A diuretic with anti-androgen effects — used for heart failure, and off-label for hormonal acne. Needs blood monitoring.
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Spironolactone blocks aldosterone, a hormone that makes the kidneys retain salt and water and lose potassium. Blocking it produces a mild diuretic effect while retaining potassium — which is why it is called potassium-sparing, and why potassium levels are the thing that must be watched.
It also blocks androgen receptors, and that second, incidental property is why it appears in dermatology at all. Reducing the effect of testosterone on the skin reduces oil production, which is why it works for hormonal acne in women.
Two quite different uses, two quite different doses: 25mg daily for heart failure, 50 to 200mg for acne.
Off-label does not mean improper — it means the licence was never extended to that use, which is common for older cheap drugs where nobody funds the trials.
For acne: three months before judging it. Improvement is gradual and often not obvious before eight to twelve weeks. A great many people stop at six weeks concluding it does not work.
For hair loss: six to twelve months, and the realistic goal is slowing loss and modest regrowth rather than restoration.
Avoid potassium supplements and low-sodium salt substitutes, which are potassium chloride. Combined with spironolactone they can push potassium to dangerous levels — and “healthy” salt alternatives are exactly the thing someone starting a heart drug is likely to buy.
Muscle weakness, palpitations, numbness or tingling can indicate high potassium and warrant prompt assessment.
The anti-androgen effect that helps women causes breast enlargement, reduced libido and erectile difficulty in men, at the doses acne requires. Those effects are not always fully reversible. Men with acne are treated differently.
Younger women on spironolactone for acne, with normal kidneys, are lower risk and are sometimes monitored less intensively — but baseline bloods remain standard.
Yes, and hormonal acne in women is the use where a remote consultation works well — the pattern is recognisable from history and photographs, and it is a genuinely underused treatment for a problem that is often managed with repeated antibiotic courses instead.
What a consultation involves: establishing the pattern is hormonal, arranging baseline potassium and kidney function, reviewing other medicines, confirming contraception is in place, and setting up the monitoring schedule.
The expectation-setting matters as much: three months before judging it, periods may become irregular, and it is a long-term treatment rather than a course.
What we will not do: prescribe it without baseline bloods, prescribe it to someone pregnant or trying to conceive, or prescribe it for acne in men.
Heart failure prescribing sits with your cardiology team and NHS GP, who hold the full picture and the monitoring. We would not take that over remotely.
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Spironolactone is a very cheap generic — decades off patent. On a private prescription the tablets cost little; the recurring cost is the blood monitoring, which is a real and ongoing expense on the private route and worth budgeting for.
If you have heart failure, resistant hypertension or PCOS, your NHS GP can prescribe and monitor this free of charge, and they hold your full record. That is the better route and we would say so.
Where paying is justified: hormonal acne that has failed topicals and antibiotics, where spironolactone is the logical next step and NHS dermatology waits are long.
For acne and hair loss, spironolactone can be stopped without tapering — though the benefit fades over a few months and acne generally returns.
For heart failure, do not stop it without advice. It is one of the drugs that improves survival, and stopping it is a decision for the team managing your heart.
Because spironolactone raises potassium, and high potassium can cause dangerous heart rhythm problems with no warning symptoms.
Bloods before starting, at one week and one month, then every three to six months. This is the trade-off for a cheap and effective drug, not bureaucracy.
Three months for a fair trial. Improvement is gradual, and stopping at six weeks — which is common — means never finding out whether it worked.
Very commonly, yes — irregular, lighter, or occasionally absent. It is not harmful, and taking a combined pill alongside usually settles it while also providing the contraception you need.
Yes, if there is any possibility of pregnancy. Spironolactone is anti-androgenic and can affect the development of a male fetus. This is not a soft recommendation.
Because at acne doses the anti-androgen effect causes breast enlargement, reduced libido and erectile difficulty — and those are not always fully reversible. Men with acne are treated differently.
No. Salt substitutes are potassium chloride, and on spironolactone they can push potassium to dangerous levels. This catches people out precisely because it looks like a healthy choice.
Seek advice, and be prepared to pause it. Dehydration with spironolactone — particularly alongside an ACE inhibitor or an anti-inflammatory — is a recognised cause of avoidable kidney injury.
No. It is a diuretic that happens to block androgen receptors. Nothing to do with anabolic steroids.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
September 5, 2026
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