Spironolactone

Patient Information Sheet: Spironolactone for Androgenic Alopecia and Other Conditions

What is Spironolactone?

Spironolactone is blood pressure medication used in dermatology to treat various conditions such acne, hirsutism (excessive hair growth), androgenic alopecia and hidradenitis suppurative. It works by blocking the effects of certain hormones in the body, including aldosterone and androgens.

Contraindications:

• Hypersensitivity to spironolactone
• Acute renal insufficiency
• Addison’s disease or conditions associated with hyperkalemia
• Pregnancy
• Concomitant use with eplerenone

Precautions:

• Use with caution in patients with cardiopulmonary disease or uncontrolled diabetes
• Prostate cancer patients should be monitored closely as it may affect androgen activity and alter PSA levels
• Use cautiously with medications that may increase potassium levels (ACE inhibitors, NSAIDs, heparin, etc.)
• Can be used whilst breast feeding under supervision.

Mechanism of Action:

• Spironolactone has moderate anti-androgenic activity, inhibiting the binding of dihydrotestosterone (DHT) to androgen receptors.
• It also reduces ovarian steroidogenesis, leading to lower levels of testosterone and other weak androgenic steroids.
• Additionally, spironolactone acts as a competitive aldosterone antagonist, increasing the excretion of water and sodium while decreasing potassium excretion.

Expected Benefits:

• Improvement in hirsutism symptoms within 3-6 months, with continued benefits seen over 12 months of treatment.
• Reduction in acne severity, with approximately 20-50% of patients experiencing clearance within a year of treatment.

Side Effects:

• Hyperkalemia (high potassium levels)
• Weakness
• Headache
• Nausea
• Vomiting
• Breast tenderness

Infrequent:

• GI cramps
• Dizziness
• Confusion
• Impotence
• Menstrual irregularities

Rare:

• Liver toxicity
• Rash
• Alopecia (hair loss)
• Osteomalacia (softening of bones)

Monitoring and Management:

• Baseline investigations include electrolyte levels and pregnancy test (if applicable).
• Regular monitoring of electrolytes is required, particularly potassium levels, within 4 weeks of starting treatment and then every 3 months.
• If hyperkalemia occurs, symptoms may include weakness, palpitations, and abnormal heart rhythms. Immediate medical attention is necessary.
• Spironolactone may interact with other medications, so it’s important to inform your doctor about all medications you are taking.

Dosage and Administration:

• For hirsutism, the initial dose is typically 50mg daily, with the possibility of increasing to 100mg daily after one week if tolerated.
• Treatment duration should be at least 6-12 months before assessing effectiveness.