Does Spironolactone Cause Dizziness?
Yes, dizziness is a recognized common side effect of spironolactone, occurring in 3-4% of patients treated for acne and listed as a frequent adverse reaction in FDA labeling. 1, 2, 3
Evidence from FDA Drug Labeling
The FDA-approved prescribing information explicitly lists dizziness as an adverse reaction under the nervous system/psychiatric category, alongside lethargy, mental confusion, ataxia, headache, and drowsiness. 3 In acute overdosage scenarios, dizziness is specifically mentioned as one of the manifestations. 3
Frequency and Clinical Context
In acne treatment: Dizziness occurs in approximately 3-4% of patients according to the American Academy of Dermatology guidelines, making it one of the more common side effects alongside menstrual irregularities (15-30%), breast tenderness (3-5%), nausea (2-4%), and headache (2%). 1, 2
In ophthalmology practice: Dizziness is listed among the most common side effects (>10% of treated patients) when spironolactone is used for central serous chorioretinopathy, alongside headache, diarrhea, fatigue, gynaecomastia, decreased libido, and menstrual disruption. 1
In cardiovascular populations: The European Society of Cardiology guidelines note that aggressive glycemic control and certain cardiovascular medications can increase the risk of dizziness, confusion, and falls in elderly patients, though this is discussed more broadly in the context of polypharmacy rather than spironolactone specifically. 1
Mechanism and Risk Factors
The dizziness associated with spironolactone is likely multifactorial:
Diuretic effect: As a potassium-sparing diuretic, spironolactone causes fluid loss which can lead to hypovolemia and orthostatic hypotension, manifesting as dizziness. 1
Electrolyte disturbances: Hyponatremia and other electrolyte abnormalities can contribute to dizziness and mental confusion. 3
Blood pressure effects: In patients with hypertension, the blood pressure-lowering effect (approximately 20 mmHg systolic reduction) may cause dizziness, particularly during dose titration. 4
Clinical Management Considerations
Monitor for dizziness particularly in:
- Elderly patients who have increased fall risk 1
- Patients with poor mobility or urinary incontinence 1
- Those on concomitant medications that affect blood pressure or electrolytes 1
- Patients with renal impairment where electrolyte disturbances are more likely 3, 5
Practical approach:
- Start with lower doses (25-100 mg daily for acne; 25 mg daily for heart failure) to minimize side effects while maintaining efficacy 1, 2
- Ensure adequate hydration to prevent hypovolemia 3
- Monitor electrolytes (sodium and potassium) periodically, as electrolyte disturbances can manifest as dizziness 3, 5
- Counsel patients to rise slowly from sitting or lying positions to minimize orthostatic symptoms 1
Important Caveats
While dizziness is a recognized side effect, it should prompt evaluation for more serious complications if severe or persistent, including hyperkalemia (especially in patients with renal impairment, diabetes, or those on ACE inhibitors/ARBs), hyponatremia, or hepatic encephalopathy in patients with liver disease. 3, 6