From the Guidelines
It is recommended to take spironolactone 50 mg and a progesterone capsule together under the guidance of a healthcare provider, as there is no significant interaction that would prevent concurrent use, but monitoring of potassium levels and other parameters is advised. When considering the use of spironolactone for acne treatment, as discussed in the guidelines of care for the management of acne vulgaris 1, it's essential to weigh the benefits against potential side effects, such as menstrual irregularities, diuresis, and breast tenderness. The guidelines conditionally recommend spironolactone for acne treatment based on moderate certainty evidence from several studies 1.
Key considerations for concurrent use include:
- Potential effects on hormone levels and electrolyte balance
- The need for potassium monitoring, especially in older patients or those with certain medical co-morbidities 1
- Avoiding a diet high in potassium to minimize the risk of hyperkalemia 1
- The importance of following the prescriber's instructions for optimal effectiveness and safety
Given the potential for spironolactone to cause feminization of a male fetus if used during pregnancy, it's crucial to ensure that concurrent use with progesterone does not increase this risk 1. However, the primary concern with spironolactone and pregnancy is its use as a solo agent, and the guidelines do not explicitly address the interaction with progesterone in this context.
In clinical practice, the decision to use spironolactone with a progesterone capsule should be made on a case-by-case basis, considering the individual patient's health status, the reason for using these medications, and the potential benefits and risks associated with their concurrent use. Regular monitoring by a healthcare provider is essential to mitigate any adverse effects and ensure the best possible outcome for the patient.
From the Research
Interaction between Spironolactone and Progesterone
- There is limited direct evidence on the interaction between spironolactone and progesterone capsules.
- A study from 1987 2 found that spironolactone had a slight effect on menstruation and follicular growth, but no significant effect on serum progesterone levels.
- Another study from 2022 3 found that spironolactone, a steroidal mineralocorticoid receptor antagonist, had agonistic actions on progesterone receptors, but the levels of progesterone did not significantly increase.
Effects of Spironolactone on Hormone Levels
- Spironolactone may have antagonistic effects on androgen receptors, as shown in a study from 2022 3.
- The same study found that spironolactone increased the serum concentration of free testosterone, but had no significant effect on estradiol, progesterone, luteinizing hormone, and follicle stimulating hormone levels.
Safety and Efficacy of Spironolactone
- A systematic review and meta-analysis from 2021 4 found that spironolactone reduced blood pressure, urinary albumin, and markers of fibrosis and inflammation, but slightly increased glycosylated haemoglobin and serum creatinine in patients with hypertension and diabetes.
- The same review found that spironolactone mildly increased serum potassium, and 2.5% of subjects experienced mild to moderate hyperkalaemia, while 1.6% developed severe hyperkalaemia and were withdrawn from the studies.
Conclusion on Interaction with Progesterone
- Based on the available evidence, there is no clear indication that spironolactone interacts negatively with progesterone capsules, but more research is needed to fully understand the effects of spironolactone on hormone levels and interactions with other medications.