What does the research show about spironolactone?

Spironolactone

One trial found spironolactone lowered deaths in severe heart failure from 46% to 35%, and trials found it lowered resistant high blood pressure. In women it improved acne and hirsutism against placebo. Hair loss data are uncontrolled. It raises blood potassium, most in heart failure, and caused breast enlargement or pain in 10% of men.

Add to Bio HackChecked 2026-11-13

Status: Prescription drug in the US, FDA-approved for heart failure with reduced ejection fraction, as add-on treatment for high blood pressure, for edema from cirrhosis or nephrotic syndrome, and for primary hyperaldosteronism. It is not FDA-approved for acne, hair loss or hirsutism.
Also called: Aldactone, CaroSpir, mineralocorticoid receptor antagonist, aldosterone antagonist, potassium-sparing diuretic, MRA
Taken for: heart failure, resistant high blood pressure, fluid retention, hormonal acne in women, female pattern hair loss, unwanted facial and body hair, lowering testosterone in feminizing hormone therapy, PCOS

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help6

ModerateShown to lower deaths in severe heart failure, 35% against 46% on placebo over 2 years, and heart failure hospital stays by 35%.
ModerateShown to lower home systolic pressure by 8.7 mm Hg more than placebo when added to three drugs in resistant high blood pressure.
ModerateShown to improve acne in adult women against placebo, with 82% against 63% reporting improvement at 24 weeks in one trial.Very common
ModerateShown to lower hirsutism scores in women by about 7.7 points on the Ferriman-Gallwey scale against placebo, in small trials rated low quality.
LimitedLimited evidence: in one clinic study, testosterone was lower with spironolactone plus estradiol than with estradiol alone, and lower still with cyproterone.
LimitedSmall open-label trials in women with PCOS found hirsutism scores fell more with spironolactone than with metformin, and more with the two combined than with either alone.

Reported risks10

ModerateShown to about double high blood potassium in heart failure, 18.7% against 9.1% on placebo in one trial. Rates in healthy young women matched baseline.Very common
LimitedLimited evidence: menstrual disorders were reported by about 12% of women taking spironolactone for hair loss, in studies with no placebo group.Very common
LimitedOne trial found more headaches on spironolactone than placebo in women treated for acne, 20% against 12%, with no serious adverse reactions.Very common
ModerateShown to cause breast enlargement or breast pain in 10% of men on spironolactone against 1% on placebo in one heart failure trial.Common
LimitedLinked to more hospital stays for high potassium, rising from 2.4 to 11.0 per 1,000 older heart failure patients on ACE inhibitors as spironolactone use grew.Common
ModerateShown to raise creatinine in heart failure. The label warns of dehydration, low blood pressure and worsening kidney function from excess fluid loss.How often is not known
LimitedThe label warns that spironolactone may affect sex development of a male fetus, based on rat studies. Limited case reports did not show birth defects.How often is not known
LimitedLinked to hospital admission for high potassium, about 12 times as likely as after amoxicillin, and to sudden death in older adults on spironolactone.How often is not known
LimitedThe label warns that potassium supplements, potassium salt substitutes, NSAIDs and heparin can raise potassium further, and that NSAIDs can blunt the diuretic effect.How often is not known
LimitedThe label warns that spironolactone lowers the kidney's clearance of lithium, raising the risk of lithium toxicity, and interferes with some digoxin blood tests.How often is not known

What people take it for, and what was found

Shown to help6

Moderate

Heart failure with reduced pumping function

Shown to lower deaths in severe heart failure, 35% against 46% on placebo over 2 years, and heart failure hospital stays by 35%.

