If you struggle with chronic bouts of blemishes and breakouts (and youre well past puberty), you may have heard about a prescription drug called spironolactone (aka, Aldactone or CaroSpir) that can help with hormonal acne.
“Spironolactone was originally a mild diuretic and high blood pressure medication that was developed in the 1950s, but it was discovered to have a secondary effect of blocking testosterone receptors in the skin,” dermatologist Kristina Collins, MD, co-founder and CEO of Austin Skin in Austin, Texas, tells LIVESTRONG.com. “It has since been used for decades to treat acne and is also FDA-approved for treatment of the hormonal condition PCOS.”
By blocking certain hormone receptors, the medication decreases your skins production of sebum, an oily substance that naturally moisturizes your skin but can also clog your pores, leading to acne, explains Howard Sobel, MD, a clinical dermatologic surgeon at Lenox Hill Hospital in New York City.
Research has shown spironolactone to be extremely effective at treating acne — in fact, one June 2017 study in the International Journal of Womens Dermatology found that 85 percent of people taking it experienced a significant improvement in their acne and more than half were completely clear of blemishes during their treatment period.
But as with any drug, it comes with its share of side effects and precautionary notes.
Here, dermatologists share the most important things they want people to know before they start taking spironolactone for acne.
Spironolactone is a commonly prescribed diuretic medication used to treat various conditions like high blood pressure, heart failure, liver disease and hormonal acne. It works by blocking aldosterone receptors and promoting the removal of excess sodium and water from the body through urination. While an effective medication when taken as directed, some people may consider stopping spironolactone suddenly or “cold turkey” for various reasons. However, this can be dangerous and lead to adverse withdrawal effects. This article provides an in-depth look at spironolactone, the potential risks of stopping it abruptly, and safer ways to discontinue this medication under medical supervision.
What is Spironolactone?
Spironolactone is the generic name for the brand-name drug Aldactone, belonging to a class of medications called potassium-sparing diuretics. It received FDA approval in 1960 and has been used for over 50 years to treat conditions involving fluid retention (edema), high blood pressure, heart failure, primary hyperaldosteronism and more.
The drug is prescribed in oral tablet form, taken once or twice daily with food. Spironolactone works by blocking the effects of the hormone aldosterone in the kidneys, which reduces sodium and water reabsorption back into the bloodstream. This promotes the removal of excess fluid through increased urination. By getting rid of extra sodium and water, spironolactone effectively lowers blood pressure and reduces swelling in patients with heart failure or liver disease.
At lower doses spironolactone can also help treat hormonal acne in women by decreasing androgen hormone levels. This makes it a useful drug with a wide range of therapeutic uses when taken properly under medical supervision. However abruptly stopping spironolactone treatment can be unsafe.
Why Stopping Spironolactone Suddenly is Dangerous
When taken regularly as prescribed, spironolactone helps the body maintain proper fluid and electrolyte balance. Suddenly discontinuing the medication disrupts this balance and can result in several risks and side effects, including
- Rebound hypertension – Blood pressure rises sharply, increasing the risk of heart attack or stroke
- Fluid retention and edema – Leads to swelling in the arms, legs, hands and abdomen
- Hyperkalemia – Potentially life-threatening elevated potassium levels
- Heart palpitations – Irregular heartbeat from electrolyte imbalances
- Acne flare-ups – Spironolactone withdrawal can worsen hormonal acne
Additionally, stopping spironolactone abruptly means the underlying condition is no longer being treated, causing symptoms to return and worsen quickly. For example, patients taking it for heart failure may experience renewed fluid buildup in the legs and lungs, making it difficult to breathe.
The body becomes dependent on spironolactone to remove excess sodium and water. When treatment is halted suddenly, the kidneys are unable to excrete fluid as efficiently. This leads to rapid water retention and a spike in blood pressure.
Also, spironolactone helps prevent too much potassium from being lost in the urine. Quitting it suddenly can cause potassium levels to rise unpredictably, creating heart rhythm issues. Therefore, it is extremely important to consult a doctor about safely discontinuing spironolactone.
Side Effects and Symptoms of Stopping Cold Turkey
Patients who stop spironolactone abruptly often report experiencing certain withdrawal symptoms and side effects. The most common include:
- Fatigue and weakness
- Dizziness or lightheadedness
- Nausea and vomiting
- Stomach cramps and diarrhea
- Muscle pains and spasms
- Increased urination
- Thirst and dry mouth
- Heart palpitations
- Anxiety or restlessness
These symptoms may vary in severity based on the dose and duration of prior spironolactone treatment. Nonetheless, they demonstrate how abruptly going off this medication can impact the body across various systems. Monitoring for adverse effects and promptly informing a doctor is crucial.
For those using spironolactone for hormonal acne, stopping treatment suddenly could also cause acne flare-ups as androgen levels spike again. This may lead to the formation of painful, cystic breakouts. Dermatologists emphasize the need for gradual withdrawal under medical guidance rather than quitting spironolactone cold turkey.
