Abstract:After 200 person-years of exposure to spironolactone and 506 person-years of followup over 8 years, no serious illnesses thought to be attributed to spironolactone were reported. The long-term use of spironolactone in the treatment of acne in women appears to be safe. Side effects, however, are common, although not usually a cause for stopping the drug.
“…The menstrual irregularity persisted in six of 34 subjects, and new cycle irregularity developed in five of 34 subjects. This drug is known to cause such irregularity in menstrual cycles (39,40,54,55), although the irregularity was not significant enough to cause drug withdrawal in this study. The hirsutism score decreased significantly by 6 months.…”
Section: Discussionmentioning
confidence: 56%
“…The drug has long been used in the treatment of hyperandrogenism (primarily hirsutism) and anovulation (35)(36)(37)(38)(39). Although the experience of spironolactone in PCOS is limited, it has a good safety record when used in smaller doses (37,40,41). To the best of our knowledge, there is no study that compares the efficacy of metformin with the antiandrogen spironolactone.…”
We compared the efficacy of spironolactone (50 mg/d) with metformin (1000 mg/d) after random allocation in 82 adolescent and young women with polycystic ovary syndrome (PCOS) on body mass index (BMI), waist-to-hip ratio, blood pressure, menstrual cyclicity, hirsutism, hormonal levels, glycemia, and insulin sensitivity at baseline and at the 3rd and 6th months of treatment. Sixty-nine women who completed the follow-up had a mean age of 22.6 +/- 5.0 yr and mean BMI of 26.8 +/- 4.0 kg/m2. The number of menstrual cycles in the spironolactone and metformin groups increased from 6.6 +/- 2.1 and 5.7 +/- 2.3 at baseline to 9.0 +/- 1.9 and 7.4 +/- 2.6 at 3rd month and to 10.2 +/- 1.9 and 9.1 +/- 2.0/ year at the 6th month (P = 0.0037), respectively. The hirsutism score decreased from 12.9 +/- 3.2 and 12.5 +/- 4.9 at baseline to 10.1 +/- 3.1 and 11.4 +/- 4.1 at the 3rd month and to 8.7 +/- 1.9 and 10.0 +/- 3.3 at the 6th month, respectively. Both groups showed improvement in glucose tolerance and insulin sensitivity, although the metformin effect was significant in the latter. Serum LH/FSH and testosterone decreased in both groups. BMI, waist-to-hip ratio, and blood pressure did not change with either drug. We conclude that both drugs are effective in the management of PCOS. Spironolactone appears better than metformin in the treatment of hirsutism, menstrual cycle frequency, and hormonal derangements and is associated with fewer adverse events.
“…The menstrual irregularity persisted in six of 34 subjects, and new cycle irregularity developed in five of 34 subjects. This drug is known to cause such irregularity in menstrual cycles (39,40,54,55), although the irregularity was not significant enough to cause drug withdrawal in this study. The hirsutism score decreased significantly by 6 months.…”
Section: Discussionmentioning
confidence: 56%
“…The drug has long been used in the treatment of hyperandrogenism (primarily hirsutism) and anovulation (35)(36)(37)(38)(39). Although the experience of spironolactone in PCOS is limited, it has a good safety record when used in smaller doses (37,40,41). To the best of our knowledge, there is no study that compares the efficacy of metformin with the antiandrogen spironolactone.…”
We compared the efficacy of spironolactone (50 mg/d) with metformin (1000 mg/d) after random allocation in 82 adolescent and young women with polycystic ovary syndrome (PCOS) on body mass index (BMI), waist-to-hip ratio, blood pressure, menstrual cyclicity, hirsutism, hormonal levels, glycemia, and insulin sensitivity at baseline and at the 3rd and 6th months of treatment. Sixty-nine women who completed the follow-up had a mean age of 22.6 +/- 5.0 yr and mean BMI of 26.8 +/- 4.0 kg/m2. The number of menstrual cycles in the spironolactone and metformin groups increased from 6.6 +/- 2.1 and 5.7 +/- 2.3 at baseline to 9.0 +/- 1.9 and 7.4 +/- 2.6 at 3rd month and to 10.2 +/- 1.9 and 9.1 +/- 2.0/ year at the 6th month (P = 0.0037), respectively. The hirsutism score decreased from 12.9 +/- 3.2 and 12.5 +/- 4.9 at baseline to 10.1 +/- 3.1 and 11.4 +/- 4.1 at the 3rd month and to 8.7 +/- 1.9 and 10.0 +/- 3.3 at the 6th month, respectively. Both groups showed improvement in glucose tolerance and insulin sensitivity, although the metformin effect was significant in the latter. Serum LH/FSH and testosterone decreased in both groups. BMI, waist-to-hip ratio, and blood pressure did not change with either drug. We conclude that both drugs are effective in the management of PCOS. Spironolactone appears better than metformin in the treatment of hirsutism, menstrual cycle frequency, and hormonal derangements and is associated with fewer adverse events.