The numbers and sources

Effect: In the RALES trial, 35% died on spironolactone and 46% on placebo over a mean 24 months (RR 0.70, 95% CI 0.60 to 0.82), and hospitalization for worsening heart failure was 35% less frequent (RR 0.65, 95% CI 0.54 to 0.77) [1]. Individual data from four trials of this drug class found a lower risk of cardiovascular death or heart failure hospitalization (HR 0.77, 95% CI 0.72 to 0.83), with a larger effect in the two trials in reduced ejection fraction (HR 0.66, 95% CI 0.59 to 0.73), where all-cause death also fell (HR 0.73, 95% CI 0.65 to 0.83) [2].
Population: 1,663 people with severe heart failure and ejection fraction of 35% or less, on an ACE inhibitor and a loop diuretic [1]; 13,846 people in four trials, one of spironolactone and one of eplerenone in reduced ejection fraction [2].
Sources: [1], [2]
Caveats: The trial was stopped early for benefit, at a mean dose of 26 mg a day [3]. The pooled analysis combines spironolactone with eplerenone and finerenone [2].

Moderate

Resistant high blood pressure

Shown to lower home systolic pressure by 8.7 mm Hg more than placebo when added to three drugs in resistant high blood pressure.

The numbers and sources

Effect: In a crossover trial in people whose blood pressure stayed high on three drugs, spironolactone lowered home systolic pressure by 8.70 mm Hg more than placebo (95% CI 7.69 to 9.72), 4.03 mm Hg more than doxazosin and 4.48 mm Hg more than bisoprolol [5]. A meta-analysis of 4 trials of add-on spironolactone in resistant hypertension found systolic pressure fell 16.67 mm Hg (95% CI 5.80 to 27.54) and diastolic 6.11 mm Hg more than placebo [6]. A Cochrane review in hypertension found a reduction of 20.09/6.75 mm Hg across 5 crossover studies, with no further reduction above 50 mg a day [7].
Population: 335 people randomized, 285 of whom received spironolactone, each drug taken for 12 weeks [5]; 869 people in 4 trials, mean 12 weeks [6]; 5 crossover studies in hypertension [7].
Sources: [5], [6], [7]
Caveats: Trials lasted about 12 weeks and did not measure heart attack or stroke. Serious adverse effects or withdrawals tended to be more frequent on spironolactone (OR 2.11, 95% CI 0.98 to 4.53) [6].

ModerateStudied in womenVery common

Acne in women

Shown to improve acne in adult women against placebo, with 82% against 63% reporting improvement at 24 weeks in one trial.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In women with facial acne, the acne-specific quality of life symptom score (range 0 to 30) at 12 weeks was 19.2 on spironolactone and 17.8 on placebo (adjusted difference 1.27, 95% CI 0.07 to 2.46), and at 24 weeks 21.2 against 17.4 (difference 3.45, 95% CI 2.16 to 4.75). Improvement was reported by 72% against 68% at 12 weeks and 82% against 63% at 24 weeks (OR 2.72, 95% CI 1.50 to 4.93). Investigator-rated treatment success at 12 weeks was 19% against 6% [9]. In a second trial, spironolactone had better treatment success at 6 months than doxycycline given for 3 months (P = 0.007) [10].
Population: 410 women aged 18 and over with facial acne for at least 6 months, mean age 29.2 [9]; 133 women with moderate acne, all also using benzoyl peroxide [10].
Sources: [9], [10]
Caveats: The difference at 12 weeks was small, and participants could keep using topical treatment [9]. An older Cochrane review could not pool acne data because single trials reported each outcome [11]. Not an FDA-approved use [3].

Moderate

Hirsutism

Shown to lower hirsutism scores in women by about 7.7 points on the Ferriman-Gallwey scale against placebo, in small trials rated low quality.

The numbers and sources

Effect: A Cochrane review found spironolactone 100 mg a day lowered Ferriman-Gallwey scores more than placebo (MD -7.69, 95% CI -10.12 to -5.26), and did about as well as flutamide and finasteride in two studies each [12]. An earlier Cochrane review found that in two trials of 100 mg against placebo, women more often reported improvement in hair growth (OR 7.18, 95% CI 1.96 to 26.28) [11].
Population: Women with hirsutism within a review of 157 studies and 10,550 women, each study of 30 to 80 people [12]; two small placebo-controlled trials [11].
Sources: [12], [11]
Caveats: Low quality evidence from small trials, most at high risk of bias [12]. The two reviews draw on overlapping trials. Not an FDA-approved use [3].

