Spironolactone Side Effects for Acne: Common vs Serious

By Nicki Wilson in Spironolactone · Published June 26, 2026 · Updated October 15, 2026

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Quick answer: Without the pill, the American Academy of Dermatology (AAD) names painful periods and cramping, irregular periods, breast tenderness and breast enlargement as the most common spironolactone side effects. For women using it for acne, it also lists fatigue, headache and dizziness, which it says rarely cause a woman to stop. MedlinePlus says to call your doctor immediately for any serious symptom it lists, including nausea, confusion, or difficulty breathing or swallowing.

This page covers women who use spironolactone for acne. The AAD says spironolactone is not prescribed to treat acne in men because of side effects, so nothing here applies to men. The facts come from the AAD, MedlinePlus, the FDA-approved label, and published trials.

What are the common side effects of spironolactone for acne?

Spironolactone is used off-label to treat acne. The Aldactone label lists heart failure, hypertension as add-on therapy, edema and primary hyperaldosteronism as its indications, and acne is not among them. Most of what is known about acne use comes from dermatology sources and trials rather than the label.

The AAD’s hormonal therapy page says that, without a birth control pill, the most common side effects are painful periods and cramping, irregular periods, breast tenderness and breast enlargement. It adds that these effects may be lower when women also take the pill. Other possible side effects are fatigue, headache and dizziness. The AAD says these rarely cause a woman to stop taking the medication.

A 2025 practice review in Cutis names a similar group: lightheadedness, headache and menstrual irregularities. It says these tend to depend on the dose, and that combined oral contraceptives can prevent or treat them. For dose questions, see our guide to spironolactone dosage for acne.

Why does spironolactone make you pee more?

The AAD explains that spironolactone is a diuretic, so you’ll find yourself urinating more often. MedlinePlus describes the same action: the drug causes the kidneys to eliminate unneeded water and sodium into the urine while reducing the loss of potassium.

MedlinePlus says to call your doctor immediately for dry mouth, thirst, dizziness, unsteadiness, headache, or other signs of dehydration. It also warns that drinking alcohol with this medication may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position.

What do trials say about headaches?

The SAFA trial in the BMJ randomly assigned 410 participants to spironolactone or a control group. Adverse reactions were slightly more common in the spironolactone group, with more headaches reported (20% v 12%; p=0.02). The abstract states that no serious adverse reactions were reported.

Does spironolactone cause spotting, dry mouth or dry skin?

Searchers often ask about specific symptoms, and the sources answer some of them directly. For periods, MedlinePlus lists irregular menstrual periods as a side effect to report if it is severe or does not go away. It also lists vaginal bleeding in post-menopausal women. The sources we checked don’t name spotting between periods for women using the drug for acne. Call your doctor immediately for unusual bleeding or bruising, and tell your prescriber about any other bleeding pattern.

Tiredness and drowsiness are on the MedlinePlus list of side effects to report if they are severe or do not go away. Restlessness, vomiting, diarrhea, stomach pain or cramps, deepening of voice, and increased hair growth appear there too. Dry mouth appears in a different place. MedlinePlus says to call your doctor immediately for dry mouth, thirst, dizziness, unsteadiness, headache, or other signs of dehydration.

We found no mention of dry skin on the AAD page, the MedlinePlus page, or the label sections we read. That doesn’t prove it never happens. It means these sources don’t list it, so tell your prescriber if your skin changes after you start.

Which spironolactone side effects are serious?

MedlinePlus separates effects to report if they are severe or do not go away from symptoms that need a call right away. It says to call your doctor immediately for any one of its listed symptoms. Call for muscle weakness, pain, or cramps, or for pain, burning, numbness, or tingling in the hands or feet. Call for inability to move arms or legs, or changes in heartbeat, or confusion, or nausea.

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MedlinePlus lists more symptoms that need an immediate call. Call for fainting, or decreased urination, or extreme tiredness, or unusual bleeding or bruising, or yellowing of the skin or eyes. It also includes pain in the upper right part of the stomach, or loss of appetite, or flu-like symptoms, or vomiting blood, or blood in stools.

The list also names rash, or hives, or itching, or difficulty breathing or swallowing. It also says to call immediately for dry mouth, thirst, dizziness, unsteadiness, headache, or other signs of dehydration. Any one of these is a reason to call your doctor immediately. You don’t need several at once. If something feels like an emergency, call 911.

