Spironolactone: Complete guide & 6 tips for reducing side effects

Spironolactone belongs to a class of medications known as diuretics, or “water pills.” It’s primarily used to treat conditions like high blood pressure (hypertension), fluid retention, and heart failure. But, it’s also widely prescribed to women for hormone—related conditions including hormonal acne and hyperandrogenism (excess levels of male hormones like testosterone). 

If your doctor has recently recommended it, or you’ve already started taking it, then you might be wondering what to expect. Like all medications, spironolactone can come with side effects. Most of these are mild and go away on their own, but rarely they can signal a serious medical concern that requires urgent treatment. 

In this guide, we’ll discuss the most common spironolactone side effects, the steps you can take to ease them, and what signs require more urgent action.

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Why women are often prescribed spironolactone 

While spironolactone is best known as a diuretic used for managing high blood pressure and heart failure, it has another important use, especially for women. Alongside its diuretic effect (increases the amount of water and salt you pee out), it's also an anti—androgen. Anti—androgens block the effects of androgen hormones, like testosterone, from affecting the body. Women naturally produce androgens in small amounts, however, some women can produce excess levels of androgens and this can lead to acne, excess facial or body hair (hirsutism), male—pattern baldness, and irregular periods. 

That’s why spironolactone is often prescribed off—label for hormone—related conditions like: 

Hormonal acne. This is often found along the jawline, chin, and cheeks. The American Academy of Dermatology (AAD) states that spironolactone has been shown to reduce hormonal acne by 50% to 100%.

Polycystic Ovary Syndrome (PCOS). PCOS sufferers often have elevated androgen levels. 

Hirsutism. An increase in hair on the face and body due to raised androgen levels.

‍Hair thinning or hair loss caused by raised androgens. 

Common spironolactone side effects in females 

Like many medications that affect hormones and fluid balance, spironolactone can cause a range of side effects. Some women will have no obvious symptoms, others may notice mild and temporary side effects while their body adjusts and rarely, some will experience more serious side effects that require medical attention. 

Here are some of the more common side effects you might experience. For a complete list, check the medication guide that comes with your prescription or speak with your healthcare provider. 

Skin and hair changes 

Acne. It can take up to 3 months to notice any change in acne, and some women report that their acne initially gets worse while taking spironolactone before improving.

Dry skin. Dry skin can be a common initial side effect. 

Sensitive skin. When skin becomes dry it can become more sensitive and easily irritated. 

Breast and hormonal symptoms 

Breast pain and tenderness. Spironolactone breast pain is a common side effect, especially in women who are pre—menopause, it should settle with time.

‍Breast enlargement (gynecomastia). This common spironolactone side effect can cause discomfort but should settle over time. 

Irregular periods. If you’re pre—menopause you may experience a disruption in your menstrual cycle. If you’re planning on becoming pregnant, speak to your healthcare provider first. This medication is not suitable for pregnancy as it can affect the normal development of the fœtus. 

Mood, sleep, and mental health 

Mood swings and irritability. Some women experience mood swings from spironolactone although it’s not known how common this is. 

Tiredness or low energy. Spironolactone fatigue is a relatively common side effect, occurring in more than 1 in 100 people. 

Reduced libido (sex drive). Some women will experience a drop in their sex drive, if this is bothersome speak to your healthcare provider.

Digestive and stomach concerns

Stomach pain, upset stomach or heartburn can occur when taking spironolactone.

‍Nausea and vomiting is a relatively common side effect, if severe then seek urgent medical advice. 

Constipation can occasionally occur but should settle with lifestyle adjustment. If it continues, speak to your doctor. 

Headaches, dizziness, and other physical symptoms 

Headaches are common and can be caused by multiple factors, for example, dehydration. 

Dizziness or lightheadedness, particularly when going from lying or sitting to standing, is common and affects more than 1 in 100 people. It should settle after a couple of days but if it doesn't go away speak to your healthcare provider. Avoid driving, cycling or using machinery if you feel dizzy. 

Leg cramps. Spironolactone leg cramps are a common complaint. They should be discussed with your healthcare provider as they may need to do further tests.

‍Increased urination. As spironolactone is a diuretic, you may feel the need to urinate more frequently. 

