Tolerance of spironolactone

Abstract

A survey of 54 patients taking spironolactone for hirsutes or acne showed that side-effects occurred in 91%; in 80% of patients, these were related to the anti-androgenic mechanism of the drug (menstrual disturbances, and breast enlargement and tenderness). The concomitant use of a contraceptive pill gave a lower incidence of menstrual abnormalities. Only seven patients (13%) had to stop the drug. In a further eight patients, a reduction in dose to between 125 and 175 mg daily achieved a compromise of controlling the disease and the side-effects. Side-effects tended to occur early and so regular review during the initial 3 months of treatment is advised. Two patients in our study developed 'chloasma'--a previously unreported complication of spironolactone. This was the only side-effect which occurred late in treatment.

PIP: 54 patients, aged 21-51, treated with 200 mg/day spironolactone for hirsutism and/or acne, were studied to determine the kinds and severity of side effects and the ameliorating effect of oral contraceptive on the side effects. Spironolactone is used to treat hirsutism and acne because of its antiandrogenic effects, brought about through suppression of gonadal androgen production by blocking cytochrome P450 and by competitive inhibition of dihydrotestosterone at the skin androgen receptor. 24 of the patients were treated for hirsutism, 21 for acne, 8 for both, and 1 for seborrhea. Side effects were menstrual disturbances (72%), dry skin (39%), and a chloasma-like pigmentation disorder of the face (2 patients). Among the 23 patients taking an oral contraceptive, gynecologic side effects of spironolactone were diminished. The acne patients improved within 3 months of treatment, but the hirsutism patients did not improve until after 4 months. Pregnancy is contraindicated in patients taking spironolactone because of the risk of feminization of a male fetus.