Can I Buy Spironolactone Over The Counter

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of spironolactone in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution for patients receiving spironolactone.

Do not take other medicines unless they have been discussed with your doctor. This especially includes potassium supplements or salt substitutes containing potassium, certain diuretics (eg, amiloride, triamterene (Dyazide, Dyrenium, Maxzide, Midamor, Moduretic), or other products containing spironolactone (Aldactazide).

The antiandrogenic effects of spironolactone were first discovered when it was being used to treat hypertension in women with concurrent polycystic ovary syndrome (PCOS) and hirsutism.3 It has been used frequently in the dermatology clinic for women with hormonal-pattern AV, defined clinically as primarily inflammatory papules, many deep-seated and tender, that are located predominantly on the lower half of the face and anterior-lateral neck region. Currently, dermatologists prescribe oral spironolactone for off-label use, with AV being a non-United States Food and Drug Administration (FDA)-approved indication. The rationale for using spironolactone in the treatment of AV is that is has been shown to inhibit sebaceous gland activity. As increased size of sebaceous glands and increased sebum secretion are essential components in the development of AV lesions, inhibition of sebaceous gland functions leads to reduced formation of acne lesions.4 Studies have shown that spironolactone decreases androgen-stimulated sebocyte proliferation in vitro and inhibits sebaceous activity in Syrian hamsters in a dose-dependent fashion.4,5 Clinically, women with high androgenic states will also have increased sebum production due to an increase in circulating androgens, with development or worsening of AV a common sequelae of androgen excess. However, the majority of women who present with late-onset or post-teen persistent AV, even with classic hormonal-pattern AV, do not exhibit an increase in serum androgen levels. Regardless, this latter subset still benefits substantially from oral spironolactone in most cases, with the onset of therapeutic effect often noted within 4 to 8 weeks.

The two most common causes of excess circulating androgen levels in women are PCOS and congenital adrenal hyperplasia (CAH).1 The overall prevalence of PCOS is estimated to be 3 to 6 percent, with approximately 23 to 35 percent of women with PCOS exhibiting AV clinically.17 In turn, it has been suggested that severe AV in women is highly suggestive of underlying PCOS, with approximately 83 percent of women with severe AV found to have PCOS in one report.17 These patients present initially with infertility or menstrual irregularities caused by anovulation. It is prudent for clinicians to evaluate the patient for a family history of PCOS, hirsutism, diabetes, and infertility. Adrenal enzyme deficiencies, such as 21-hydroxylase deficiency (late-onset congenital adrenal hyperplasia), although rare, are important to consider in refractory cases. These adrenal deficiency syndromes are seen with a higher prevalence in those of Eastern European Jewish descent when evaluating patients with adult AV.18 Anti-androgen therapy may be helpful in female patients with severe seborrhea, acne, hirsutism, and alopecia, or the so-called seborrhea/acne/hirsutism/alopecia syndrome (SAHA syndrome); late-onset AV (acne tarda); and hyperandrogenism of ovarian or adrenal origin.

There is also data to suggest that spironolactone not only improves facial AV, but is efficacious in improving truncal AV as well. One study of adult women on 75 to 150mg of spironolactone daily, over a mean treatment duration of 17 months, reported at least a 50-percent improvement of facial AV and truncal AV in 37.5 percent of the cases.23

Additional studies have shown spironolactone to be useful for AV in adult women. In a 12-week, randomized, placebo-controlled trial of male and female patients (N=36) with severe AV treated with 50 to 200mg of spironolactone daily, the greatest therapeutic outcomes were noted in 11 of 15 patients treated with 100 to 200mg, both objectively and subjectively, although no statistical analysis was reported.23 This is likely due to the small number of subjects included in the trial, especially after breaking down specific dosage groups. Another randomized, placebo-controlled trial of 21 women on 200mg daily of spironolactone for 12 weeks revealed significant improvement of AV evaluated subjectively (p

