Skincare
Aldactone
spironolactone
Oral anti-androgen for adult female hormonal acne. 50-100mg daily.
- Manufacturer
- Multiple
- FDA approved
- 1960
Why is Aldactone prescribed?
Originally a potassium-sparing diuretic for high blood pressure and heart failure. Used off-label for adult female hormonal acne and hirsutism (excess facial/body hair).
How does Aldactone work?
Blocks androgen receptors in skin (reduces hormonal acne) and in hair follicles (reduces unwanted hair growth). Takes 3 months for full effect.
Who qualifies for Aldactone?
Adult women with hormonal acne (jawline, chin, around-menstruation flares). Not appropriate for men (causes breast tissue growth). Requires periodic potassium and creatinine monitoring.
How should Aldactone be used?
Start 25-50mg daily, titrate to 50-100mg based on response. Sometimes paired with oral contraceptives for synergy.
What should I do if I forget a dose?
Spironolactone is dosed once or twice daily. If missed: take when remembered if within a few hours, or skip and resume regular schedule. Do not double up — increases risk of hypotension and hyperkalemia. Consistency matters for steady hormonal effect.
What side effects can Aldactone cause?
Increased urination, low blood pressure, breast tenderness, irregular menstrual cycles. High potassium (rare, monitored via labs). Discontinue if pregnant — risk of feminization of male fetus.
What interactions should clinicians watch for?
Most clinically significant: potassium-sparing effect — avoid combining with potassium supplements, ACE inhibitors, ARBs, or other potassium-sparing diuretics (hyperkalemia risk). Some patients on lithium need closer monitoring. May increase digoxin levels. Disclose all medications and check periodic potassium labs.
What special precautions should I follow?
Pregnancy & lactation
Spironolactone is not recommended during pregnancy — animal studies show feminization of male fetuses. Contraindicated in pregnancy and breastfeeding for the typical hormonal-acne or PCOS dosing. Effective contraception is required for sexually active patients prescribed spironolactone for acne or hair-related indications.
Alcohol
No formal contraindication with moderate alcohol. Heavy alcohol use combined with spironolactone may amplify dizziness and blood pressure effects. Stay hydrated; spironolactone is a diuretic and dehydration risk compounds with alcohol.
What does Aldactone cost?
$10-25/month generic. Via telehealth dermatology: $30-50/month bundled with consultation.
Primary sources
Related clinical resources
What clinicians say
Quotes from published interviews, peer-reviewed commentary, and conference presentations. Each is attributed and linked to the original source.
“Spironolactone is a well-tolerated and effective treatment for acne in adult women, particularly those with hormonal patterns of disease. Low-dose regimens (50 to 100 mg daily) demonstrate efficacy comparable to oral antibiotics with a favorable long-term safety profile when used as monotherapy or in combination with topical retinoids.”
Source: JAMA Dermatology — Spironolactone in the Treatment of Adult Acne in Women (2019 — JAMA Dermatology)
“Aldactone tablets are indicated as adjunctive therapy in primary hyperaldosteronism, edematous conditions, and essential hypertension. Spironolactone has been shown to be a tumorigen in chronic toxicity studies performed in rats. Aldactone should be used only in those conditions described under indications and usage.”
Source: FDA-approved Aldactone (spironolactone) prescribing information — current label. Note: acne treatment is off-label. (Approved 1960; current label 2014)