Limited

Lowering testosterone in feminizing hormone therapy

Limited evidence: in one clinic study, testosterone was lower with spironolactone plus estradiol than with estradiol alone, and lower still with cyproterone.

The numbers and sources

Effect: Median total testosterone was 2.0 nmol/L on estradiol plus spironolactone, 10.5 nmol/L on estradiol alone and 0.8 nmol/L on estradiol plus cyproterone acetate. Serum urea was higher on spironolactone than on cyproterone [15].
Population: 114 transfeminine people on estradiol for more than 6 months at two clinics, 38 of them also on spironolactone [15].
Sources: [15]
Caveats: A retrospective cross-sectional study with no randomization. It measured hormone levels, not physical changes. Not an FDA-approved use [3].

LimitedStudied in women

Hirsutism and cycles in PCOS

Small open-label trials in women with PCOS found hirsutism scores fell more with spironolactone than with metformin, and more with the two combined than with either alone.

Compared with metformin 1,000 mg a day [22][23]; metformin 1,700 mg a day alone [24]; spironolactone alone [23]

The numbers and sources

Effect: Over 6 months, the Ferriman-Gallwey hirsutism score fell from 12.9 to 8.7 on spironolactone 50 mg a day and from 12.5 to 10.0 on metformin. Menstrual cycles rose from 6.6 to 10.2 a year on spironolactone and from 5.7 to 9.1 on metformin (P = 0.0037). Testosterone fell in both groups, and weight and blood pressure did not change [22]. In a three-arm trial, spironolactone 50 mg plus metformin raised cycles a year and lowered hirsutism score, total testosterone and glucose and insulin area under the curve more than either drug alone (P < .05) [23]. Adding spironolactone 25 mg to metformin lowered the hirsutism score more than metformin alone (P < 0.001), while regular menses returned in 68% on the combination and 82% on metformin alone [24].
Population: 82 adolescent and young women with PCOS randomized, 69 completing, mean age 22.6 [22]; 198 women with PCOS randomized, 169 completing [23]; 56 women with PCOS [24].
Sources: [22], [23], [24]
Caveats: All three trials were open-label, small and lasted 6 months, with no placebo group. Two came from the same research group [22][23]. Not an FDA-approved use [3].

Mixed results1

LimitedStudied in womenVery common

Female pattern hair loss

Limited evidence: in uncontrolled studies about 43% of women improved on spironolactone alone and 44% regrew hair on an antiandrogen. No placebo-controlled result was sourced.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: A systematic review of trials and observational studies found hair loss improved in 56.60% of women overall, 43.21% on spironolactone alone and 65.80% on combined therapy, with significant heterogeneity. Hair loss did not improve or improved modestly in 37.80% [13]. In an open before-and-after study of spironolactone 200 mg a day or cyproterone acetate for at least 12 months, 44% of women had hair regrowth, 44% had no clear change and 12% kept losing hair, with results for the two drugs combined [14].
Population: Women with female pattern hair loss in randomized and observational studies [13]; 80 women aged 12 to 79 with biopsy-confirmed hair loss, 40 on spironolactone [14].
Sources: [13], [14]
Caveats: Neither source reports a comparison with placebo, so the share that would have improved untreated is unknown. Not an FDA-approved use [3].

Not shown to help2

Limited

Heart failure with preserved pumping function

One trial found no significant drop in cardiovascular death, cardiac arrest or heart failure hospital stay, 18.6% against 20.4%. Heart failure hospital stays alone fell 17%.