Since spironolactone is associated with risk of hyperkalemia, serum potassium monitoring may be considered with use of a DROSP-containing OC, especially when used in combination with spironolactone. However, although hyperkalemia is a potential concern, there is some data to suggest that using a DROSP-containing OC in combination with spironolactone is safe and effective. In one study of 27 women with severe-nodulocystic facial AV on EE 30µg and DROSP 3mg (Yasmin) plus spironolactone 100mg daily, reported side effects were not significant enough to cause cessation of treatment.38 Baseline serum potassium levels were measured and a second level was obtained 4 to 6 weeks later during therapy. None of the patients demonstrated elevated serum potassium levels. No patients discontinued therapy from adverse events and 85 percent of women experienced excellent improvement or were entirely clear after six months of the combination treatment.38

It is important to establish prior to initiating therapy with spironolactone that there is no history of renal disease, that the patient does not utilize salt substitutes (many contain potassium in place of sodium), and is not utilizing potassium supplements, other potassium-sparing diuretics (i.e., amiloride, triamterene), ACE inhibitors, or ARBs. Many clinicians do not obtain baseline laboratory testing, including serum electrolytes, in young healthy female patients with AV with no medical problems who are not on any medication that may put them at risk for hyperkalemia when combined with spironolactone. Nevertheless, obtaining a complete blood cell count and chemical profile (including serum electrolytes) is a prudent approach to establish a baseline and to exclude some potential unexpected concerns in the given patient, such as pre-existing hyperkalemia or impaired renal function. After starting spironolactone for AV, clinical monitoring every 4 to 6 weeks, with adjustment of dose based on clinical response and assessment of side effects, is recommended until stabilization occurs.35 Laboratory monitoring in general is not essential overall, but some clinicians choose to test for hyperkalemia during the initial three months of treatment and periodically thereafter (Table 4).35 Serum potassium level monitoring and other testing, if applicable, can always be incorporated based on clinical judgment for individual patients who exhibit certain risk factors, such as older individuals and those on OCs containing DROSP.34 It is uncommon to experience hyperkalemia from spironolactone in healthy individuals; however, new-onset muscle cramps or weakness can be important clinical clues.

Hyperkalemia is a commonly feared potential consequence of spironolactone therapy, although it is generally not a relevant concern in a healthy population of young women. Spironolactone is best avoided in patients with renal insufficiency, as this increases the risk of hyperkalemia. In patients with heart failure, the incidence of hyperkalemia may be increased as was shown in one study of patients with left ventricular systolic dysfunction who were on spironolactone therapy (N=134).56 Some patients had to discontinue therapy with spironolactone because of hyperkalemia (17.1%), renal function deterioration (14.5%), gynecomastia (5.3%), and other side effects (1.3%).56 This study suggests that serum potassium levels should be closely monitored along with serum creatinine and blood urea nitrogen (BUN) levels in this subset of patients. Studies from the Randomized Aldactone Evaluation Study (RALES) showed that daily doses of 12.5 to 25mg of spironolactone coadministered with ACE inhibitors, loop diuretics, and digoxin were safe provided that serum potassium levels were monitored carefully.57

Currently, there are no reports linking spironolactone with human congenital defects, and no well-controlled, prospective studies evaluating spironolactone exposures in pregnant women.64 However, in a surveillance study conducted between 1985 and 1992 involving 229,101 completed pregnancies, 31 newborns had been exposed to spironolactone during the first trimester of pregnancy. Two major birth defects were noted with one expected for other reasons and the other an oral cleft defect; no other anomalies in five major categories were noted among these 31 newborns, including hypospadias, cardiovascular defects, spina bifida, polydactyly, and limb reduction defects.64 Importantly, there is at least one case report of two appropriately developed, healthy males after exposure to high-dose treatment with spironolactone (200-400 daily) and potassium supplementation for maternal Bartter syndrome.65

You will need blood tests while you are taking spironolactone to check the amount of potassium in your blood, especially when you first start spironolactone, during dose changes or if you become unwell with any illness that affects your kidneys. Try to avoid things with a high potassium content, such as salt substitutes or low-sodium salt. This is so the level of potassium in your body does not become too high. Contact your doctor immediately or phone Healthline 0800 611 116 if you develop signs of too much potassium in your blood, such as irregular heart beat (heart beat feels fluttery), tingling feelings, paralysis (difficulty moving) or difficulty breathing. 781b155fdc