What is the average dose of spironolactone for acne?

Dr. Patrick Mahar, dermatologist, talks about the most commonly prescribed doses of spironolactone for the treatment of acne for women.

Medically reviewed by:
Dr. Patrick Mahar
Dermatologist

If you have started spironolactone or you’re thinking about it and are wondering when you’ll actually see results? You’re not alone. One of the biggest frustrations with acne treatments is not knowing how long to wait before deciding if something is working and spironolactone is no exception.

Unlike fast-acting spot treatments, spironolactone works by targeting the hormonal root cause of acne, which means results take time. But when it works, it can significantly reduce breakouts, oil production, and recurring hormonal acne.

The challenge? Many people stop too early (or use the wrong dose) before seeing the full benefits.

That’s why getting the right plan from the start matters.

A personalized spironolactone treatment plan, tailored to your skin, hormone patterns, and acne severity, can help you reach the right dose faster and avoid unnecessary delays in results.

With Miiskin, you can get a prescription for spironolactone online, reviewed by a board-certified dermatologist.

Get a spironolactone prescription for acne in as little as 24 hours.

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What is spironolactone?

Dr. Patrick Mahar, dermatologist, says that spironolactone is a potassium-sparing diuretic (water pill) initially developed to treat conditions such as heart failure and high blood pressure¹ but it is nowadays used off-label for various medical purposes such as:

Hormonal acne in women
Excessive hair growth (hirsutism)
Excessive production of aldosterone
Abnormal accumulation of fluid in body tissues, leading to swelling or edema
Very low levels of potassium (hypokalemia)²
Hair loss in women³

It is important to note that spironolactone is not appropriate for men or women who are pregnant or breastfeeding women unless there are specific circumstances, and it is prescribed to you by your doctor.

Do I need a prescription to get spironolactone for acne?

Yes, oral spironolactone and topical spironolactone can only be purchased with a doctor’s prescription.

How can I get an online prescription of oral or topical spironolactone?

You can request a spironolactone prescription by having a consultation with an online dermatologist via Miiskin. Consultation price is $59 and $39 for prescription renewals. You will get and answer and your prescription (if medically adequate for you) in 1-2 working days.

Get a spironolactone prescription for acne in as little as 24 hours.

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How does spironolactone work for acne?

Spironolactone (Aldactone) is a diuretic (water pill) used to treat female acne as hormone therapy by targeting the hormonal aspect of the disease⁵.

Dr. Mahar says that spironolactone slows down the body’s production of skin oil (sebum) by preventing a hormone called dihydrotestosterone (DHT) from attaching to specific receptors.

Spironolactone does not show results as quickly as other treatment options⁶ ⁷ .

How long does spironolactone take to work for acne?

Dr. Mahar says that spironolactone is not as fast working as other prescription medications, so depending on your skin, you should see improvements after 8 to 12 weeks.

Studies show that many women experience high success rates and that improvement ranges from a 50% to 100% reduction in their face and body acne after week 12 .

What is the “normal” (recommended) dose of spironolactone for acne?

According to Dr. Patrick Mahar, the typical spironolactone dose recommended for acne patients varies from 50 to 200 mg per day.

What is the highest dose of spironolactone for acne?

Dr. Mahar explains that 200 mg per day is at the higher end of the dosing range used for spironolactone for acne. Most patients start at a lower dose, which may be gradually increased depending on how well the treatment works and whether side effects occur. Not everyone will need a dose this high.

What is the lowest dose of spironolactone for acne?

Dr. Mahar explains that 50 mg per day is a common starting dose of spironolactone for acne, although lower doses such as 25 mg may sometimes be prescribed. The appropriate starting dose depends on the individual, and it may be gradually adjusted based on treatment response and side effects.

Is 25 mg of spironolactone enough for acne?

Dr. Mahar explains that a 25 mg dose of spironolactone may be insufficient to treat acne in many cases. Typically the starting dose is usually 50 mg. If this isn’t effective, the dose may be gradually increased by a healthcare provider. The goal is to find the lowest effective dose with minimal side effects, so regular follow-ups are important.

Is 50 mg of spironolactone enough for acne?

Dr. Mahar explains that 50 mg of spironolactone is a common starting dose for acne and may be effective for some patients. If acne does not improve sufficiently and the medication is well tolerated, a healthcare provider may gradually increase the dose. The appropriate dose depends on factors such as your response to treatment and any side effects you experience.

Is 200 mg of spironolactone too much for acne?

Dr. Mahar explains that 200 mg of spironolactone is at the higher end of the dosing range used to treat acne. Healthcare providers generally start with a lower dose and increase it gradually when needed and well tolerated. Not everyone needs 200 mg, the aim is to use the lowest dose that provides adequate acne control with acceptable side effects.

When is the best time to take spironolactone?

According to Dr. Mahar, spironolactone can generally be taken at any time of day, but taking it in the morning is often more convenient because it can increase urination. If you take it twice daily, the second dose is usually best taken earlier in the afternoon rather than close to bedtime. Try to take spironolactone at the same time each day and consistently either with or without food, according to your dermatologist’s instructions.

Get a spironolactone prescription for acne in as little as 24 hours.

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Advantages of using oral spironolactone for acne

Traditional acne prescription medication such as oral antibiotics and isotretinoin are usually recommended for three to six months, respectively. The long-term use of antibiotics can contribute to bacterial resistance and the use of isotretinoin can cause multiple side-effects, some of which can be serious.

