Safety
No boxed warning. Spironolactone can raise potassium; the label says to check potassium within a week of starting and regularly after, and not to use it with high potassium, Addison’s disease or eplerenone. Avoid it in pregnancy, because it may affect the development of a male fetus. Irregular periods, breast tenderness, dizziness and headache can occur (headaches: 20% vs 12% on placebo in SAFA).
Talk to a licensed clinician about your health history and every medication you take before you start.
Legal status
Prescription only; FDA-approved. FDA-approved and generic, but acne is an off-label use, so a prescriber has to decide it suits you. Not a controlled substance.
What spironolactone for acne is
Acne is an off-label use of spironolactone. Topical spironolactone creams are compounded and not FDA-approved.
FDA-approved for
- Heart failure with reduced ejection fraction
- High blood pressure (as an add-on)
- Edema from cirrhosis or nephrotic syndrome
- Primary hyperaldosteronism
Dosing
Tablet, taken by mouth (compounded topical versions also exist), once a day. In the SAFA trial: 50 mg a day for 6 weeks, then 100 mg a day. Your prescriber sets your dose.
How well it works
In the SAFA trial of 410 women (BMJ, 2023), 82% on spironolactone said their acne had improved at 24 weeks, against 63% on placebo. At 12 weeks, investigators rated 19% as a treatment success, against 6% on placebo. Individual results vary.
Spironolactone for acne cost
None of the online providers we compare publishes a monthly price for it. For a full breakdown, read How much does an online dermatologist cost?.