Spironolactone: The Ins and Outs of This Diuretic

For those suffering from high blood pressure, heart failure, edema, and high levels of aldosterone, spironolactone could be the answer to your problems. And at lower doses, the drug can also aid those who suffer from acne.

What is spironolactone?

Spironolactone is a unique type of diuretic known as a “potassium-sparing” diuretic. Also commonly referred to as “water pills”, diuretics help reduce the sodium and water concentrations of the body.

Diuretics can be highly beneficial in the treatment of heart failure, high blood pressure, and other obesity or weight-related complications. There are three types of diuretics: thiazide diuretics, loop diuretics, and potassium-sparing diuretics; spironolactone is the latter.

Potassium-sparing diuretics are unique in that they limit the amount of potassium excreted in urine output. Other diuretics do not share this potassium-sparing effect, which can lead to hypokalemia or dangerously low levels of potassium. Although spironolactone has many clinical uses, its most common uses include the treatment of high blood pressure, heart failure, edema, and high levels of aldosterone (hyperaldosteronism).

Aldosterone Antagonists

Aldosterone is a hormone secreted by the adrenal glands, located atop the kidneys. In most people, the kidneys produce a normal, healthy amount of aldosterone. However, in certain individuals, the kidneys begin to produce too much aldosterone, causing a condition known as Hyperaldosteronism.

Hyperaldosteronism may arise due to a kidney tumor but frequently arises as a complication of organ dysfunction in another site, especially those affected by high blood pressure, obesity, or excess weight.

Commonly, dysfunction of the heart, liver, or kidneys may cause secondary hyperaldosteronism. In these instances, aldosterone antagonists are used to reduce the amount of aldosterone produced by the kidneys. Spironolactone and other diuretics are regularly used in an effort to reduce aldosterone production.

Do You Need a Prescription for Spironolactone?

Although spironolactone is incredibly beneficial in certain contexts, it also poses potential side effects and dangerous complications. Like most drugs, spironolactone requires a prescription from a physician.

Spironolactone’s Established Health Benefits

While some of the spironolactone’s benefits remain under investigation, the drug also has many establish benefits well-supported in the scientific literature. These benefits include, most notably, applications in heart failure, blood pressure reduction, diuresis, and the treatment of hyperaldosteronism.

Treating Heart Failure

Spironolactone has been used to reduce morbidity in patients facing heart failure. While not a panacea, spironolactone has been shown to reduce the risk of morbidity in patients with congestive heart failure. Spironolactone has been shown to improve the two-year survival rate in patients with both heart failure and renal (kidney) dysfunction and reduce the risk of hospitalization in patients with heart failure.

However, given the enormous variability of heart failure and the multiple factors that influence treatment, spironolactone may be better for some patients than others.

Reversing The Effects of Edema

Because of its diuretic function, spironolactone is commonly used to treat edema, a condition characterized by water retention, especially in the lower body compartments, including the legs, ankles, and feet. Edema often occurs as a result of high blood pressure, obesity, and heart or organ dysfunction.

Lowering High Blood Pressure

One-third of US adults have high blood pressure, and less than 60% have their condition under control. Also commonly referred to as hypertension, high blood pressure is responsible for more than 1,000 deaths every single day. High blood pressure is a common but serious condition, dramatically increased risk for heart attack and stroke, two of the leading causes of preventable death among Americans.

High blood pressure typically arises thanks to poor lifestyle management. Excess body weight (either overweight or obesity), poor diet, and insufficient exercise are all key drivers of high blood pressure.

While lifestyle management is the most important factor in reducing blood pressure to safe, normal levels, medications are often used as adjunct therapies in an effort to control blood pressure while lifestyle changes are underway.

Spironolactone is commonly used for the treatment of high blood pressure, especially in overweight or obese patients. A number of studies have shown that spironolactone is highly effective in this application, even in patients with resistant hypertension, a condition characterized by high sodium consumption and hyperaldosteronism.

