who take it for hirsutism/acne. I have been tested and don't have PCOS (I think I used to, and it disappeared when I lost a lot of weight in recent years). But I don't have high blood pressure/water retention/hyperaldosteronism or any of the normal reasons for taking spiro. - I take it for (idiopathic) hirsutism & acne.

Licorice is known to stimulate adrenal function and was used in centuries past to treat adrenal insufficiency, before doctors started using cortisol supplementation. But it is known also that excess cortisol in women can cause acne/hirsutism, so I am hesitant about using licorice, not knowing if it might counteract the effect of spiro. in reducing acne/hirsutism, since it's hard to know what dosage to use so I wouldn't end up overstimulating my adrenal gland.

Has anyone tried this, or are educated on how to use it and can give me suggestions? Will it undo the good effects of the spiro. or will it only affect the aldosterone mechanism? How much should I take? Also, does it give you migraines?

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Instead of putting it in my signature like some people do, I'll put my history here:

I am 32 and have had acne and extremely oily skin for years. I tried just about everything - benzoyl peroxide (most effective - of everything I tried - as a preventive, but still always had active acne while using it), salicylic acid (made skin so dry and flaky & made it break out worse, even though I used oil-free moisturizer), sulfur, long-term antibiotics, tea tree oil (made me break out in awful cysts - maybe I'm allergic to it or something), Differin (seemed to have no effect), Accutane (cured me temporarily but it came back, and the initial breakout was so horrendous I couldn't go out in public for a long time, and would never be willing to go through that again), DIM (really broke me out), some vitamin cure (seemed to heal zits more quickly but didn't clear me up)...and whatever new treatment came out, if it looked safe, I would try it. Any type of oil breaks out my skin.

This year my doctor tried spironolactone. (Also she added the topical treatments, Benzaclin in the morning and Differin at night, to help since the spiro. can take months to achieve its full effect. Differin did nothing until she upped me to the 0.3% dose - that seems to really do something.) I wish I had known about this sooner. It really seems to help, like nothing else has. She started me on 25 mg twice a day (which seemed to do nothing) but now has upped it to 50 mg twice a day (which seems effective). My back - which used to be outrageously broken out, with cysts and probably hundreds of pimples, for years - is finally clearing up, and my face is improving as well. It also seems to even out my hormones somehow - I'm less moody and emotional than I used to be (it's like I used to be on continual PMS).

But it has had pretty bad side effects in my case. I was so tired and faint that I would have to leave work early because I would feel so weak, and often couldn't think straight until I lay down - because my blood pressure/heart rate would go so wild when I was in an upright position. I lost a whole lot of weight with very little effort. My blood pressure was low, I felt cold, I was always fighting dehydration, I would crave sweets/salt, my blood sugar was out of control, and I no longer had that adrenaline rush that used to drive me through stressful events or long hours at work. My acne had gone wild and male-pattern hair growth was worsening. The fatigue/faintness was the worst it had ever been, once my spiro. dosage was upped to 100 mg a day. I couldn't function at work, and the fatigue was so severe it was crippling, interfering with relationships as well. So I consulted my doctor, who did a LOT of tests - no hypothyroidism (actually if TSH were any lower, I'd have hypERthyroidism), no diabetes, no PCOS, no anemia, sex hormone levels were normal, liver function was normal, EKG was normal, etc. Finally she sent me to an endocrinologist, who suspected adrenal insufficiency and did a cortrosyn stim test. It turns out my adrenal gland has not failed, but it appears quite exhausted. The spiro. apparently made matters worse by aggravating the symptoms of adrenal exhaustion.

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Hi there

Am really interested in your post about your history on spiro. I too am having major side effects similar to those you describe; severe exhaustion, weakness fast heart rate lightheadedness. So much so that have had to come home from work as felt was going to pass out.

My doctors response is to take me off it - am seeimg tomorrow. Is it worth me looking into the adrenal function side or just try something else? I have been taking for 3 months (6 weeks at 100mg) and I have loevely skin again. Am upset that I can't seem to cope with the spiro..

any advice would be welcome as no one else seems to describe such extreme reaction.

Thank you

dizzyblonde

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Hi!

It's hard to answer your question without finding out more information from you.

1) Is your life extremely stressful, or has it been, for a long period of time in the recent past? (stress = physical or emotional stress of any kind)

2) Were you tired and weak all the time before getting on spiro. and spiro. just made it worse, or did it all start once you got on spiro.?

