7 Uses for Spironolactone – From Heart Failure to Female Pattern Hair Loss

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.

7 ways to use spironolactone

Here are seven conditions for which spironolactone at different doses can help:

  1. Severe heart failure. Spironolactone at a starting dose of 12.5 to 25 mg once daily 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.
  2. 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.
  3. Edema/swelling. For lower extremity swelling, spironolactone 25 to 200 mg taken daily in 1 to 2 divided doses helps get some fluid off.
  4. Acne in women. Several studies have shown that spironolactone taken at a dose of 50 to 200 mg once daily improves acne.
  5. Excess hair growth in women (hirsutism). Oral contraceptives are the initial choice for the treatment of hirsutism, excess hair growth on the face or body, 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 one to two divided doses is better than placebo and better than oral contraceptives alone.
  6. 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.
  7. Abdominal fluid buildup due to liver disease. Spironolactone is well studied in patients with liver disease or cirrhosis. When fluid accumulates in the abdomen (a condition known as ascites), spironolactone 100 mg once daily slowly dosed up to a maximum of 400 mg once daily helps.

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. Anti-male hormone effects of spironolactone have been shown to cause feminization of the male fetus in animal studies.

Dr O.

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