Oral and topical spironolactone have the advantage that may be used long term. Studies have also shown spironolactone is effective at treating acne with improvement ranging from a 50% to 100% reduction of acne breakouts⁴.

benefits of using spironolactone for acne

Potential side effects of oral spironolactone

Spironolactone may cause more side effects than the ones mentioned on this list, this is just a summary of the most common side effects.

Increase in urination
Headaches
Frequent bowel movements
Menstrual disorders
Breast tenderness
Fatigue
Dizziness
Low blood pressure
Elevated blood-potassium
Decreased sex drive⁸

Common spironolactone interactions

Spironolactone has over 100 drug interactions. Please tell your online dermatologist if you are taking any medicines or supplements.

Alcohol and spironolactone

If you’re using spironolactone for acne, a mild alcohol consumption is generally permissible. Nevertheless, follow the suggested recommendations of having a maximum of 2 alcohol units daily and 14 units per week.

As a guidance, a regular 175ml glass of wine constitutes 2 units, while a pint of beer usually contains 2 to 3 units of alcohol.

Ibuprofen and spironolactone

Spironolactone has many drug interactions which include common painkillers such as ibuprofen, diclofenac, naproxen or aspirin. You should not take these medications unless instructed by your doctor to do so.

Spironolactone and Adderall

Adderall is a stimulant commonly used to treat attention deficit hyperactivity disorder (ADHD) and It can increase heart rate and blood pressure. On the other hand, spironolactone lowers blood pressure. Taking these medications together could potentially lead to unpredictable changes in blood pressure, which might be harmful. You should let your doctor know if you are taking Adderall before they prescribe oral spironolactone.

Spironolactone and magnesium

Both magnesium and spironolactone can affect the balance of electrolytes in your body, particularly potassium . If you have been prescribed spironolactone it may be best to skip the magnesium supplements at least while you are taking the medication.

Spironolactone and lithium

Spironolactone and lithium may have similar effects on the body when it comes to inhibiting a hormone called aldosterone, therefore taking them both at the same time is not recommended.

Spironolactone and Zoloft (sertraline)

Spironolactone and Zoloft (sertraline) can both lower blood pressure, therefore they should not be taken at the same time unless advised for your doctor.

Spironolactone and tretinoin

In recent years, there has been growing attention on the concurrent use of tretinoin and spironolactone for addressing hormonal acne. Our comprehensive article, ‘Exploring Tretinoin and Spironolactone for Hormonal Acne Treatment,’ delves into the separate mechanisms of action and scientific evidence supporting their combined application. By incorporating findings from relevant clinical studies, we aim to provide a thorough understanding of this potent acne-fighting combination.

FAQ about the spironolactone dosage for acne

Learn about common spironolactone doses used for acne, including typical starting doses, how the dose may be increased, the usual dosing range, and why treatment should be individualized based on effectiveness and side effects.

Can you use spironolactone long term?

Dr. Mahar says that you can safely take spironolactone long term, together with an effective contraception method. Your healthcare provider will probably suggest having occasional blood tests to make sure your potassium levels are properly balanced, and your blood pressure is not too low.

Other acne treatments for acne such as minocycline, doxycycline, Seysara and isotretinoin, should not be used long-term.

When to take spironolactone?

Dr. Mahar says that you will usually take spironolactone in the morning. If you have been prescribed by your doctor a higher dose, you might need to take it twice a day. If this is the case try to make sure you take the second dose no later than 4:00 pm.

If you take spironolactone at night, you may need to go to the bathroom a few times during the night.

Can you use spironolactone while trying to conceive?

Dr. Mahar says that spironolactone should not be taken while you are pregnant, trying to conceive or breastfeeding as it may cause birth defects.

How much water should i drink when taking spironolactone?

Dr. Mahar says that when you are taking spironolactone, it’s important to stay adequately hydrated, generally aiming for around 8 glasses (2 liters) of water daily, though this can vary based on individual needs. Since spironolactone is a diuretic, balancing hydration is crucial. You should avoid both dehydration and overhydration to maintain proper electrolyte levels, particularly potassium. Monitoring your urine color (pale yellow is ideal) can help gauge hydration. Always follow your healthcare provider’s advice, especially if you have conditions like kidney or heart issues, and watch for signs of dehydration or overhydration.

What happens if I miss a dose of spironolactone for acne?

Dr. Mahar says that in most cases, if you accidentally take an extra dose of spironolactone, you are likely to be alright. However, there may be a small chance that your blood pressure might drop too low. It is important to get in touch with your doctor if you start feeling unwell and if you have kidney or liver disease.

Your doctor will probably ask you to check your blood pressure at home and keep an eye out for symptoms such as nausea, dizziness, or drowsiness throughout the day.

If you experience these symptoms, call your doctor.

What happens if I take a double dose of spironolactone?

Lee el articulo en Español Espironolactona ¿Para qué sirve?

Article References:
https://www.mayoclinic.org/drugs-supplements/spironolactone-oral-route/side-effects/drg-20071534?p=1
https://reference.medscape.com/drug/carospir-aldactone-spironolactone-342407
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010138/
https://www.dermatologytimes.com/view/spironolactone-safe-and-effective-adult-female-acne
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https://my.clevelandclinic.org/health/drugs/19755-spironolactone-tablets
https://www.dermatologytimes.com/view/spironolactone-safe-and-effective-adult-female-acne
https://www.bmj.com/content/381/bmj-2022-074349
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https://www.mayoclinic.org/drugs-supplements/spironolactone-oral-route/side-effects/drg-20071534?p=1
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https://pubmed.ncbi.nlm.nih.gov/670960/
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