We want to make sure you fully understand your treatment. Below outlines the directions, benefits and risks with Spironolactone.

Spironolactone is a diuretic with anti-androgenic properties that is commonly used off-label by dermatologists to treat acne. It targets the hormonal causes of acne. Hormonal acne typically flares before or during your menstrual cycle and is often concentrated on the lower face, jawline, and neck.

It is essential that you do not get pregnant on this medication due to the risk of birth defects. Should you decide to try for pregnancy or find out you are pregnant, you should stop the medication right away and inform your doctor. If you think there is any chance you may be pregnant before starting the medication, please take a pregnancy test before starting it.


Start out slowly. 🐢 You can start by taking 1/2 a pill (or half your dose) daily for the first week and increase to 1 full pill thereafter if you are tolerating the medication well.

Drink plenty of water. 💦 Spironolactone is a diuretic that will make you urinate more frequently. It’s important to stay hydrated by drinking plenty of fluids throughout the day to avoid lightheadedness.

Take at night. 🌙 Taking the medication at night can help minimize side effects of feeling lightheaded.

Take with food. 🥗 Taking spironolactone with food will help with absorption and reduce stomach upset and nausea. Some doctors recommend taking this pill after dinner.

Review your birth control options. 📝 You should take extra precautions to avoid pregnancy while taking spironolactone. There are many birth control options to consider. We encourage you to review them with your primary care provider or gynecologist.

Irregular menstrual cycles or spotting can occur at higher doses of spironolactone. Birth control pills help prevent pregnancy and have the added benefit of regulating your period. The most effective birth control pill for acne is Yasmin followed by Ortho-tri-cyclen.

Take as instructed. 👩🏻‍⚕️ Be consistent for best results. It takes 3-6 months to reach maximal effect.

Do NOT take this medication if:

  • You take potassium supplements or drugs that increase potassium levels such as lisinopril or bactrim.
  • You have a history of high potassium levels, Addison’s disease, adrenal gland disorder or electrolyte abnormalities.

Review with your prescriber prior to taking this medication if:

  • You have a history of kidney or heart disease.


Common side effects include breast tenderness, mild headaches, irritability, fatigue, menstrual spotting or irregularity, heavier periods, stomach upset, decreased libido and breast enlargement. Most mild side effects tend to improve with time.

Very rarely, elevations in liver function or potassium levels can occur, especially in patients with a history of kidney disease. Unless recommended by your prescriber, there is no need for lab work if you are under age 45 and do not have underlying kidney or heart disease.

If you have had an estrogen-dependent cancer in the past (breast, uterine, ovarian or cervical), please discuss this with your oncologist before starting treatment with spironolactone. To date, there is no evidence that spironolactone increases the risk of cancer in humans. If you have specific questions or concerns, please reach out to your Apostrophe dermatologist.

If your Apostrophe dermatologist also prescribed an oral antibiotic, you can take both at the same time.

Make sure to update your medication lists and discuss any new medications you are taking with your primary care provider.

Please let your Apostrophe provider know about any significant changes to your medical history, and any medication changes while using spironolactone to ensure there are no interactions. You should inform all providers you see that you take spironolactone before they add any oral medications so they can also verify the medications are safe to use together before prescribing. (edited)

Stop this medication and notify your Apostrophe doctor if you develop hives, muscle cramps, weakness, cardiac irregularities, drowsiness, a rash or any other unusual or persistent symptoms.

For patients on SSRIs: Low sodium levels have been reported during treatment with certain antidepressants (SSRIs). Patients on an SSRI and a diuretic such as spironolactone may be at greater risk of developing low sodium levels. Symptoms of low sodium levels include muscle cramps or weakness, nausea and vomiting, lethargy or low energy, headache and confusion, mental status changes and seizures. If you experience any of these symptoms, please stop spironolactone and let your provider know.

To learn more about your medication, click this link.