Preventing Low Potassium Levels

There are three classes of diuretic drugs: thiazide diuretics, loop diuretics, and potassium-sparing diuretics. Spironolactone is a potassium-sparing diuretic. Diuretics work to reduce the amount of sodium and water in the body in patients for whom high sodium acts as a driver for high blood pressure, organ dysfunction, and cardiac risk.

Diuretics work by increasing urine output and the excretion of urinary sodium. However, diuretics that do not spare potassium may lead to an additional output of potassium in the urine, leading to a potentially dangerous condition known as hypokalemia, or low potassium.

Potassium-sparing diuretics like spironolactone work by interfering with the exchange of sodium and potassium in the kidneys, or by inhibiting the production of excess aldosterone.

The use of potassium-sparing diuretics is incredibly important in many cases, as hypokalemia is associated with worse treatment outcomes, including an increased risk of mortality. In a study of dialysis patients, spironolactone was shown to successfully treat hypokalemia and high blood pressure. Other studies have also shown the benefit of spironolactone treatment in dialysis patients.

Reducing Symptoms of Hyperaldosteronism

Hyperaldosteronism is a condition characterized by excess secretion of the hormone aldosterone.

Aldosterone is secreted by the adrenal glands but may be secreted in higher levels than normal thanks to growths (either benign or malignant) on the adrenal gland, or due to dysfunction of the adrenal glands themselves- this is known as idiopathic hyperaldosteronism. Hyperaldosteronism that occurs thanks to one of the aforementioned causes is known as primary hyperaldosteronism.

However, the second form of hyperaldosteronism may occur when the heart, liver, or kidneys are malfunctioning, often because of high blood pressure or other weight or obesity-related complication. This is known as secondary hyperaldosteronism. High blood pressure (also known as hypertension) may also cause secondary hyperaldosteronism independent of weight status.

Common complications of untreated hyperaldosteronism include (but are not limited to): dangerously high blood pressure, erectile dysfunction, gynecomastia, and damage to the eyes, kidneys, brain, and heart. Diuretics are commonly used to treat hyperaldosteronism, as hyperaldosteronism often causes fluid buildup (edema) that may otherwise cause vessel damage to organs and increase the risk for heart attack and stroke.

Studies have shown that spironolactone is a highly effective treatment for hyperaldosteronism. Spironolactone is particularly beneficial for the treatment of primary hyperaldosteronism, as it elicits an aldosterone blocking effect. Spironolactone is commonly used for patients with a experiencing resistant hypertension and heart failure in conjunction with hyperaldosteronism.

Spironolactone Benefits That Require More Research

While spironolactone is highly beneficial in certain medical applications (as discussed above), the benefits of spironolactone treatment in other areas are disputed, and studies are ongoing.

Although there are potentially other therapeutic uses for spironolactone, the scarcity of research in these areas leaves much to be desired. However, ongoing research may yield additional or more compelling evidence for the use of spironolactone in the treatment of the following conditions.

Spironolactone Acne Treatment

Although there are many causes of acne, certain types are more resistant to treatment than others. Acne vulgaris is a common type of acne that typically responds to home care. However, hormonally driven cases are often more resistant to treatment, requiring a dermatological intervention. Women with high androgen production are especially prone to acne vulgaris.

Because of its effect as an androgen receptor antagonist, spironolactone is regularly used for the treatment of women with androgen dysfunction and its related side effects, including acne and hair loss.

Studies have shown that spironolactone is highly useful in the treatment of androgen-related acne vulgaris, with many patients showing moderate to dramatic improvement.

Is Spironolactone a Good Option For Weight Loss?


Spironolactone functions as a diuretic. Diuretics are commonly referred to as “water pills”, as they increase diuresis or urine output. Diuretics are often used to treat edema (fluid buildup) and hypertension, as diuretics reduce the amount of sodium and fluid in the body, thereby improving blood pressure and reducing the risk for heart attack and stroke in high-risk patients.

Because of spironolactone’s diuretic function, it often causes some degree of weight loss because of the loss of body water. However, the weight loss is nearly 100% water, not fat. For this reason, spironolactone is not a safe or effective treatment for weight loss.

