How to Stop Aldactone (Spironolactone) While Planning Pregnancy
Discontinue spironolactone immediately when planning pregnancy, ideally before attempting conception, due to its anti-androgenic effects that can cause feminization of male fetuses. 1
Timing of Discontinuation
Stop spironolactone as soon as you begin planning pregnancy - the FDA label explicitly states to "avoid spironolactone in pregnant women or advise a pregnant woman of the potential risk to a male fetus" based on its anti-androgenic properties and animal data showing feminization of male fetuses 1
No specific washout period is mandated, unlike medications such as methotrexate (which requires 3 months) or mycophenolate (which requires 6 weeks before conception) 2. However, stopping before attempting conception is the safest approach 1
If you discover you are pregnant while taking spironolactone, discontinue immediately and contact your obstetrician for counseling 1
Rationale for Immediate Discontinuation
The urgency stems from spironolactone's mechanism of action:
Anti-androgenic activity: Spironolactone competes with dihydrotestosterone for androgen receptor binding and inhibits enzymes in androgen biosynthesis, which is critical for male sexual differentiation during embryogenesis 3
Animal data: Doses of 200 mg/kg/day in rats between gestation days 13-21 caused feminization of male fetuses, with persistent reproductive tract changes including decreased prostate and seminal vesicle weights 1
Pregnancy Category C classification: While human data are limited and case reports have not definitively demonstrated major malformations, the theoretical risk to male fetuses warrants avoidance 1, 3
Managing the Transition Period
For Hyperandrogenic Conditions (Hirsutism, Acne, PCOS)
Consider pregnancy-compatible alternatives before discontinuing spironolactone, such as topical treatments for acne or mechanical hair removal methods for hirsutism 2
Oral contraceptives can be used until you are ready to conceive (if you were taking them with spironolactone for menstrual regulation), then discontinue when actively trying to conceive 4, 5
Long-lasting effects may persist: Studies show that 60% of patients with hyperandrogenic skin disorders maintained improvement for an average of 33.7 months after spironolactone withdrawal, though 40% relapsed after 17.5 months 6
For Hypertension or Heart Failure
Transition to pregnancy-safe antihypertensives before conception, including methyldopa, nifedipine, labetalol, or clonidine 7
Avoid ACE inhibitors and angiotensin receptor blockers entirely, as these must also be stopped before pregnancy 7
Target blood pressure of 110-135/85 mmHg during pregnancy to reduce maternal hypertension risk while minimizing fetal growth impairment 7
Preconception Counseling Essentials
Discuss family planning with your healthcare provider well in advance of attempting conception to allow time for medication adjustments and alternative treatment planning 2
Achieve disease control (whether hypertension, heart failure, or hyperandrogenic conditions) before conception to optimize pregnancy outcomes 7
Use reliable contraception until you and your provider have established a pregnancy-safe treatment plan 7
Common Pitfalls to Avoid
Do not continue spironolactone "just a little longer" after deciding to conceive - the risk to a male fetus exists throughout pregnancy, particularly during critical periods of sexual differentiation 1
Do not assume limited human data means safety - the absence of definitive proof of harm in humans does not override the clear mechanism of action and animal data showing anti-androgenic effects 1, 3
Do not abruptly stop without a management plan for your underlying condition - work with your provider to establish alternative treatments before discontinuation 2