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No. 061medication

Spironolactone

Spironolactone is a medication that is FDA-approved, prescription only.

Also known as Aldactone, CaroSpir, spiro

Spironolactone blocks the hormone aldosterone, which is why it is approved for heart failure, high blood pressure and fluid retention. It also blocks androgen effects on the skin and hair follicles, so dermatologists prescribe it off-label for adult women with hormonal acne and female pattern hair loss.

Unbranded dropper bottle and cream jars arranged on a bright white-tiled bathroom shelf.
FDA-approved · Prescription

Is Spironolactone FDA-approved?

Approved by the FDA. A licensed clinician has to decide it is right for you and prescribe it. FDA-approved since 1960, prescription only, for heart failure, high blood pressure, edema and primary hyperaldosteronism. Acne and hair loss are off-label uses. The old boxed warning about tumors in rats was removed from the label in 2018.

As of October 7, 2026.

Key takeaways

  • Spironolactone is FDA-approved for heart failure, high blood pressure, fluid retention and primary hyperaldosteronism.
  • Dermatologists prescribe it off-label for hormonal acne and female pattern hair loss in women; the AAD acne guideline gives it a conditional recommendation.
  • In the SAFA trial of adult women with acne, benefits were clearer at 24 weeks than at 12.
  • It is not used in pregnancy, and it is not prescribed for acne in men because of feminizing side effects.

How does Spironolactone work?

Spironolactone blocks the receptor for aldosterone, a hormone that makes the kidneys hold on to salt and water. Blocking it lowers blood pressure and fluid build-up, while letting the body keep more potassium.

It also blocks androgen receptors. In the skin, androgens drive oil production and acne; in genetically sensitive hair follicles, they drive thinning. Blocking that signal is why it can help some women with hormonal acne or pattern hair loss.

Unbranded amber dropper bottles and a wooden soap dish beside a bright white sink.
A clear pill bottle with a blank white label and tan capsules stands against a bright sage-green background.
Back of a head with hair styled in a loose messy bun against a bright, airy pink-white background; face not visible.

Is spironolactone FDA-approved for acne or hair loss?

No. The Aldactone label covers heart failure, high blood pressure, edema from cirrhosis or kidney disease, and primary hyperaldosteronism. Acne, hair loss and excess hair growth are off-label uses. DailyMed: Aldactone (spironolactone) prescribing information

Older labels opened with a boxed warning about tumors in long-term rat studies. The March 2018 version of the label no longer has a boxed warning; the rat data now appear only in the nonclinical toxicology section. DailyMed archive: Aldactone label, March 2018 (boxed warning removed)

Do you need potassium blood tests on spironolactone?

The label warns about high potassium and recommends checking it soon after starting and periodically, especially with kidney problems or other potassium-raising drugs. DailyMed: Aldactone (spironolactone) prescribing information

For acne, a 2015 JAMA Dermatology study of 974 healthy young women found high potassium no more often than the baseline rate and concluded routine monitoring was unnecessary in that group. Your clinician decides based on your age, kidneys and medicines. Plovanich et al.: Potassium monitoring in healthy young women taking spironolactone for acne (JAMA Dermatol 2015)

What does the evidence say about Spironolactone?

Moderate human evidence

Strong evidence for its approved heart and blood pressure uses. For acne in adult women, the SAFA randomized trial found benefit by 24 weeks; evidence for hair loss is mainly smaller studies and clinical experience.

What to expect

What trials and prescribing information measured over time. Everyone responds differently.

  1. A few weeks

    The AAD says some people see fewer breakouts within a few weeks.

  2. 12 to 24 weeks

    In the SAFA trial, acne benefits were modest at 12 weeks and clearer at 24 weeks.

  3. 6 to 12 months

    For female pattern hair loss, the AAD says it takes 6 to 12 months to tell whether it works.

What do clinicians say about Spironolactone?

Dermatologists see spironolactone as a useful non-antibiotic option for adult women with hormonal acne and as a long-standing treatment for female pattern hair loss, used off-label with contraception counseling.

Summaries of published guidelines, drug labels, regulators and reviews, each attributed to its source. DiscoverMedica does not employ clinicians.

Is Spironolactone right for you, and who should avoid it?

Often considered for

  • Adults with heart failure with reduced ejection fraction, high blood pressure, fluid retention or primary hyperaldosteronism (approved uses)
  • Adult women with hormonal acne who want a non-antibiotic option (off-label)
  • Women with female pattern hair loss (off-label)

Not a fit, or needs extra care

  • Pregnancy, or trying to become pregnant
  • High blood potassium, significant kidney disease or Addison disease
  • People taking potassium supplements, salt substitutes, or other potassium-raising drugs without their prescriber planning for it
  • Men seeking acne treatment, because of breast enlargement and other feminizing effects

Only a licensed clinician who knows your history can decide whether it is right for you.

What are the risks and side effects of Spironolactone?