3) Have you been through any recent traumatic experiences or major life changes? (I'm not asking you to share personal information - that's just a yes/no question.)

4) Do you have polycystic ovary syndrome?

Prolonged excessive stress and traumatic events (major life changes, in multiples, can also do it) can drain your adrenal gland such that it is no longer able to cope with stress - a condition known as adrenal insufficiency. Other causes can result in a condition with the same symptoms, but a different name: Addison's disease. Some of the primary symptoms are severe fatigue, faintness, low blood pressure, and a reduced ability to cope with stress. Google "adrenal insufficiency" or "Addison's disease" and see if the symptoms match yours, particularly BEFORE you started spiro. The brown skin spots - they are a symptom in some cases, but you can have adrenal insufficiency and not have them - so don't let that rule it out in your mind.

If you don't have the symptoms of adrenal insufficiency, spiro. could be the only cause for how you are feeling, and in that case you have to make the hard choice between spiro. and feeling well - believe me, I know how that feels - I hope you don't have to make that decision.

If you DO have the symptoms of adrenal insufficiency, and they have only worsened since being on spiro., you do need to ask a doctor to check your adrenal gland function. Spiro. will definitely aggravate symptoms of existing adrenal problems. There is a rare condition with similar symptoms to adrenal insufficiency, called "postural orthostatic tachycardia syndrome" - google that as well.

In any case, if you are so tired and weak that it's interfering with your job and life, you need to see a doctor. Excessive fatigue is a symptom that needs to be checked by a doctor - it has so many possible causes - it can be something as severe as cancer, onset of diabetes, adrenal insufficiency, hypo- or hyper-thyroidism - or it can be something as simple as an unresolved infection - or it can be a result of depression, anxiety, guilt, or even post-traumatic stress disorder - or it could be some sort of autoimmune dysfunction such as allergies or chronic fatigue syndrome or the like. (Autoimmune disorders do seem to have some linkage with stress level & adrenal function.)

The fact that your heart rate goes wild makes me wonder if your potassium levels are out of whack. Has the doctor checked your potassium levels since putting you on spiro.? That is often known to happen to patients on spiro. and it's supposed to be general policy to check your potassium levels after a period of time of being on spiro., to see whether it's safe to continue on the drug.

If your heart rate goes really fast once you stand up, but your blood pressure is generally low and doesn't rise by that much when you stand up, that's a typical spiro. side effect, because spiro. plays with the hormone aldosterone, which regulates all of that. But if you had problems with feeling faint in an upright position before you started spiro., that is a classic symptom of adrenal problems (since it is your adrenal gland that secretes aldosterone); but there are other causes of it as well.

I did mention a study I read about that suggests taking licorice if you are not taking it for its typical label use (blood pressure/congestive heart failure/water retention) and can't deal with the diuretic side effects of spiro (and you don't have high blood pressure - licorice can raise blood pressure). Specifically this was studied on patients who have polycystic ovary syndrome (that's why I asked you if you have that) - it was shown to be effective in PCOS patients. I don't know of any testing on patients who don't have PCOS. Check out these websites:

you can read an abstract of the study report at: or or read an article about it at

(I'm not sure why these links won't show up when I post this reply...so just google "licorice spironolactone side effects pcos study" and the websites I tried to put in here will come up.)

Also, if you want to stay on the spiro, it's good to consider these coping strategies:

1) Drink lots of water and if you usually have a low-salt diet, add more salt to your diet. Low blood pressure and dehydration cause severe fatigue. Low blood pressure can make you feel faint. At one point my doctor told me I was severely dehydrated (from the spiro's diuretic action), so now I try to drink a LOT of water while taking spiro. That DOES help. But if you're drinking a lot of water, you need enough salt as well so you don't flush out too much sodium when you go to the bathroom so frequently. Also, the salt will help raise your blood pressure to a more normal-for-you level if it has gone lower than usual (DON'T add salt if you already have high blood pressure).

2) If you can, rearrange your work schedule around the times you do have energy. I have a flex work schedule so I can avoid working during that late afternoon time when the energy slump or faintness might hit.

3) Exercise more - but use an exercise bike or something that doesn't make you stand for long periods of time. This will get your blood circulating - and if you have an adrenal problem but which is not as severe as total adrenal failure (= adrenal insufficiency, or Addison's disease), it will help also because exercise raises cortisol levels and it is the lack of cortisol that produces the symptoms of adrenal insufficiency. I have noticed I feel MUCH better when I exercise, even though spiro. does make me more tired in general.

