What is the dosing for Spironolactone (Aldactone) in the treatment of Polycystic Ovary Syndrome (PCOS)?

Spironolactone Dosing for Polycystic Ovary Syndrome (PCOS)

For PCOS treatment, spironolactone should be initiated at 50-100 mg daily, with the option to increase to 200 mg daily based on clinical response and tolerability. 1, 2, 3

Dosing Guidelines

• Initial dose: 50-100 mg daily 1, 3, 4
• Maintenance dose: 50-200 mg daily, depending on clinical response and side effects 1, 4
• Low-dose option: 25 mg daily may be effective when combined with metformin for treating hyperandrogenism 2
• Duration: Treatment typically continues for several months, with clinical effects on hirsutism becoming noticeable after 3-6 months 3, 5

Monitoring Requirements

• Baseline assessment: Serum potassium, sodium, and renal function 1
• Follow-up monitoring: Serum potassium, sodium, and renal function should be checked periodically 1
• No routine potassium monitoring is necessary in young, healthy women without risk factors for hyperkalemia 1
• Consider potassium monitoring in patients with risk factors: older age, renal dysfunction, or concomitant use of ACE inhibitors, ARBs, NSAIDs, or digoxin 1

Clinical Effects and Efficacy

• Hirsutism: Significant reduction in hirsutism scores within 3-6 months 3, 4
• Menstrual regularity: Improvement in menstrual cyclicity within 3-6 months 3, 5
• Hormonal effects: Reduction in testosterone and other androgens 5, 4
• Combination therapy: May be more effective when combined with metformin for treating both hyperandrogenism and metabolic aspects of PCOS 2, 5

Side Effects and Precautions

• Common side effects: Menstrual irregularities (22%), breast tenderness (17%), diuresis (29%) 1
• Serious but rare: Hyperkalemia (uncommon in young healthy women) 1
• Contraindications: Pregnancy (Category C), severe renal impairment, hyperkalemia 1
• Pregnancy warning: Potential feminization of male fetus; concomitant use of contraception is recommended 1
• Dietary considerations: Patients should avoid foods high in potassium and low-sodium processed foods 1

Special Considerations

• Spironolactone appears more effective than metformin for treating hirsutism and menstrual irregularities in PCOS 3
• For PCOS patients with metabolic concerns, combining spironolactone with lifestyle modifications or metformin may provide additional benefits 2, 5
• Higher doses (200 mg daily) may be more effective for hirsutism but carry increased risk of side effects 4
• Low-dose spironolactone (25-50 mg) may be sufficient when used in combination therapy 2, 6

Common Pitfalls and Caveats

• Avoid use during pregnancy due to potential feminization of male fetus 1
• Avoid concomitant use with other potassium-sparing diuretics, ACE inhibitors, or ARBs without careful monitoring 1
• Clinical improvement in hirsutism requires at least 3-6 months of treatment; patients should be counseled about realistic expectations 3, 4
• Menstrual irregularities may occur as a side effect; consider combined oral contraceptives if this is problematic 1
• Spironolactone alone may not address all metabolic aspects of PCOS; consider combination therapy for patients with insulin resistance 2, 5