  • It can raise blood potassium, especially with kidney problems, potassium supplements, salt substitutes, ACE inhibitors or ARBs.
  • Common effects include breast tenderness, irregular or painful periods, fatigue, headache and dizziness.
  • It can harm the development of a male fetus, so it is not used in pregnancy and birth control matters.
  • In men it can cause breast enlargement, which is why it is not used for acne in men.

What should you ask a clinician about Spironolactone?

  • Do I need potassium blood tests, given my age and kidney health?
  • What birth control should I use while taking it?
  • How long should I try it before judging whether it helps my acne or hair?

These save with the compound when you add it to My Journal, so they’re on the printout for your visit.

How do people get Spironolactone through telehealth?

A close-up of a hand typing on a dark laptop keyboard on a white desk; no face, no screen visible, softly lit.

  1. For acne or hair loss, a dermatologist or telehealth skin service reviews your history and photos and asks about pregnancy plans and kidney health.

  2. If prescribed, generic spironolactone is filled at a local or mail-order pharmacy, often with contraception counseling.

  3. Some clinicians check potassium or kidney function first, depending on your age and medicines.

  4. Follow-ups check side effects and progress over several months.

What programs often include

  • Clinician review and prescription
  • Follow-up messaging or visits
  • Contraception counseling for people who could become pregnant

How some providers do it

  • NurxAcne treatment that can include spironolactone after an online consultation, with a separate consultation fee.
  • Amazon PharmacyFills generic spironolactone (generic Aldactone) from your own prescriber.

From each provider’s own site, checked October 7, 2026. Programs change, so confirm the details before you sign up.

Where can I get Spironolactone?

5 providers list Spironolactone on DiscoverMedica, lowest listed price first.

NurxSpironolactone for acne (plus $40 consultation fee)
Lowest listed priceClinician consult required
$45 per 3-month supplylisted price†
Start at Nurx
Lemonaid HealthSpironolactone for acne
Clinician consult required
$90/3 months of medslisted price†
Start at Lemonaid Health
Amazon PharmacySpironolactone tablet (generic Aldactone)
Clinician consult required
see site
Start at Amazon Pharmacy
Mark Cuban Cost Plus DrugsSpironolactone tablet (generic Aldactone)
Clinician consult required
see site
Start at Mark Cuban Cost Plus Drugs
Walmart PharmacySpironolactone tablet (generic), low-cost program
Clinician consult required
see site
Start at Walmart Pharmacy

† Prices as listed by the provider when we checked; they change.

Spironolactone: questions, answered

What are the side effects of spironolactone?

The AAD lists painful or irregular periods, breast tenderness or enlargement, fatigue, headache and dizziness as common side effects in women treated for acne. The Aldactone label names gynecomastia as the most common reaction overall and warns about high potassium, especially with kidney problems or potassium-raising medicines. It can harm a male fetus, so it is not used in pregnancy.

Does spironolactone work for acne?

For adult women, yes, in many cases. In the 2023 SAFA trial of 410 women, 82% reported improvement at 24 weeks compared with 63% on placebo, with smaller differences at 12 weeks. The AAD acne guideline gives it a conditional recommendation. It is used off-label and is not prescribed for acne in men.

Does spironolactone help with hair loss?

The American Academy of Dermatology says spironolactone has been prescribed for decades for female pattern hair loss and can help restore growth and slow further loss in some women. Results take 6 to 12 months to judge. It is off-label for this use and not an option during pregnancy or when planning one.

Is spironolactone safe long term?

It has been FDA-approved since 1960 and is widely used for years at a time for blood pressure and heart failure. The old boxed warning about rat tumors was removed in the 2018 label. Long-term use still means watching potassium and kidney function when relevant, and preventing pregnancy, so periodic review with your clinician matters.

Can men take spironolactone?

Men take it for its approved heart, blood pressure and fluid uses. For acne, the AAD says it is not prescribed to men because of side effects such as breast enlargement and other feminizing effects. The label lists gynecomastia as the most common adverse reaction, and it can also lower libido and cause erection problems.

Important safety information

Key risks

  • It can raise blood potassium, especially with kidney problems, potassium supplements, salt substitutes, ACE inhibitors or ARBs.
  • Common effects include breast tenderness, irregular or painful periods, fatigue, headache and dizziness.
  • It can harm the development of a male fetus, so it is not used in pregnancy and birth control matters.
  • In men it can cause breast enlargement, which is why it is not used for acne in men.

Talk to a clinician first, or avoid it, if

  • Pregnancy, or trying to become pregnant
  • High blood potassium, significant kidney disease or Addison disease
  • People taking potassium supplements, salt substitutes, or other potassium-raising drugs without their prescriber planning for it
  • Men seeking acne treatment, because of breast enlargement and other feminizing effects

This is not a complete list of risks. Read the full prescribing information and any Medication Guide, and talk to a licensed clinician or pharmacist about your own situation. If you have a severe reaction, call 911. You can report side effects to the FDA through MedWatch at 1-800-FDA-1088.

Sources

Also checked for this guide

Guide reviewed October 7, 2026.

Educational information only, not medical advice. It does not replace a conversation with a licensed clinician.

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