There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
The FDA Drug Labels for spironolactone (PO) do not address this question.
From the Research
Dosing of Spironolactone for PCOS
The appropriate dosing of Spironolactone for a 15-year-old patient with Polycystic Ovary Syndrome (PCOS) can be informed by several studies:
- A study from 2004 1 compared the efficacy of spironolactone (50 mg/d) with metformin (1000 mg/d) in adolescent and young women with PCOS.
- A 2023 systematic review and meta-analysis 2 found that spironolactone (100 mg/daily) exhibited a significant reduction in Ferriman-Gallwey score in idiopathic hirsutism, while a lower dose of spironolactone (50 mg/day) showed no significant difference relative to metformin on FG Score, serum total testosterone, and HOMA-IR among PCOS women.
- Other studies have used doses of 50 mg/day 3, 75 mg daily 3, and 200 mg/day 4 to treat hyperandrogenism and hirsutism in women with PCOS.
Key Findings
Key findings from these studies include:
- Spironolactone can be effective in reducing hirsutism and improving menstrual cyclicity in women with PCOS 1, 2, 4, 3.
- The optimal dose of spironolactone for PCOS is not established, but doses ranging from 50 mg/day to 200 mg/day have been used in various studies 1, 2, 4, 3.
- Combination therapy with metformin and spironolactone may be more effective than monotherapy in improving insulin resistance and reducing androgen levels in women with PCOS 5.
Considerations for Dosing
Considerations for dosing spironolactone in a 15-year-old patient with PCOS include:
- Starting with a low dose (e.g., 50 mg/day) and adjusting as needed to minimize side effects and optimize efficacy 1, 2, 3.
- Monitoring for potential side effects, such as menstrual irregularity, nausea, vomiting, and diarrhea 2, 4, 3.
- Considering combination therapy with metformin or other agents to improve insulin resistance and reduce androgen levels 5.