MedlinePlus lists “tiredness” among the effects to report if they are severe or do not go away. It lists “extreme tiredness” or “lack of energy” among the effects that need an immediate call. Call your doctor immediately for extreme tiredness or lack of energy, and tell your prescriber if tiredness is severe or does not go away.

How serious is the potassium risk for women taking it for acne?

The Aldactone label says the drug can cause hyperkalemia, meaning high blood potassium. It says the risk is increased by impaired renal function or by potassium supplements. It is also increased by potassium-containing salt substitutes or by drugs that raise potassium, such as ACE inhibitors and angiotensin receptor blockers. The label also lists hyperkalemia, Addison’s disease and concomitant eplerenone as contraindications.

The label advises monitoring serum potassium within 1 week of starting or changing the dose, and regularly after that. For acne specifically, a 2015 JAMA Dermatology study looked at 974 healthy young women. Of 1,802 potassium tests, 13 were abnormal, and the authors concluded that routine potassium monitoring is unnecessary for healthy women taking spironolactone for acne.

Those two sources point in different directions, so don’t decide on your own. The AAD says that before your dermatologist prescribes spironolactone, you will need some blood tests. Which tests you get, and when they repeat, is your prescriber’s call based on your health history and other medicines.

The AAD also advises that too much potassium can be dangerous, so skip the coconut water and supplements that contain potassium. MedlinePlus says to avoid potassium-containing salt substitutes. It also names ibuprofen, naproxen and acetylsalicylic acid among nonprescription products that may interact with spironolactone.

What should you do about side effects?

Tell your prescriber about every medicine and supplement you take before you start, including nonprescription ones. Then take spironolactone exactly as directed. MedlinePlus says not to take more or less than prescribed, and that your doctor may start a low dose and increase it gradually.

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The AAD says the dose is raised in steps, so you’ll need to see your dermatologist every 4 to 6 weeks when you start. Use those visits to report breast tenderness or period changes. Don’t wait for a visit to call about extreme tiredness, lack of energy, or anything else on the MedlinePlus serious list. It also says studies show that taking spironolactone at the same time every day can improve your results.

If you miss a dose, MedlinePlus says to take it as soon as you remember. If it’s almost time for the next dose, skip the missed one. Do not take a double dose to make up for a missed one. MedlinePlus warns that alcohol with this medication may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. Dizziness is on its list of dehydration signs that need an immediate call.

The AAD says painful periods and cramping, irregular periods, breast tenderness and breast enlargement may be decreased when women also take the pill. If those are the ones bothering you, ask your prescriber whether pairing the two makes sense. Our article on spironolactone and birth control for acne explains how the combination works.

Is spironolactone safe long term, and does it raise cancer risk?

When hormonal therapy helps to clear acne, the AAD says a patient may stay on it for a long time. It adds that long term hormonal therapy appears to be safe. That statement is the AAD’s summary, so ask your prescriber how often to recheck your health while you continue.

You may see a warning about tumors. MedlinePlus states that spironolactone has caused tumors in laboratory animals. The AAD explains that the breast cancer warning followed animal studies at very high doses. It says we really don’t have evidence that shows taking spironolactone increases the risk of getting breast cancer, and it calls the question still controversial.

A 2022 JAMA Dermatology meta-analysis found no statistically significant link between spironolactone use and breast cancer (risk ratio 1.04, 95% CI 0.86 to 1.22). It rated the certainty of evidence as very low. The mean ages in the pooled studies ran from 62.6 to 72.0 years, so they don’t directly describe young women taking it for acne.

We found no source in this review that describes what happens when you stop spironolactone, and none that lists withdrawal symptoms. Ask your prescriber before you stop, so you can plan what replaces it. Our article on how long spironolactone takes to work for acne covers the timing of results.

Who should avoid spironolactone or tell their doctor first?

The AAD says if you get pregnant while taking spironolactone, your baby can have serious birth defects. It adds that if you can get pregnant, you’ll need to use birth control while taking it. The label says to avoid spironolactone in pregnant women or advise a pregnant woman of the potential risk to a male fetus. MedlinePlus says to call your doctor if you become pregnant while taking it.

MedlinePlus asks you to tell your doctor if you have Addison’s disease, kidney disease, or liver disease, and if you are pregnant, plan to become pregnant, or are breastfeeding. It also asks you to report conditions that may cause high blood levels of potassium. The label says spironolactone is not present in breast milk. Limited data found the metabolite canrenone in low amounts expected to be clinically inconsequential. Long term effects on a breastfed infant are unknown.

