Spironolactone

Spironolactone is a prescription oral treatment that is not FDA approved for the treatment of acne, but is still sometimes prescribed for resistant cases of acne. It is usually taken once or twice a day, normally alongside other topical / oral acne treatments and/or an oral contraceptive.

• Available forms:
  
  
  • Oral treatment: 
    
    
    • Tablet:
      Brand names (US):
      • Aldactone®
        Generic available
    • Suspension (Liquid – shake before use): 
      Brand name (US):
      • Carospir® 
        No generic available

• Available in these doses: 
  
  
  • Tablets: 25 mg, 50 mg, 100 mg
  • Suspension: 25 mg per 5 ml (Carospir®)

Dosing information:

The starting dose is normally 25 to 50 mg of spironolactone per day in order to monitor the effects and tolerance of the treatment. 

Usually, the dose is then increased to 50 mg to 100 mg of spironolactone per day. The optimal dose varies from person to person. Sometimes, clinical improvement may be seen at a dose as low as 25 mg of spironolactone per day, and at other time, a dose of up to 200 mg of spironolactone per day is necessary to achieve visible improvement. In general, lower doses may reduce the risk of experiencing side-effects.

• Who is it for? 
  
  
  • Gender:
    • Females
  • Severity of acne:
    • Moderate-to-severe acne
  • Age:
    • For adult use. Safety and efficacy have not been evaluated in children.
  • Other:
    For females whose acne is unresponsive to topical treatment, oral antibiotics, and oral contraceptives

How to use it:

Spironolactone is an oral treatment and is available as a tablet or oral suspension (liquid form of spironolactone; Carospir®). Spironolactone tablets and oral suspension release the medication differently in your body. You should only take the form of spironolactone prescribed by your physician. Do not switch to a different spironolactone product without consulting your physician. 

Spironolactone is usually taken once or twice a day, around the same time(s) every day. 

It may take some time before the effects of spironolactone are seen on acne. Spironolactone needs to be taken for 3 to 6 months in order to determine whether it is effectively treating your acne. 

Follow the instructions on your prescription carefully and take spironolactone exactly as prescribed by your physician. Do not change the dose or the frequency of your medication, unless your physician advises you to do so. If you have any questions about the medication or the prescription, ask your physician or pharmacist. 

• Tablet:
  • Spironolactone tablets should be taken with water and preferably with food. 

• Suspension: 
  • The oral suspension can be taken either with or without food, however be consistent and take it the same way every day (either with or without food). Before use, the oral suspension should be shaken well in order to mix the medication evenly. Measure the prescribed amount of suspension using a marked measuring spoon, oral syringe, or the medicine cup (as provided).

Be aware of: 

• Before taking spironolactone, let your physician or pharmacist know if you are allergic to spironolactone or any of the other ingredients in the tablets or oral suspension. 
• Before taking spironolactone, tell your physician if you have Addison’s disease (a disorder in which the adrenal glands do not produce enough hormones), kidney problems, or other conditions that increase the potassium levels in your blood. If you do suffer from any of these conditions, your physician may advise you not to take spironolactone.
• Before taking spironolactone, tell your physician if you have a liver disease. 
• Before having surgery (which also includes dental surgery), tell your physician or dentist that you take spironolactone.
• Spironolactone may cause dizziness, lightheadedness or fainting, especially when you get up suddenly from a lying or sitting position. Avoid driving or operating machinery until you know how spironolactone affects you. If you are feeling dizzy or lightheaded, lie down to avoid fainting. Then sit for a few moments before standing up. Drinking alcohol while using spironolactone may increase the risk of dizziness, lightheadedness or fainting.
• If you are using spironolactone and are pregnant or want to become pregnant, talk to your physician about spironolactone use during pregnancy.
• If you are using spironolactone and are considering breastfeeding, talk to your physician about spironolactone use during breastfeeding.
• Spironolactone may increase the potassium levels in your blood. Avoid taking potassium-containing salt substitutes. Talk with your physician about your diet and the amount of potassium-rich foods (such as bananas, prunes, raisins, and orange juice) that you eat. 
• Spironolactone may cause imbalances in your electrolyte levels or increase your uric acid and blood sugar levels.
• If you are becoming sick while you are taking spironolactone, especially if you have severe nausea, continuous vomiting, or diarrhea, consult your physician. These conditions cause an increased loss of fluid and salt which may lead to a low blood pressure, which may be worse when taking spironolactone. 
• If you are exercising, and/or sweating a lot for any other reason like being in hot weather, you lose an increased amount of fluid through your sweat, which may lead to low blood pressure while using spironolactone. It is important to drink plenty of water in this case to avoid a drop in blood pressure. 
• Spironolactone may lead to swelling of the breasts and breast pain in some patients. 

Drug interactions: 

Some drugs interact with spironolactone and should not be used together with spironolactone. However, your physician may prescribe other drugs together with spironolactone which may cause a slight interaction, and in this case precautions are necessary. Inform your physician or pharmacist about all the prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take before starting spironolactone.

Drugs that should not be used with spironolactone at all are:

• Eplerenone (Brand name: Inspra®)
• Triamterene (Brand name: Dyrenium®)

What if I overdose? 

In case of overdose, contact an emergency facility or call the American Association of Poison Control Centers at 1 (800) 222-1222 (available 24/7).

If immediate assistance is necessary because the victim has collapsed, had a seizure, has trouble breathing, or cannot be awakened, call 911 at once.

Information can also be found online at https://www.poisonhelp.org/help

Symptoms of overdose may include:

• Irregular or slow heartbeat
• Nervousness
• Numbness or tingling in the hands, arms, legs, feet, or lips
• Rash with flat or raised skin lesions
• Redness of the skin (rash)
• Weakness or heaviness of the legs
• Drowsiness
• Confusion
• Nausea
• Vomiting
• Dizziness
• Diarrhea
• Loss of muscle tone

What if I miss a dose?

As soon as you recall that you have missed a dose, take the missed dose. However, skip the missed dose if it is almost time for your next dose and continue with your prescribed dosing schedule. Do not take a double dose to make up for the missed dose. 

Storage:

Store your medication in the container that the pharmacist provided and keep it out of reach and out of sight of children. Many containers can be opened by children. Keep the container tightly closed. Always lock safety caps and immediately place the medication in a safe location that is up and away from the sight of young children, to prevent poisoning (www.upandaway.org).

Store the medication at room temperature. Keep the medication away from excessive heat and moisture – do not store in the bathroom. Do not freeze spironolactone.

Disposal:

Do not keep outdated medication and medication that you no longer use. Unneeded medications should be disposed of in a way that pets, children, and other people cannot consume them. Do not flush the medication down the toilet. Contact your pharmacist to learn about the availability of a medicine take-back program in your neighborhood, or get in touch with your local garbage/recycling department to ensure safe disposal. If you do not have access to a take-back program, you can find more information on safe disposal of medication on the FDA website: (https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm)