Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone

Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne

“…To date, there have been 4 small-scale clinical studies, 6-9 each fewer than 100 patients, that have measured serum potassium as a secondary outcome in patients taking spironolactone for acne. Three studies [6][7][8] yielded zero cases of hyperkalemia, and one study 9 showed a 13.7% rate of mild hyperkalemia, which was defined as a serum potassium measurement of 4.8 to 5.3 mEq/L (to convert potassium level to millimoles per liter, multiply by 1.0). Although the US Food and Drug Administration recommends frequent potassium monitoring in patients taking spironolactone, it is unclear whether this guideline is applicable to healthy patients taking spironolactone for acne.…”

Hirsutism, Acne, and Hair Loss: Management of Hyperandrogenic Cutaneous Manifestations of Polycystic Ovary Syndrome

“…A randomized, placebo-controlled double-blind trial evaluating the effectiveness of 200 mg spironolactone in acne compared with placebo concluded that spironolactone significantly reduced the number of inflamed lesions (64); however, a Cochrane review on the use of spironolactone in acne demonstrated that spironolactone was not effective in acne (27). Increased efficacy has been shown when spironolactone is added to combined oral contraceptives (65). Combined oral contraceptives used in conjunction with spironolactone results in a decrease in adverse effects such as dysmenorrhea, irregular menses and breast tenderness.…”

K+larity for Spironolactone

“…The newer generation of oral contraceptives containing the progestin drospirenone may theoretically increase the risk of hyperkalemia because they are also aldosterone antagonists. A study 4 looking at 27 patients prescribed both spironolactone and drospirenonecontaining oral contraceptives found no cases of hyperkalemia. Despite the intriguing results of this study 4 and others, their small sample size undermines the findings.…”

“…A study 4 looking at 27 patients prescribed both spironolactone and drospirenonecontaining oral contraceptives found no cases of hyperkalemia. Despite the intriguing results of this study 4 and others, their small sample size undermines the findings. Finally, Plovanich et al 7 provide us with a large, welldesigned study to assuage our fears of hyperkalemia.…”

“…One prospective study 3 of 64 women prescribed spironolactone found that in all, acne improved to some degree and over half of them were clear after spironolactone use. Another smaller study 4 followed 27 women with severe acne and found that 85% were entirely clear or had "excellent" results (>75% clearance) at 6 months. Because of the paucity of data, the efficacy of spironolactone for acne treatment is considered indeterminate by the Cochrane Database.…”