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I am currently on Spironolactone 50mg OD for treatment of acne (mainly for small bumps on my face) I understand that Spironolactone is a Potassium-sparing diuretic and that while on potassium-sparing diuretics, potassium supplements should not be taken (adapted from BNF) so i was wondering if i have to be mindful of my potassium intake from food sources and if yes, what are the limits like? I was not told by my doctor about anything except for the fact that it is very safe (as compared to roaccutane)
Whenever I try to go off the Spironolactone, the bumps would return and i was wondering if there are any permanent solution to this problem? I have discussed it with my aesthetic doctor and he mentioned that if i stop the medications, the problem will recur. Prior to starting Spironolactone, i have tried applying tretinoin 0.025% but the effect were not as good. I still have some tretinoin on hand do you think i can apply the tretinoin while on spironolactone?
Thank you 🙂
Dear ilovetoffeenutfrappe (sounds terribly sweet!),
Permanent solution? Roaccutane. Personally, I don’t subscribe to the scary effects that the internet and some doctors make it out as having, because there have been many good studies that show it is a very safe drug, if prescribed and managed appropriately.
I have no qualms with taking it myself, or recommending it to friends and family – even for mild to moderate acne as a permanent fix, if other treatment options do not seem to be working.
You can read this previous post about accutane in Singapore, and my personal experience with it.
Having said that, spironolactone is also a very good choice in acne treatment for females, especially if you find that your acne is hormonal (happens cyclically, say around your periods), and occurs mostly at your jaw/chin/neck.
Here are some quick facts about spironolactone, in answer to your questions:
- Spironolactone takes at least 3 months to work
- Only used for females, as it blocks male hormones (testosterone)
- Don’t get pregnant while on spironolactone as it can cause feminization of a male baby
- You may pee a little bit more (as you rightfully pointed out that it is a diuretic)
- Yes, you can’t eat too many bananas/drink too much coconut water as spironolactone tends to increase your potassium levels, which can cause heart rhythm problems if your potassium get too high (rare, as I assume you are young, and your kidney does a very good job of regulating the levels).
Checking your potassium levels at the start, with a repeat a couple of weeks later (to ensure that your kidney is regulating your potassium levels well), or as otherwise advised by your doctor is ideal.
I’d say don’t stress too much about foods containing potassium, as long as you aren’t overeating. Evidence suggests that in the young and those without underlying kidney problems, (and who are not on any other potassium-sparing hypertensive medications), the likelihood of encountering problems with high potassium levels is extremely unlikely.
Overall, yes, spironolactone is indeed a very safe drug.
I still have some tretinoin on hand do you think I can apply the tretinoin while on spironolactone?
Yes, I would almost always recommend patients to use a topical retinoid (like tretinoin) for the management of acne, as long as he/she is not concurrently on oral isotretinoin as well.
Combination therapy in combating acne is far superior, and studies have also shown that taking spironolactone and applying topical tretinoin to be much more effective than using either one alone in the control of acne.
Besides being an extremely effective anti-acne treatment, topical retinoids are also a very good anti-aging/wrinkles agent, and many dermatologists I know with amazing skin use it as part of their skin care regime. What’s not to like???
Just take care to apply it only at night (it makes your skin photosensitive!), and if you find that it dries out your skin too much, you can apply it on alternate days.
Dear Frappe (rather long name above),
Dr Ethan has made a wonderful point that Isotretinoin is a great choice if you are not planning any pregnancy in the near future.
Spironolactone is prescribed by me to patients when they are fearful of Isotretinoin (blaming the fear-mongers for this), and have acne which is associated with their menstrual cycles.
It’s generally safe in all the patients I have given it to. One patient has noted a slight shorter period cycle, albeit with improved skin so she’s happy 🙂
I would suggest you sit down and discuss with your doctor, instead of merely relying on Dr Google. We can drown from drinking 16 litres of water in 24 hours, and an overdose of Panadol can also cause liver failure.
So I’d say, don’t scare ourselves, as long as what we do is measured and cautious. Good luck!
Dr Winston Lee
South Bridge Aesthetics Clinic