The AAD notes that for women 35 or older, or women with a blood clot or stroke history, spironolactone may be prescribed without the pill. The Aldactone label also says safety and effectiveness in pediatric patients have not been established.

How does spironolactone compare with other acne options?

The 2024 AAD acne guideline gives a conditional recommendation to spironolactone, along with combined oral contraceptive pills. Strong recommendations go to benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline.

If side effects are a concern, our acne treatment comparison lays out the other prescription choices. Our spironolactone for acne overview is the broader starting point.

How does The Goal Is Clear handle spironolactone?

The Goal Is Clear’s FAQ says spironolactone is part of its treatment library for hormonal acne in adult patients who can use it. A board-certified dermatologist evaluates whether it is appropriate for your case during intake, factoring in history, other medications and lab needs. Care is not a guarantee of any prescription.

The how it works page says you take a quiz of about two minutes and upload a front photo and a side photo. A board-certified dermatologist then reviews your case within 24 hours. It adds that you can message your dermatologist through your dashboard about side-effect reports, dosage concerns and refill questions. A real person reads every message.

The pricing page says medication is billed separately by the pharmacy, as low as $0 for the prescription with insurance. The about page says BNG Health Services, LLC operates the brand and is not the prescribing physician.

Common questions about spironolactone side effects

Does spironolactone make you tired or dizzy? The AAD lists fatigue, headache and dizziness as other possible side effects that rarely cause a woman to stop. MedlinePlus says to call your doctor immediately for extreme tiredness or lack of energy, or for fainting, or for dry mouth, thirst, dizziness, unsteadiness, headache, or other signs of dehydration. Tell your prescriber if tiredness is severe or does not go away.

Does spironolactone cause irregular periods or spotting? The AAD names irregular periods and painful periods among the most common effects without the pill, and says the pill may reduce them. The sources we checked don’t name spotting. Call your doctor immediately for unusual bleeding or bruising, and tell your prescriber about any other bleeding pattern.

Does spironolactone make you pee more? Yes, the AAD says it is a diuretic, so you’ll find yourself urinating more often. MedlinePlus says to call your doctor immediately for decreased urination, or for dry mouth, thirst, dizziness, unsteadiness, headache, or other signs of dehydration.

Is spironolactone safe to take long term? The AAD says taking hormonal therapy long term appears to be safe. On breast cancer, it says we really don’t have evidence that shows spironolactone increases that risk, and it calls the question still controversial. A 2022 meta-analysis found no statistically significant association (risk ratio 1.04, 95% CI 0.86 to 1.22), with very low certainty, in studies with mean ages of 62.6 to 72.0 years. Your prescriber sets the plan and any lab checks.

When should you call your doctor about spironolactone? Call immediately for any symptom on the serious list, such as muscle weakness, pain, or cramps, or confusion, or nausea, or fainting, or decreased urination, as MedlinePlus lists. Also call if you become pregnant while taking it.

What is the takeaway on spironolactone side effects?

Without the pill, the AAD’s most common side effects are painful periods and cramping, irregular periods, breast tenderness and breast enlargement. It also lists fatigue, headache and dizziness, and it says spironolactone is a diuretic, so you urinate more often. On the MedlinePlus serious list, each item is its own reason to call your doctor immediately. Skip coconut water and supplements that contain potassium. MedlinePlus also says to avoid potassium-containing salt substitutes. If you can get pregnant, the AAD says you’ll need to use birth control while taking spironolactone. Ask your prescriber about any symptom that worries you.

If you’d like a board-certified dermatologist to look at your case, take the quiz and upload a front photo and a side photo. The how it works page says the quiz takes about two minutes.

This article is general information, not medical advice. A prescription is never guaranteed, and treatment decisions stay with the board-certified dermatologist who reviews your case. Spironolactone is used off-label for acne. Aldactone® is a registered trademark of its respective owner. The Goal Is Clear is operated by BNG Health Services, LLC, which is not the prescribing physician; board-certified dermatologists prescribe.

Sources

General information from published sources, not medical advice. Your dermatologist makes every treatment decision after reviewing your case. The Goal Is Clear is operated by BNG Health Services, LLC, which is not the prescribing physician.

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