4) Give the licorice a try (again, only IF you have never had a problem with high blood pressure). Don't get licorice candy that has sugar and all that other stuff - it might not even have any real licorice in it - just licorice flavor. Go to a health food store and get licorice tea.

5) Take B-complex vitamins (and vitamin C). Low energy levels - and mild adrenal problems - can be aided by the use of these vitamins.

6) Whatever you do, DON'T eat high -potassium foods like bananas or take potassium supplements, or use salt substitutes (which usually contain potassium). I noticed that I nearly lost it - physically felt absolutely awful, weak, almost prostrated with exhaustion - recently after eating a banana. I like bananas, so it's hard NOT to eat them. But if your potassium levels go too high, you can have major problems, including severe fatigue and muscle weakness - if it's bad enough, you can go into a coma. Spiro. is a potassium-sparing diuretic so it's not safe to add lots of extra potassium to your diet while you are on it - that could worsen your fatigue and seriously endanger your health. Eat healthy, but google high-potassium foods and keep them off your "eat often" list.

7) Get a lot of sleep, and don't go to bed after 10 PM, and if your work schedule will permit, don't get up any earlier than 7 AM (9 AM would be better, but most working people can't pull that off!). I know I sound crazy, but your adrenal gland secretes cortisol at certain times of the day, and if you have adrenal fatigue, you will more quickly recover if you give your adrenal gland a rest. That "second wind" you get when you stay up past 11 - that lasts till about 1 or 2 in the morning - that's from your adrenal gland. So is that energy you have between 6 and 8 in the morning. Your adrenal gland gets active pumping out its hormones at those times. If you want to give the gland a rest, and thus help it recover, don't be up at those times. Regularly staying up late or getting too little sleep is also, itself, a recipe for adrenal disaster, because it stresses your adrenal gland. Your adrenal gland can only take but so much stress before it fails - then you can't cope with stress anymore and you start having symptoms like yours. I noticed that the side effects of spiro. are much less severe when I get a little more sleep than I need, each night (I know it can be hard to pull that off when you work or have a family to take care of, but if you can, try it). I used to be able to pull off the "stay up into the morning hours and then go to work the next day" deal all the time, but I can't do it - and survive - while on spiro.

My endocrinologist found out I don't have actual adrenal insufficiency, but the symptoms would indicate adrenal fatigue, so right now I'm trying to do some of the things I suggested to you. If you want more info. on adrenal fatigue, what it is and how to treat it yourself (including licorice!), buy the book called "Adrenal Fatigue" by James Wilson. It's only about $10 on Amazon.com.

Sorry this is SO long. I wanted to answer your question thoroughly, and I don't know how to be concise. =)

Please tell me if this answers what you needed to know - I'll try to write back tonight if you have more questions, so you'll have the answers before your dr. appt. tomorrow.

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Hi again

Thank you for your informative post - so kind of you!

I have now stopped taking the spiro. I had a major dizzy, weakness and racing heart occurrence last week and again this week that really frightened me. This happened 3 months in on 100 mg of spiro - I had the usual dehydration side effects prior to this despite drinking alot of water, but this was in a competely different league.

My doctor had never been keen on me using spiro as he considers it to be a really strong drug. I had another blood test this morning so we will see if any of the electrolytes were responsible for my symptoms. If not then it will need further investigation. However, I am now 2 days with nos spiro and am feeling brighter although am off work and still feel exhausted.

So the plan now is to begin Yasmin BCP. I am so disappointed and rather upset as the spiro had cleared my skin at 3 months and this 3rd period I have had no spots at all. Soul destroying to find a med that is seemingly safe and effective working so well for my skin - but my body not being able to tolerate it within normal parameters. Sigh!

I am hoping to start Yasmin this week once my results are back and I am trying to stay positive that this will help - although there have been mixed reviews. But I always responded well to Diannette BCP and now the spiro so given that Yasmin is a BCP and has a very small dosage of spiro it is not unreasonable to hope that it will be effective for me.

Any experience people have regarding Yasmin I would be keen to hear and will now spend time on the boards checking out Yasmin in the same way have been doing for spiro!

Good luck all with your spiro journey - please monitor any side effects closely - your body's tolerance can change suddenly and it is wise to be aware of this.

dizzyblonde

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