Seven Uses for Spironolactone: Skin, Hair, and Heart

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Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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For a really cheap and safe medication, spironolactone has many uses. From heart health to hair growth this potassium-sparing diuretic is safe and effective.

How does spironolactone work for so many conditions?

When it comes to the heart, lowering blood pressure, and helping relieve edema, spironolactone works by competing with aldosterone for receptor sites in the kidneys—which increases sodium and water removal while conserving potassium. That’s why it is called a potassium-sparing diuretic.

Wait, but what else?

When it comes to excess hair growth, acne, and female pattern hair loss, spironolactone also works because it blocks androgen (male hormone) receptors and weakly inhibits androgen synthesis.

Here are 7 ways Spironolactone is used:

  1. Severe Heart failure. When spironolactone is used at a starting dose of 12.5 to 25 mg once daily it has been shown to increase survival and reduce hospitalization when added to standard therapy. It is also recommended in patients after a heart attack who develop heart failure symptoms or have a history of diabetes mellitus.
  1. High blood pressure. Spironolactone is not recommended as first-line treatment for high blood pressure but when added to another blood pressure medication, 25 mg of spironolactone works.
  1. Acne in women. Several studies have shown that spironolactone taken at a dose of 50 to 200 mg once daily improves acne.
  1. Edema/swelling. For lower extremity swelling, spironolactone 25 to 200 mg taken daily in 1 to 2 divided doses helps get some fluid off.
  1. Hirsutism in women (excess hair growth on face or body). Oral contraceptives are the initial choice for the treatment of hirsutism in young women. However, studies have shown that spironolactone added to oral contraceptives delivers better results. When used for hirsutism, 50 to 200 mg daily in 1 to 2 divided doses is better than placebo and better than oral contraceptives alone.
  1. Ascites, due to liver disease (cirrhosis). Spironolactone is well studied in patients with liver disease or cirrhosis and when fluid accumulates in the abdomen (ascites), spironolactone 100 mg once daily titrated up to a maximum of 400 mg once daily helps.
  1. Female pattern hair loss (characterized by thinning on the crown). In a 2005 British Journal of Dermatology study, 44% of women treated with spironolactone 200 mg daily had regrowth of hair, while another 44% had no change.

Spironolactone is not for everyone. Women of reproductive age need to be aware that it should not be used during the first trimester of pregnancy because the antiandrogen effects of spironolactone have been shown to cause feminization of the male fetus in animal studies.

Dr O.

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