7 Spironolactone Uses: From Heart Failure to Hair Loss

Did you know there’s a medication that treats heart conditions and can also clear up your acne? That medication is spironolactone (Aldactone, CaroSpir). Spironolactone is a versatile medication that treats many different types of health conditions. Read on to learn more about how spironolactone works and what conditions it covers.

What is spironolactone?

Spironolactone belongs to the mineralocorticoid receptor antagonist drug class. But it’s more commonly called a potassium-sparing diuretic (water pill). It was FDA-approved in 1960 for the treatment of heart failure, high blood pressure, and edema (swelling caused by excess fluid).

Spironolactone comes as a tablet and oral suspension. You can take it with or without food, but it’s important to stay consistent with when and how you take it. Spironolactone is also an ingredient in Aldactazide. This is a combination tablet that also contains hydrochlorothiazide, another diuretic medication.

How does spironolactone work for so many conditions?

Spironolactone works by blocking a hormone called aldosterone in the kidneys. Aldosterone is a hormone that makes the body hold on to water and sodium and remove potassium. By blocking it, spironolactone helps the body remove excess fluid from the body through the kidneys. And, it also helps the body hold on to potassium.

Spironolactone also prevents other hormones, such as testosterone, from binding to their receptors. More on that later.

Now that we know the basics, let’s dive into seven conditions that spironolactone can treat.

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1. Heart failure

Spironolactone can increase survival, prevent swelling, and lower the frequency of hospitalization for people who have heart failure. It’s recommended for most people who have symptomatic heart failure. Spironolactone treats heart failure by blocking the effects of aldosterone, which helps prevent damage to the heart tissues and improve overall heart function.

The typical spironolactone dosage for heart failure is 25 mg once daily. It’s usually taken with other heart failure medications. It’s not typically used for heart failure on its own.

2. High blood pressure

You can take spironolactone for high blood pressure, too. It’s not a first-choice treatment option unless you also have heart failure. But it may help lower blood pressure that’s not well-controlled by other medications. 

Spironolactone also treats low potassium levels caused by other diuretics that treat high blood pressure, such as furosemide (Lasix). Low potassium levels can cause muscle cramps and heart rhythm problems. Spironolactone is unique in that it helps your body retain potassium and also lowers your blood pressure.

For high blood pressure, you’ll usually take 25 mg to 100 mg of spironolactone per day. But you may need higher doses (up to 200 mg per day) to treat low potassium levels. Your healthcare provider will figure out the best dose for your needs.

3. Swelling due to liver and kidney problems

Edema is swelling caused by a buildup of fluid in the body. You’ll often see signs of edema in the legs, face, and stomach.

Certain liver and kidney problems can cause edema. And spironolactone can remove fluid to treat this type of swelling. Your healthcare provider may consider adding spironolactone to your treatment regimen if fluid and sodium restriction or other diuretics have not worked for you.

The spironolactone dosage for edema ranges from 25 mg to 200 mg per day. Your healthcare provider can help find the dose that’s most effective for you.

4. Too much aldosterone

As mentioned, aldosterone is an important hormone that helps control sodium and potassium levels in the body. People with primary hyperaldosteronism have too much aldosterone. This can lead to high sodium levels and low potassium levels. Which in turn can cause high blood pressure, an irregular heart beat, and muscle weakness.

Non-cancerous tumors are a common cause of this condition. In some cases, surgery is required to remove these tumors. But spironolactone can also block aldosterone to help treat this condition. It’s most often taken short-term before surgery, at a dose of 100 mg to 400 mg daily.

But if you can’t have surgery, or the cause of your high aldosterone is unknown, you can take spironolactone long term. It’s recommended to take the lowest dosage possible for your symptoms.

5. Acne in women

The American Academy of Dermatology suggests that 50 mg to 200 mg of spironolactone daily can help improve acne for some women. But, this is considered an off-label use.

Testosterone is one of the main hormones that regulate sebum production. Sebum is an oily substance that’s made by certain glands in your skin. And too much sebum can lead to acne. As mentioned earlier, spironolactone can block testosterone. This in turn helps prevent the production of sebum and the formation of acne.

Talk to your healthcare provider to see if spironolactone is an appropriate acne treatment option for you. Since it isn’t approved by the FDA for acne, your provider may want to try a different option first.

6. Excess hair growth in women

Hirsutism is another off-label condition that spironolactone can treat. This condition causes excessive hair growth on the face or body in women.

There’s generally a greater level of testosterone in women with hirsutism. Spironolactone helps slow down testosterone production and remove testosterone from the body. These actions can help lessen hair growth.

Oral contraceptives are typically the first-choice treatment option for hirsutism. Birth control pills that have the progestin drospirenone, such as Yasmin or Ocella, may be more helpful for hirsutism than others. That’s because drospirenone is made from spironolactone and affects the body in a similar way.

Still, oral contraceptives may not be effective or appropriate for everyone. Studies suggest that spironolactone is also an effective treatment option. The recommended dose is 100 mg to 200 mg of spironolactone per day.

7. Female pattern hair loss

Female pattern hair loss is characterized by thinning on the crown of the head. Currently, the only FDA-approved medication for this condition is over-the-counter topical Rogaine.

Some studies show that spironolactone can be an effective treatment choice for female pattern hair loss. You can take it alone or with topical Rogaine. There’s no standard dose, but in studies the dosage ranged from 25 mg to 200 mg daily. And you may need to take spironolactone for 1 year or longer before seeing noticeable results.

Who shouldn’t take spironolactone?

Although spironolactone can be helpful for certain health conditions, it may not be the best choice for everyone. Spironolactone should be avoided if you:

• Are pregnant: It’s recommended that pregnant women avoid spironolactone. It may affect the proper development of your baby.

• Have high potassium levels: One of spironolactone’s effects is to raise potassium levels. So if you already have high potassium levels, spironolactone may make it worse.

• Have Addison’s disease: This is a rare disorder that lowers the production of certain hormones, including aldosterone. Since spironolactone lowers aldosterone levels in the body, it can make Addison’s disease worse.

• Are taking eplerenone: Eplerenone (Inspra) and spironolactone are in the same drug class. Taking them at the same time can cause low blood pressure or potassium levels. It can also raise your risk of other side effects, like nausea, headache, or bleeding in your stomach.

Let your healthcare provider know about your medical history and all of the medications you’re taking before starting spironolactone. This will help them make sure it’s safe for you to take.

How to save on spironolactone

There are many ways to save on spironolactone, which is available as both a brand-name and generic medication.

• Save with GoodRx. GoodRx can help you save over 80% off the average retail price of the generic version. Generic spironolactone’s price at certain pharmacies is less than $5.40 with a free GoodRx discount.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for brand-name Aldactone through the PAN foundation. 

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Written by:

ThienLy Neal, PharmD

ThienLy Neal, PharmD, has over 10 years experience in the pharmacy field, including in such settings as retail, hospital, compounding, and managed care. She has led various clinical programs while focusing on medication adherence programs, specialty drug initiatives, and polypharmacy safety initiatives.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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