“…1. We identified 10 RCTs [30–39], 18 case series in which acne status or severity was an outcome [40–52, 54, 55, 57, 59, 60], and three [53, 56, 58] articles reporting on the side effects of spironolactone in female patients with acne, but which contained no data on clinical outcomes. Eleven studies [61–71] were out of scope and five were unobtainable [72–76] (see Electronic Supplementary Table 2).Fig.…”
BackgroundThe management of acne in adult females is problematic, with many having a history of treatment failure and some having a predisposition to androgen excess. Alternatives to oral antibiotics and combined oral contraceptives (COCs) are required.ObjectiveOur aim was to conduct a hybrid systematic review of the evidence for benefits and potential harms of oral spironolactone in the management of acne in adult females.MethodsThe review was conducted according to a previously published protocol. Three reviewers independently selected relevant studies from the search results, extracted data, assessed the risk of bias, and rated the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsTen randomized controlled trials (RCTs) and 21 case series were retrieved. All trials were assessed as being at a ‘high risk’ of bias, and the quality of evidence was rated as low or very low for all outcomes. Apart from one crossover trial that demonstrated statistical superiority of a 200 mg daily dose versus inflamed lesions compared with placebo, data from the remaining trials were unhelpful in establishing the degree of efficacy of lower doses versus active comparators or placebo. Menstrual side effects were significantly more common with the 200 mg dose; frequency could be significantly reduced by concomitant use of a COC. Pooling of results for serum potassium supported the recent recommendation that routine monitoring is not required in this patient population.ConclusionThis systematic review of RCTs and case series identified evidence of limited quality to underpin the expert endorsement of spironolactone at the doses typically used (≤100 mg/day) in everyday clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1007/s40257-016-0245-x) contains supplementary material, which is available to authorized users.
“…Dosis de 3 mg de drosperinona equivalen aproximadamente a 1 mg de ACP y 25 mg de espironalactona 67 . Un estudio de seguimiento a 8 años sobre la seguridad de la espironolactona no reportó complicaciones graves: inusuales efectos adversos incluían la hiperkalemia, siendo mayor el riesgo en enfermedad hepática, renal y suprarrenal 68 . Otros efectos adversos menos frecuentes incluyen irregularidad menstrual (minimizado con el uso concomitante de ACOP), sensibilidad mamaria y cefalea 36 .…”
Section: Medicamentos Antiandrógenos: Espironolactona Finasteride Y unclassified
“…Otros efectos adversos menos frecuentes incluyen irregularidad menstrual (minimizado con el uso concomitante de ACOP), sensibilidad mamaria y cefalea 36 . Un reciente estudio de cohorte no encontró un aumento del riesgo de cáncer de mama con espironolactona 68 . El finasteride es un inhibidor de la progesterona derivado 5α-reductasa que bloquea la conversión de la testosterona al andrógeno dihidrotestosterona 19 , siendo la dosis más utilizada de 5 mg/día 69 .…”
Section: Medicamentos Antiandrógenos: Espironolactona Finasteride Y unclassified
IntroducciónEl Síndrome de Ovario Poliquístico (SOP) es uno de los trastornos endocrinos más frecuentes que afectan a las mujeres en edad reproductiva, cuya prevalencia ha sido estimada entre 8%-18%1 . Las mujeres con SOP tienen asociada una amplia gama de trastornos reproductivos y metabólicos, como diabetes mellitus tipo II, obesidad, dislipidemia, resistencia a la insulina, hipertensión arterial y enfermedad cardiovascular 2 . En la actualidad, constituye la primera causa de infertilidad asociada a anovulación en países desarrollados 3 . Las pacientes con SOP tienen un riesgo aumentado de trastornos psiquiátricos y mayor deterioro de su calidad de vida 4 .
DiagnósticoLos criterios del Instituto Nacional de Salud de Estados Unidos del año 1990 definieron el SOP por la presencia de oligo o anovulación y signos clínicos o bioquímicos de hiperandrogenismo 5 . Posteriormente, el año 2003, los criterios de Rotterdam ampliaron la definición a la presencia de 2 de 3 de las siguientes características: oligo o anovulación, signos clínicos o bioquímicos de hiperandrogenismo y ovarios poliquísticos en la ecografía. Es importante enfatizar que ambas definiciones requieren la exclusión de otras causas de anovulación e hiperandrogenismo, como hiperplasia suprarrenal congénita, síndrome de Cushing y tumores secretores de andrógenos 6 . La Asociación Americana de Endocrinología recomienda tomar niveles de testosterona total y testosterona libre, dehidroepiandrostenediona sulfato, prolactina, LH, FSH y 17 hidroxiprogesterona durante los primeros 7 días del ciclo menstrual 7 . Hasta dos tercios de las mujeres con SOP tendrán elevados los niveles de testosterona, que están asociados con mayor morbilidad metabólica y reproductiva 8 . Se recomienda evaluar intolerancia a la glucosa y dislipidemia en todas las pacientes con SOP, especialmente en las pacientes obesas 7,6 . Otros análisis incluyen hormona tiroestimulante, T4L, hormona transportadora de esteroides sexuales (SHBG) y ecografía abdominal.
Resumen
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