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Spironolactone has been widely used for over 50 years to treat fluid retention, mild high blood pressure, and a
few rare hormonal problems. In 1991, it was found to be highly effective in the treatment of certain hormonally-
related conditions of women. It cannot be used by most men because of side effects. What are “hormonally-related conditions”?
(1) Adult acne, (2) unwanted facial or body hair, and (3) “pattern”
hair loss of the scalp account for the vast majority. It is not uncommon for a woman to have two, or even all
three of these hormonal problems. They are almost never caused by abnormally high (or low) hormone
. In fact, hormone levels are usually normal. The problem is not with how much
hormone is made, but
how much hormone is used
at its destination, in this case your oil glands and hair follicles. If your oil glands
and/or hair follicles are too sensitive to normal fluctuations in your hormones, you “overreact” to those
fluctuations. The result is one or more of the problems listed. THREE IMPORTANT POINTS:
(1) Adult acne is NOT the same as teenage acne, and does not usually respond to teen acne treatments.
(2) “Pattern” hair loss is as common in women as baldness is in men. However, women do NOT go bald the way
men do; their hair just becomes thin in the same, central area of the scalp.
(3) The same hormones can cause hair LOSS on the scalp and hair GROWTH elsewhere. How could that be?
Because different hair follicles have different hormone receptors. Spironolactone does not change your hormone levels,
because as mentioned, hormone levels are not the
It works by preventing hormones from binding to your hair follicles and oil glands, blunting the
unwanted effect. Since your hormone levels remain the same, hormone-associated side effects are avoided. Of
course, no drug is completely free of side effects, but in our years of experience with this therapy, side effects
have been quite rare, and those we have seen have been quite mild. Less than 5% have noticed irregular or
frequent menstrual periods, which can be easily controlled with birth control pills or other methods. The
package insert lists breast tenderness and fatigue as other possible side effects. Very few of the several
thousand women we have treated with spironolactone has experienced either of these but they are possible.
The package insert also mentions reports of ”tumors in laboratory animals." This is outdated and misleading
information. Spironolactone has been prescribed for over 50 years, with many people taking it daily for years at
a time, yet there is no evidence that it has caused a single tumor in a human, even after many years of
continuous treatment. It is our opinion that any such risk is negligible. You must not get pregnant while taking
this drug or use it with the birth control pill Yasmin.
We recommend 2 forms of birth control if one is
If your blood pressure is normal, spironolactone will not affect it. However, if you are taking any other blood
pressure medicines, spironolactone may increase their effect. If you are being treated for high blood
pressure now, please tell us.
We may be able to substitute spironolactone for one or more of your present
medicines. Please ask your internist or family doctor about any potential problems with blood pressure
medicines (or any other medication you are taking), or ask him or her to call me to discuss it. Spironolactone
should NOT be taken with drugs known as ACE inhibitors.
Most people must take spironolactone regularly
for a minimum of 4 months to have a beneficial effect. If it
proves to be effective, you can count on remaining on spironolactone for 6 to 12 months. While taking
spironolactone, do not eat LARGE AMOUNTS of whole-grain cereals, bananas, potatoes, tomatoes, carrots,
celery, orange or grapefruit juices, clear broths, or salt substitutes such as "Nu-salt". REASONABLE AMOUNTS
of any of these foods is not usually a problem.
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