Side effects that require urgent medical review 

While most side effects of spironolactone are mild and manageable, there are some rare but serious reactions that need urgent medical attention. If you experience any of the following, contact your doctor or seek emergency care right away. 

Allergic reaction (anaphylaxis) 

This potentially life-threatening reaction requires emergency medical treatment. Signs include: 

- Hives or an intense skin rash 

- Swelling of the lips, mouth, throat, or tongue 

- Difficulty breathing, feeling wheezy, or breathing very fast 

- Skin, lips, or tongue turning blue, pale, or grey 

-Sudden confusion, drowsiness, or dizziness 

- Loss of consciousness

Raised potassium levels (hyperkalemia) 

Because spironolactone helps the body retain potassium, levels can sometimes become too high which can be dangerous. Watch for: 

- Muscle weakness 

- An irregular or slow heartbeat 

- Tingling or numbness in your limbs 

- Feeling faint or lightheaded 

- Tummy pain 

- Diarrhea 

- Nausea or vomiting 

In healthy women under 45, this is a rare side effect, but it can be more common if you have kidney or heart problems or take other medications that affect potassium levels. 

Dehydration 

Spironolactone can cause you to pee more. Too much fluid loss can result in dehydration. Here’s what to watch for: 

- Feeling thirsty 

- Dark or strong—smelling urine 

- Peeing less than usual 

- Feeling dizzy or light—headed 

- Headache 

Kidney damage 

Spironolactone can affect how your kidneys work and cause kidney damage. Signs include: 

- Diarrhea 

- Reduced urination 

- Nausea or vomiting 

- Feeling drowsy or confused 

- Liver damage 

Rarely, spironolactone can affect liver function, here are some signs of liver damage to be aware of: 

- Yellowing of the whites of your eyes 

- Yellowing of the skin

- Very dark-coloured urine 

What are the long-term side effects of spironolactone? 

Many patients stay on spironolactone for a long time and according to the British Health Service, the NHS, it is safe to do so. However, you may require occasional blood tests to make sure your liver, kidney, and potassium levels are all stable. 

6 tips to manage spironolactone side effects and support your body 

Most spironolactone side effects are manageable and for many women, they ease over time as the body adjusts. But if you’re struggling with discomfort, there are practical steps you can take to help support your body and ease symptoms while you’re taking spironolactone. 

1. Manage your hydration. Since spironolactone is a diuretic, it's important to stay well—hydrated to avoid dehydration, tiredness, headaches, and muscle cramps. Speak to your healthcare provider about how many glasses of water you should be aiming to drink a day as reccomendations can vary from person to person. 

2. Eat a balanced diet. Eating a diet rich in fibre, protein, and healthy fats not only supports your overall well—being but can help prevent constipation, nausea, and bloating. Some people taking spironolactone need to limit their potassium consumption, so make sure you check with your doctor about how much potassium—rich food (like bananas, spinach, and sweet potatoes) you’re allowed to eat. 

3. Go easy at the start. Since uncomfortable side effects like dizziness and lightheadedness are more common at the start, make sure you take it easy in the first few days while you adjust. Standing up slowly after lying or sitting down, and avoiding high—energy activities will help prevent dizziness. 

4. Take your medication with or right after a meal. If you are feeling nauseous then try taking your spironolactone with or just after a meal. It may also help to avoid rich or spicy foods and to eat smaller meals, more frequently. 

5. Maximise your energy levels. Making sure you are getting good quality, regular sleep, eating a balanced diet and exercising (if you can) can help boost your energy levels. 6. Don’t be afraid to speak to your healthcare provider. If something doesn’t feel right, 

or your symptoms are bothering you, then it’s important to let your healthcare provider know. They may need to change your dose, stop the medication, or do a blood test. 

Key takeaways

Spironolactone is a “diuretic” that is primarily used to treat high blood pressure and heart failure. 

Due to its anti—androgen action, it’s commonly prescribed to women for hormonal acne, PCOS, and other hormone—related concerns. 

Mild side effects like breast tenderness, irregular periods, fatigue, dizziness, and dry skin are common but usually settle over time. 

Serious side effects, like allergic reactions, high potassium, liver or kidney damage, or severe dehydration are rare but require urgent medical attention. 

Long—term use is generally safe under proper medical supervision with regular blood tests. 

Always talk to your healthcare provider if you have any concerns or you’re unsure about a symptom you’re experiencing. 

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