While spironolactone (Aldactone) can be used for conditions like high blood pressure, heart failure, and low potassium levels, there is evidence to support the use for treatment of acne. As an off-label indication, acne has not been approved by the FDA as a labeled indication for this drug. However, based on a few small studies, this may be an appropriate treatment option for your situation.
Spironolactone is considered to be a potassium-sparing diuretic and works in the kidney to reduce the excretion of potassium by blocking the hormone aldosterone. Spironolactone also displays an effect on hormones by blocking the receptor site of androgen type hormones. Androgen hormones can lead to increased sebaceous glands and sebum secretions which leads to development of acne.
Spironolactone treatment for acne has been studied in a variety of small studies such as this one. This study included only 85 women, but the majority of patients had complete clearing of acne or marked improvement. Only 7% of patients did not have any type of improvement. Also, spironolactone was well tolerated in this study.
Outside of the FDA-approved indications, spironolactone can be used for acne, polycystic ovary syndrome, and female hair growth. These indications are considered “off-label,” meaning that the manufacturer did not gain approval from the FDA to use their drug for these conditions. It is illegal for drug manufacturers to add off-label indications to the drug label, nor can they market off-label indications to consumers or health care professionals unless they receive FDA approval.
Just because a drug has off-label indications does not mean that it is inappropriate to prescribe and use the drug. In fact, it is common practice to use drugs for off-label indications in healthcare for a variety of reasons. Many times, the large studies needed to gain FDA approval for certain indications may be cost prohibitive or impractical to complete. Health care professionals still need sufficient evidence to use medications off-label.
Spironolactone can cause high potassium, however, this does not seem to be common among healthy females. With that being said, patients on potassium supplements or who have poor kidney function would be at risk of high potassium. In addition, due to its hormonal effects, males have had breast growth and females have had menstrual disruptions and breast tenderness while taking spironolactone.