Tapering Off Spironolactone Under Doctor Supervision
The safest way to stop spironolactone is to do so gradually under the direction of your prescribing physician. This process of slowly tapering down dosage over days, weeks or months allows the body to steadily adjust without major impacts.
Doctors may utilize the following tapering strategies:
- Reduce dose frequency – Taking spironolactone every other day before stopping
- Cutting tablet strength – Transitioning from 100 mg to 50 mg doses
- Extending intervals between doses – Increasing time between doses over the tapering period
The specific tapering regimen will depend on the individual situation, including the starting dosage, duration of use, and reason for discontinuing spironolactone. Closely following the doctor’s instructions can help prevent adverse events.
Doctors will also arrange periodic lab tests during the tapering period to monitor blood pressure, kidney function, electrolytes and other relevant markers. This helps ensure the body is adjusting well at each dose reduction. Any concerning results may require the tapering schedule to be slowed down or adjusted.
Seeking Prompt Medical Care with Symptoms
If you experience symptoms like severe fatigue, irregular heartbeat, shortness of breath or muscle weakness after stopping spironolactone, seek immediate medical help. Inform healthcare providers about your history of spironolactone use and discontinuation.
Signs of hyperkalemia or high potassium like numbness, chest pain and severe nausea also warrant emergency care to avoid life-threatening complications. Alert paramedics about your situation if calling an ambulance.
Do not attempt to self-medicate symptoms with over-the-counter drugs before consulting a doctor. Be open about the decision to stop spironolactone independently so physicians can provide appropriate treatment.
Alternative Medications and Lifestyle Changes
For some patients, doctors may recommend alternative medication options that are safer to stop based on the underlying condition being treated:
Heart failure – May change to loop diuretics like furosemide (Lasix) or thiazide diuretics like chlorothiazide
Hypertension – Can prescribe calcium channel blockers, ACE inhibitors or beta blockers instead
Hormonal acne – May replace with anti-androgen birth control pills or antibiotics like doxycycline
Additionally, lifestyle measures like limiting sodium intake, exercising regularly, managing stress and hydrating properly can also help manage symptoms. However, do not alter medication or self-treat without consulting your healthcare provider first.
The Takeaway
Spironolactone is a potassium-sparing diuretic that should never be stopped suddenly without medical supervision. The abrupt cessation can cause rebound effects like acute hypertension, edema, hyperkalemia and worsened heart failure. Tapering off spironolactone gradually under a doctor’s guidance can prevent adverse events. Seek prompt medical attention if you experience severe symptoms after independently halting this medication. With the right precautions, alternative treatments and lifestyle changes, spironolactone can be safely discontinued.
Men Should Not Take It
Because spironolactone is an anti-androgen, it interferes with “male” hormones like testosterone.
This can be problematic for certain men, as it can result in something known as gynecomastia, or enlarged breasts, Dr. Collins says, and it can also negatively affect sexual function.
However, spironolactone is sometimes prescribed to reduce testosterone in trans women, according to NHS.
You Shouldn’t Get Pregnant While Taking It
Spironolactone is not recommended for anyone planning to get pregnant. The drug has been shown to cause birth defects in animal studies, per Pfizer, the company that makes it.
For that reason, you shouldnt take the drug if youre trying to conceive. And if youre not planning for a baby but are sexually active, you should use some form of contraception to avoid an unplanned pregnancy.
In fact, it might be a good idea for some people to take this med along with hormonal contraceptives. Spironolactone can cause side effects such as breast pain and irregular periods, and hormonal contraceptives can reduce these effects, according to NHS.
Plus, for people with PCOS, taking the two together can help reduce symptoms like acne, excessive hair growth and high blood pressure more effectively than taking just one of the meds alone, according to a May 2022 review in Cureus.
Side Effects of Stopping Lexapro
FAQ
What happens if you suddenly stop taking spironolactone?
Does spironolactone need to be tapered off?
Should you take a break from spironolactone?
How long does it take for spironolactone to leave your system?
What happens if you stop taking spironolactone?
You shouldn’t stop taking spironolactone without first talking with your doctor. Stopping this medication suddenly won’t cause withdrawal symptoms. But when you stop taking spironolactone it will quickly stop working to manage your condition. As a result: All of these things may be dangerous for you.
Can I return spironolactone?
Prescription medications may not be eligible for returns: Due to their nature and potential for tampering‚ many online pharmacies do not accept returns for prescription medications like Spironolactone. Check the specific policy of the pharmacy regarding returns for prescription drugs.
What should I do if I experience side effects from spironolactone?
A: If you experience any side effects from Spironolactone‚ it is important to contact your healthcare provider or seek medical attention. They can provide guidance on how to manage the side effects and determine if any adjustments to the medication are necessary.
Is spironolactone safe?
The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses. Spironolactone oral tablet is a generic medication that’s used in adults with certain conditions including high blood pressure.