What are the common side effects of spironolactone in adult women treated for hormonal acne?

Common Side Effects of Spironolactone in Adult Women Treated for Hormonal Acne

Menstrual irregularities are the most common side effect, occurring in 15-30% of women taking spironolactone, and this risk increases substantially with higher doses. 1, 2

Most Frequent Side Effects

Menstrual Irregularities (15-30% of patients)

• This is the most common adverse effect and is dose-dependent, with women taking 200mg/day having a relative risk of 4.12 compared to those on lower doses. 1, 2
• Concomitant use of combined oral contraceptives or hormonal IUDs can minimize or prevent this side effect. 1, 2
• This side effect is significantly more common at doses of 200mg/day compared to lower doses. 3

Breast Tenderness (3-5%)

• Occurs in 3-5% of women taking spironolactone for acne. 1, 2
• This is a dose-related effect that may be temporary. 4

Dizziness (3-4%)

• Affects 3-4% of patients on spironolactone therapy. 1, 2
• May be described as lightheadedness and tends to be dose-dependent. 5

Nausea (2-4%)

• Reported in 2-4% of women treated with spironolactone. 1, 2

Headache (2-20%)

• Occurs in 2% of patients in most studies, though one randomized controlled trial reported rates as high as 20.4% versus 12% with placebo. 1, 2

Less Common Side Effects (1-2% each)

• Polyuria (increased urination): Occurs in 1-2% of patients due to the diuretic properties of spironolactone. 1, 2
• Fatigue: Affects 1-2% of women on therapy. 1, 2

Overall Tolerability

In clinical practice, 57.5% of women report no adverse effects at all when using low-dose spironolactone (50-100mg/day). 6 This excellent tolerability profile makes spironolactone a well-tolerated option for adult female acne, with most side effects being mild, temporary, and manageable through dose adjustment or concurrent use of oral contraceptives. 1, 5

Important Clinical Considerations

Hyperkalemia Risk

• Hyperkalemia is NOT a common side effect in young, healthy women without comorbidities. 1, 2
• Studies show no increased rates of hyperkalemia in healthy women taking spironolactone compared to controls not on the medication. 1
• Only 0.75% of reproductive-age women taking 50-200mg daily exhibited potassium levels >5.0 mmol/L, and half of these normalized on repeat testing. 2
• Routine potassium monitoring is not required in young, healthy women without risk factors. 1, 2

Pregnancy Considerations

• Spironolactone is pregnancy category C and has been shown in animal studies to cause feminization of male fetuses at high doses. 1, 2
• All women must be counseled to avoid pregnancy while on spironolactone and should use effective contraception. 1, 2

Dose-Dependent Pattern

• Side effects increase disproportionately at doses above 100mg/day, while lower doses (75-100mg daily) are as effective as higher doses (150-300mg daily) but with substantially fewer side effects. 2, 5