The numbers and sources

Effect: Over a mean 3.3 years, the composite of cardiovascular death, aborted cardiac arrest or heart failure hospitalization occurred in 18.6% on spironolactone and 20.4% on placebo (HR 0.89, 95% CI 0.77 to 1.04). Hospitalization for heart failure was less frequent (12.0% against 14.2%, HR 0.83, 95% CI 0.69 to 0.99). Total deaths and hospitalizations for any reason did not differ [4]. In the two trials of this drug class in mildly reduced or preserved ejection fraction, cardiovascular death or heart failure hospitalization was less frequent (HR 0.87, 95% CI 0.79 to 0.95) and cardiovascular death did not differ (HR 0.92, 95% CI 0.80 to 1.05) [2].
Population: 3,445 people with symptomatic heart failure and ejection fraction of 45% or more [4]; the same trial pooled with a trial of finerenone [2].
Sources: [4], [2]
Caveats: Only [4] tested spironolactone in this group.
Why limited: This rests on one trial, of 3,445 people. Strength counts independent studies that agree, so one trial is limited at any size.

Limited

After a heart attack

One trial found routine spironolactone after a heart attack did not lower cardiovascular death or heart failure against placebo over 3 years.

The numbers and sources

Effect: Cardiovascular death or new or worsening heart failure occurred at 1.7 events per 100 patient-years on spironolactone and 2.1 on placebo (HR 0.91, 95% CI 0.69 to 1.21). A first heart attack, stroke, heart failure event or cardiovascular death occurred in 7.9% against 8.3% (HR 0.96, 95% CI 0.81 to 1.13). Serious adverse events were reported in 7.2% against 6.8% [8].
Population: 7,062 people with a heart attack treated by percutaneous coronary intervention, median 3 years [8].
Sources: [8]
Caveats: One trial, in people selected for a heart attack and not for heart failure.
Why limited: This rests on one trial, of 7,062 people. Strength counts independent studies that agree, so one trial is limited at any size.

Doses studied

The label starts heart failure treatment at 25 mg once daily, up to 50 mg, and reports a mean dose of 26 mg in RALES. For high blood pressure it lists 25 to 100 mg a day and states that doses above 100 mg generally do not lower blood pressure further. For edema it lists 25 to 200 mg a day [3].

The resistant hypertension trial used 25 mg, doubled to 50 mg after 6 weeks [5]. The trial in preserved ejection fraction used 15 to 45 mg a day [4]. The acne trial used 50 mg a day, raised to 100 mg at week 6 [9]. The hirsutism trials used 100 mg a day [12], and the hair loss study used 200 mg a day [14].

Risks

Reported risks9

ModerateVery common

High blood potassium

Shown to about double high blood potassium in heart failure, 18.7% against 9.1% on placebo in one trial. Rates in healthy young women matched baseline.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In heart failure with preserved ejection fraction, hyperkalemia occurred in 18.7% on spironolactone and 9.1% on placebo [4]. Across four trials of this drug class, the odds of hyperkalemia doubled (OR 2.27, 95% CI 2.02 to 2.56), and serious hyperkalemia above 6.0 mmol/L occurred in 2.9% against 1.4% [2]. In resistant hypertension, potassium exceeded 6.0 mmol/L once in 6 of 285 people [5]. After RALES was published, hospitalization for hyperkalemia among older Ontario heart failure patients on ACE inhibitors rose from 2.4 to 11.0 per 1,000, and the associated deaths from 0.3 to 2.0 per 1,000 [16]. Among healthy young women taking spironolactone for acne, 0.72% of potassium measurements were high, against 0.76% at baseline in that population [17].
Population: 3,445 people with heart failure [4]; 13,846 people in four heart failure trials [2]; 285 people with resistant hypertension [5]; more than 1.3 million Ontario adults aged 66 or older [16]; 974 healthy young women with 1,802 potassium measurements [17].
Sources: [4], [2], [5], [16], [17]
Caveats: The risk depends on who is taking it. The label names impaired kidney function, potassium supplements and drugs that raise potassium as factors [3]. Low potassium was halved on these drugs in heart failure (7% against 14%) [2].

