SPIRONOLACTONE
Drugs in Pregnancy and Lactation.
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Name: SPIRONOLACTONE
Class: Diuretic
Risk Factor: CM*
Fetal Risk Summary
Spironolactone, a potassium-conserving diuretic, has an action that results from its antagonism of aldosterone in the distal convoluted renal tubule. The diuretic action results in an antihypertensive effect. Spironolactone also has progestational and anti-androgenic activity. The latter activity may result in apparent estrogenic adverse effects in humans (1).
Reproduction studies in mice at 20 mg/kg/day, a dose substantially below the maximum recommended human dose on a body surface area basis (MRHD), revealed no embryo or fetal adverse effects (1). In rabbits dosed at 20 mg/kg/day (approximately the MRHD), an increased number of resorptions and lower number of live fetuses was observed. Because of spironolactone's anti-androgenic activity, feminization of male rat fetuses occurred at a dose of 200 mg/kg/day administered to the mothers during late embryogenesis and fetal development (1). In addition, rat offspring of both sexes exposed in utero in late gestation to 50 or 100 mg/kg/day exhibited permanent dose-related changes in their reproductive tracts (1).
No reports linking spironolactone with human congenital defects have been located. Some have commented, however, that spironolactone may be contraindicated during pregnancy based on the known anti-androgenic effects in humans and the feminization observed in male rat fetuses (2). Other investigators consider diuretics in general to be contraindicated in pregnancy, except for patients with cardiovascular disorders, because they do not prevent or alter the course of toxemia and they may decrease placental perfusion (3,4 and 5). In general, diuretics are not recommended for the treatment of pregnancy-induced hypertension because of the maternal hypovolemia characteristic of this disease.
In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 31 newborns had been exposed to spironolactone during the 1st trimester (F. Rosa, personal communication, FDA, 1993). Two (6.5%) major birth defects were observed (one expected), one of which was an oral cleft (none expected). No anomalies were observed in five other categories of defects (cardiovascular defects, spina bifida, polydactyly, limb-reduction defects, and hypospadias) for which specific data were available.
[*Risk Factor D if used in pregnancy-induced hypertension.]
Breast Feeding Summary
It is not known whether unmetabolized spironolactone is excreted in breast milk. Canrenone, the principal and active metabolite, was found with milk:plasma ratios of 0.72 (2 hours) and 0.51 (14.5 hours) (6). These amounts would provide an estimated maximum of 0.2% of the mother's daily dose to the infant (6). The effects on the infant from this ingestion are unknown. However, consideration should be given to the fact that spironolactone is tumorigenic in rats (1). The American Academy of Pediatrics considers spironolactone to be compatible with breast feeding (7).
References
- Product information. Aldactone. G.D. Searle, 2000.
- Messina M, Biffignandi P, Ghiga E, Jeantet MG, Molinatti GM. Possible contraindication of spironolactone during pregnancy. J Endocrinol Invest 1979;2:222.
- Pitkin RM, Kaminetzky HA, Newton M, Pritchard JA. Maternal nutrition: a selective review of clinical topics. Obstet Gynecol 1972;40:773–85.
- Lindheimer MD, Katz AI. Sodium and diuretics in pregnancy. N Engl J Med 1973;288:891–4.
- Christianson R, Page EW. Diuretic drugs and pregnancy. Obstet Gynecol 1976;48:647–52.
- Phelps DL, Karim A. Spironolactone: relationship between concentrations of dethioacetylated metabolite in human serum and milk. J Pharm Sci 1977;66:1203.
- Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.
Q&A about Spironolactone
Does spironolactone cure acne? Does it help with female hairloss? Any information will help. I also would like to know about side effects and if it could potentially harm me.
I couldn't tell you exactly how it works, but I know that Spironolactone blocks adrogen production, a hormone that is very much involved with acne production and hair growth. I'm not going to search the web and cut and paste an explanation, I'm just going to tell you from my own medical experience that I have prescribed it for treatment of hair loss and acne.
Since it is a water pill, the usual side effects are water loss (you'll urinate more frequently), increased potassium levels (although rare, it's potentially the most dangerous one), and kidney problems. If you're female, I warn my patients that it will probably cause menstrual irregularities and occasional breast tenderness, but those symptoms will probably fade away.
My recommendation is to see your primary care doctor and see if he/she can manage it, check your blood work, etc. If not, then see if your doctor can refer you to a dermatologist. Good luck.
I have alot of dark coarse chin hairs. I have read alot about spironolactone helping alot with getting this under control. But at what dose, and for how long until I would start to notice a difference? also, does it lower blood pressure a whole lot? I naturally have low blood pressure so I hope it will be ok for me to take for hirsutism. thanks
When I first went on it thru the brand name Aldactone I was put on it at 100 mgs per day when I started to notice improvement. It didn't affect my BP by dropping it any lower.
I would recommend getting back in touch with your doctor to see what they say.
I'm currently on a diuretic called spironolactone for pcos symptoms, and I think I'm experiencing mild dehydration (sunken eyes, pale flabby skin, dizziness). I'm trying to drink as much water as possible. It just seems like it's not enough though. How much water should I be drinking, and is there anything else I can do for my body to stay hydrated?
You can replace fluids and electrolytes by drinking sports drinks or other oral rehydration solutions (ORS). Drink the solution right away. Do not wait until dehydration becomes severe.
Packets of oral rehydration salts are widely available. Mix the contents of a packet with 1 quart or liter of drinking water. If you are not sure if the water is safe to drink, first boil the water for at least 5 minutes.
If you don't have a sports drink or ORS packet, you can make an oral rehydration solution using the following recipe: To 1 quart or liter of drinking water or boiled water, add the following:
2 tablespoons sugar
1/4 teaspoon salt
1/4 teaspoon baking soda (bicarbonate of soda).
If you don't have any baking soda, add another 1/4 teaspoon of salt. If possible, add 1/2 cup orange juice or some mashed banana to improve the taste and provide some potassium.
Drink sips of the ORS every 5 minutes until urination becomes normal. (It's normal to urinate 4 or 5 times a day.) Adults and large children should drink at least 3 quarts or liters of ORS a day until they are well.
Good Luck!
I am wondering about the drug Spironolactone and it's effects on people taking it for acne. Since this drug dramatically increases potassium in the bloodstream, what the the effects if a person takes too much potassium? Are their side effects? I thought potassium was a good thing, but I hear now that too much can kill you?
I just started Spironolactone for my hormonal acne (50mg) today, but as of the past couple of nights I put some Clearasil 10% BP on my face and the lines above the corners of my mouth have been itchy and inflamed all day. I have put some ice on it but I don't know how to make it go away any faster. Anyone had any weird swelling effects in one small area one day after starting Spironolactone? Any help would be appreciated! Thanks!
I just got the Mirena IUD and it's causing some spots to appear on my skin. I want to try Spironolactone. Has anyone had success with this drug for acne?
hi,ihave to take spironolactone for my acne problem.i do bodybuilding to gain size in my muscles.ive heard this medicine excretes water from body.i wanna know if it will have any bad effect on size gaining or not.if so, what can i do to reduce the damage to my muscles to least?
Creatine Monohydrate combined with drinking lots of water should take care of any issues you might have. Be sure that you drink as much water as you can, however, especially during the loading phase.
Good Luck and I Hope this Helps... :)
I ask this because I've been checking out reviews on acne.org and everyone of the reviewers are females. This stuff seems to work very well, but can men take Spironolactone?
Has any one heard of too much magnesium inhibiting the absorption of spironolactone, or just making it not work as well.
I haven't heard anything with decrease absorption with that particular medication but you can check with your pharmacist