Can Spironolactone Cause Headaches?
Yes, spironolactone commonly causes headaches, occurring in more than 10% of treated patients according to established guidelines. 1
Frequency and Clinical Significance
Headache is classified as one of the most common side effects of spironolactone, reported in >10% of patients across multiple clinical contexts. 1 This places headache among the highest frequency adverse effects alongside fatigue, gynecomastia, decreased libido, and menstrual disruption. 1
The FDA drug label explicitly lists headache as a documented adverse reaction in the nervous system/psychiatric category, though it does not specify exact frequency data. 2
Side Effect Profile Context
When counseling patients about spironolactone, headache should be discussed as part of the expected common side effects:
Most Common Side Effects (>10% frequency): 1
- Headache
- Fatigue
- Diarrhea
- Gynecomastia (in men)
- Decreased libido
- Menstrual irregularities (15-30% in women, dose-dependent)
Other Neurological Effects: 2
- Dizziness (3-4%)
- Lethargy
- Mental confusion
- Drowsiness
- Ataxia
Clinical Management Considerations
Monitoring approach: While headache is common, it typically does not require discontinuation of therapy. In long-term safety studies of spironolactone for acne, side effects occurred in 59% of patients but resulted in drug cessation in only 15%, with diuretic effects and menstrual irregularities being the primary reasons for stopping—not headache. 3
More serious concerns to prioritize: The critical adverse effect requiring vigilant monitoring is hyperkalemia, which can cause cardiac arrest, particularly in high-risk patients (elderly, diabetes, renal/liver disease). 1 Potassium monitoring should occur at baseline, 2-3 days, 7 days, and monthly for the first 3 months. 4
Important Caveats
Drug interactions that increase risk: Concurrent use with trimethoprim-sulfamethoxazole significantly increases hyperkalemia risk and should be avoided, particularly in patients ≥75 years or with chronic kidney disease. 4 When both drugs are necessary, intensive potassium monitoring is mandatory. 4
Contraindications to remember: 1
- Concomitant potassium supplements or potassium-sparing diuretics
- Potent CYP3A4 inhibitors
- Combined ACE inhibitor and ARB therapy
- Pregnancy (Category C—risk of fetal feminization)