LimitedStudied in womenVery common

Irregular periods

Limited evidence: menstrual disorders were reported by about 12% of women taking spironolactone for hair loss, in studies with no placebo group.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In a review of studies in female pattern hair loss, menstrual disorders were reported in 11.85% of women, scalp itching or increased scurf in 18.92% and facial hair growth in 6.93% [13]. A Cochrane review of hirsutism treatments lists irregular bleeding as a known adverse event of spironolactone [12]. The label lists irregular menses, amenorrhea and postmenopausal bleeding [3].
Population: Women with female pattern hair loss in randomized and observational studies [13].
Sources: [13], [12], [3]
Caveats: No placebo rate is available, and rates varied widely between studies [13].

LimitedStudied in womenVery common

Headache

One trial found more headaches on spironolactone than placebo in women treated for acne, 20% against 12%, with no serious adverse reactions.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In women treated for acne at 50 to 100 mg a day, headache was reported by 20% on spironolactone and 12% on placebo (P = 0.02). Adverse reactions overall were slightly more frequent on spironolactone, and none were serious [9].
Population: 410 women with facial acne treated for 24 weeks [9].
Sources: [9]
Caveats: One trial in young women without heart or kidney disease.

ModerateCommon

Breast enlargement and breast pain in men

Shown to cause breast enlargement or breast pain in 10% of men on spironolactone against 1% on placebo in one heart failure trial.

The numbers and sources

How common: Common: between 1 in 100 and 1 in 10 people.
Effect: In RALES, gynecomastia or breast pain was reported by 10% of men on spironolactone and 1% of men on placebo [1]. The label reports gynecomastia in about 9% of men at a mean dose of 26 mg a day, states that the risk rises with dose and that onset ranges from 1 to 2 months to over a year, and that it is usually reversible [3].
Population: Men among 1,663 people with severe heart failure [1].
Sources: [1], [3]
Caveats: One trial at a low dose. Rates at the higher doses used for other conditions were not sourced.

LimitedCommon

With ACE inhibitors or ARBs

Linked to more hospital stays for high potassium, rising from 2.4 to 11.0 per 1,000 older heart failure patients on ACE inhibitors as spironolactone use grew.

The numbers and sources

How common: Common: between 1 in 100 and 1 in 10 people.
Effect: Among older adults on ACE inhibitors recently hospitalized for heart failure, spironolactone prescriptions rose from 34 to 149 per 1,000 patients between 1994 and 2001. Over the same period hospitalization for hyperkalemia rose from 2.4 to 11.0 per 1,000 and the associated deaths from 0.3 to 2.0 per 1,000, an estimated 560 additional hospitalizations [16]. The label names ACE inhibitors and ARBs among drugs that raise the risk of hyperkalemia with spironolactone [3].
Population: More than 1.3 million Ontario adults aged 66 or older [16].
Sources: [16], [3]
Caveats: A population time-series, not a comparison of individuals. In RALES, where everyone took an ACE inhibitor, serious hyperkalemia was minimal in both groups [1].

ModerateHow often is not known

Kidney function and low blood pressure

Shown to raise creatinine in heart failure. The label warns of dehydration, low blood pressure and worsening kidney function from excess fluid loss.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In heart failure with preserved ejection fraction, spironolactone was associated with increased serum creatinine. With frequent monitoring, creatinine of 3.0 mg/dL or higher and dialysis did not differ significantly from placebo [4]. The label states that excessive diuresis may cause symptomatic dehydration, low blood pressure and worsening kidney function, particularly in salt-depleted people or those taking ACE inhibitors or ARBs, and that it can also cause low sodium, low magnesium, low calcium, raised blood sugar and raised uric acid [3].
Population: 3,445 people with heart failure [4].
Sources: [4], [3]
Caveats: The abstract gives no rate for the creatinine rise.