Currently, there are no scientific studies confirming the safety or reliability of spironolactone as a weight loss treatment, and it should not be used as such.

Spironolactone Hair Loss Treatment

While hair loss affects both men and women, hair loss tends to be more prevalent and worrisome for men. However, many women also experience female pattern baldness. In several small studies, spironolactone has been shown to inhibit androgen production and reduce the severity of hair loss.

Because of its role as an anti-androgen, spironolactone consumption via oral route is not recommended for hair loss treatment in males. While the application of topical spironolactone has been suggested to treat hair loss in males, no studies are available to promote the efficacy or safety of topical spironolactone in hair loss treatment for males.

Spironolactone Side Effects and Risks

As is the case for most drugs, spironolactone does bear the potential for side effects: any drug treatment always carries some degree of risk.

However, given the typical uses for spironolactone (namely, heart failure, hypertension, or hyperaldosteronism), individual prescriptions are typically given to patients whose doctors have determined that the benefits of spironolactone treatment outweigh any potential risk.

Because of its function as a diuretic, many of the common side effects of Spironolactone mimic dehydration. Symptoms include (but are not limited to): fatigue, drowsiness, increased thirst, dizziness, lightheadedness, stomach upset, diarrhea, vomiting, and headache. In the event that these symptoms occur or worsen in severity, contact your primary physician promptly.

While most patients taking spironolactone do not experience serious complications or side effects, certain patients are at greater risk than others. Patients with a history of kidney or liver dysfunction, untreated electrolyte/mineral balance, or poor adrenal function should always undertake caution with spironolactone and should communicate their medical history to their doctor before beginning treatment.

Risks of Decreased Testosterone in Men

Spironolactone exhibits an anti-androgen effect that has been shown to be beneficial in the treatment of women suffering from abnormally high levels of androgen, a hormone typically more plentiful in males. Naturally, one might assume that the anti-androgen properties of spironolactone may thereby cause hormonal dysfunction in male patients. In some males, gynecomastia has occurred with spironolactone treatment.

However, the incidence of gynecomastia is highly variable and appears to be dose dependent, with short courses of spironolactone therapy far less likely to cause gynecomastia than longer courses of treatment.

Studies have shown that the variability of testosterone in male patients undergoing spironolactone treatment is highly varied. In most cases, the hormonal disruption seen with spironolactone treatment resolve once treatment has completed. Given the variability in an endocrine function that arises with spironolactone treatment, both men and women should always discuss the potential for hormonal abnormalities with treatment.

However, if a physician recommends spironolactone therapy, he or she has likely weighed the benefits of treatment to be greater than the risk of endocrine disruption.

The Recommended Spironolactone Dosage

Spironolactone dosing is highly individual, with patient individuality weighing heavily in dosing protocol. Always speak to your doctor about dosing, and never self-dose: he or she will determine the right dose dependent upon your age, weight, disease status, and any other medications or supplements you may be taking.

Spironolactone is commonly consumed in tablet form, with anywhere from 12.5-400mg/day commonly employed in various treatment modalities.

Spironolactone Reviews: What Customers Are Saying

Consumer reviews of spironolactone from drugs.com, everydayhealth.com, and Amazon speak to the variability of efficacy. The overwhelming majority of consumer reviews focus on spironolactone as a treatment for acne.

Overall, the number of positive reviews for spironolactone as an acne treatment outnumber the negative reviews by about 4:1. However, a small subset of reviews mentioned feelings of lethargy, unwanted weight gain, and lightheadedness.




Spironolactone: Where to Go From Here

Spironolactone is a diuretic that elicits anti-androgen, anti aldosterone, and potassium-sparing effects. Spironolactone is highly beneficial in the treatment of heart disease, heart failure, hypertension, and hyperaldosteronism.

However, the efficacy of spironolactone in the realms of acne treatment and hair loss still require additional research. Spironolactone is not a safe or effective treatment for weight loss. Always discuss spironolactone treatment with your doctor, and never prescribe or self-dose medications.