LimitedHow often is not known

With trimethoprim-sulfamethoxazole

Linked to hospital admission for high potassium, about 12 times as likely as after amoxicillin, and to sudden death in older adults on spironolactone.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Among older adults on long-term spironolactone, hospital admission for hyperkalemia within 14 days was far more likely after trimethoprim-sulfamethoxazole than after amoxicillin (adjusted OR 12.4, 95% CI 7.1 to 21.6) [20]. Sudden death within 14 days was also more likely (adjusted OR 2.46, 95% CI 1.55 to 3.90) [21].
Population: Ontario residents aged 66 or older on spironolactone, with 6,903 hyperkalemia admissions over 18 years [20] and 11,968 sudden deaths [21].
Sources: [20], [21]
Caveats: Observational, in older adults. The label lists trimethoprim among drugs that can raise potassium [3].

LimitedHow often is not known

With potassium supplements, NSAIDs or heparin

The label warns that potassium supplements, potassium salt substitutes, NSAIDs and heparin can raise potassium further, and that NSAIDs can blunt the diuretic effect.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: The label states that taking spironolactone with potassium supplements or drugs that can increase potassium may lead to severe hyperkalemia, and names NSAIDs, heparin and low molecular weight heparin among those drugs. It states that NSAIDs can reduce the diuretic and blood pressure effect, and that kidney function can worsen with nephrotoxic drugs such as NSAIDs [3].
Population: People taking spironolactone with these products, as described in the label [3].
Sources: [3]
Caveats: The label gives no rate.

LimitedHow often is not known

With lithium or digoxin

The label warns that spironolactone lowers the kidney's clearance of lithium, raising the risk of lithium toxicity, and interferes with some digoxin blood tests.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: The label states that spironolactone, like other diuretics, reduces the renal clearance of lithium and so increases the risk of lithium toxicity. It also states that spironolactone and its metabolites interfere with radioimmunoassays for digoxin and raise the apparent digoxin level, and that the effect on actual digoxin exposure is unknown [3].
Population: People taking spironolactone with lithium or digoxin, as described in the label [3].
Sources: [3]
Caveats: The label gives no rate.

Mixed results1

LimitedHow often is not known

Use in pregnancy

The label warns that spironolactone may affect sex development of a male fetus, based on rat studies. Limited case reports did not show birth defects.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: The label states that, based on its mechanism and on animal studies, spironolactone may affect sex differentiation of the male during embryogenesis. Rat studies found feminization of male fetuses and endocrine dysfunction in females exposed before birth. Limited data from published case reports and case series did not demonstrate an association with major malformations [3].
Population: Rats, and a limited number of published human case reports, as described in the label [3].
Sources: [3]
Caveats: The warning rests on animal data and mechanism. The human data are too few to give a rate.

Checked, no increase found1

Moderate

Breast and other cancers

Not linked to breast cancer in women over 55, at 0.39% a year against 0.38% in unexposed women, or to other cancers in a pooled analysis.

The numbers and sources

How common: Uncommon: between 1 in 1,000 and 1 in 100 people.
Effect: In a UK cohort of women over 55, breast cancer occurred at 0.39% a year in those prescribed spironolactone and 0.38% in matched unexposed women (adjusted HR 0.99, 95% CI 0.87 to 1.12) [18]. A meta-analysis of 7 observational studies found no significant association with breast cancer (RR 1.04, 95% CI 0.86 to 1.22), ovarian, bladder, kidney, gastric or esophageal cancer, and a lower risk of prostate cancer (RR 0.79, 95% CI 0.68 to 0.90) [19].
Population: 28,032 exposed and 55,961 unexposed women followed a mean 4.1 years [18]; 4,528,332 people in 7 studies, mean ages 62.6 to 72.0 [19].
Sources: [18], [19]
Caveats: Observational, with certainty rated low or very low, and few younger women [19]. The label reports that spironolactone caused tumors in rats at high doses [3].

Claims tested and not found

That spironolactone raises the risk of breast cancer. In 28,032 exposed and 55,961 unexposed women over 55, breast cancer rates did not differ (HR 0.99, 95% CI 0.87 to 1.12) [18], and a meta-analysis of 7 studies found no significant association (RR 1.04, 95% CI 0.86 to 1.22) [19].
That healthy young women taking spironolactone for acne often develop high potassium. In 974 healthy young women, 13 of 1,802 potassium measurements were high (0.72%), equivalent to the 0.76% baseline rate in that population [17].
That routine spironolactone after a heart attack lowers cardiovascular death or heart failure. In 7,062 people, neither primary outcome differed from placebo over a median 3 years [8].
That doses above 50 mg a day lower blood pressure further. Across doses of 25 to 500 mg a day in a Cochrane review, doses above 50 mg did not produce further reductions in systolic or diastolic pressure [7].

Sources

Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine. 1999. https://doi.org/10.1056/NEJM199909023411001
Jhund PS, Talebi A, Henderson AD, et al. Mineralocorticoid receptor antagonists in heart failure: an individual patient level meta-analysis. The Lancet. 2024. https://doi.org/10.1016/S0140-6736(24)01733-1
Aldactone (spironolactone) tablets, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0fed2822-3a03-4b64-9857-c682fcd462bc
Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. New England Journal of Medicine. 2014. https://doi.org/10.1056/NEJMoa1313731
Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. The Lancet. 2015. https://doi.org/10.1016/S0140-6736(15)00257-3
Zhao D, Liu H, Dong P, Zhao J. A meta-analysis of add-on use of spironolactone in patients with resistant hypertension. International Journal of Cardiology. 2017. https://doi.org/10.1016/j.ijcard.2016.12.158
Batterink J, Stabler SN, Tejani AM, Fowkes CT. Spironolactone for hypertension. Cochrane Database of Systematic Reviews. 2010. https://doi.org/10.1002/14651858.CD008169.pub2
Jolly SS, d'Entremont MA, Pitt B, et al. Routine Spironolactone in Acute Myocardial Infarction. New England Journal of Medicine. 2025. https://doi.org/10.1056/NEJMoa2405923
Santer M, Lawrence M, Renz S, et al. Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ. 2023. https://doi.org/10.1136/bmj-2022-074349
Dréno B, Nguyen JM, Hainaut E, et al. Efficacy of Spironolactone Compared with Doxycycline in Moderate Acne in Adult Females: Results of the Multicentre, Controlled, Randomized, Double-blind Prospective and Parallel Female Acne Spironolactone vs doxyCycline Efficacy (FASCE) Study. Acta Dermato-Venereologica. 2024. https://doi.org/10.2340/actadv.v104.26002
Brown J, Farquhar C, Lee O, Toomath R, Jepson RG. Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane Database of Systematic Reviews. 2009. https://doi.org/10.1002/14651858.CD000194.pub2
van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N. Interventions for hirsutism (excluding laser and photoepilation therapy alone). Cochrane Database of Systematic Reviews. 2015. https://doi.org/10.1002/14651858.CD010334.pub2
Aleissa M. The Efficacy and Safety of Oral Spironolactone in the Treatment of Female Pattern Hair Loss: A Systematic Review and Meta-Analysis. Cureus. 2023. https://doi.org/10.7759/cureus.43559
Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. British Journal of Dermatology. 2005. https://doi.org/10.1111/j.1365-2133.2005.06218.x
Angus L, Leemaqz S, Ooi O, et al. Cyproterone acetate or spironolactone in lowering testosterone concentrations for transgender individuals receiving oestradiol therapy. Endocrine Connections. 2019. https://doi.org/10.1530/EC-19-0272
Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. New England Journal of Medicine. 2004. https://doi.org/10.1056/NEJMoa040135
Plovanich M, Weng QY, Mostaghimi A. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA Dermatology. 2015. https://doi.org/10.1001/jamadermatol.2015.34
Mackenzie IS, Macdonald TM, Thompson A, Morant S, Wei L. Spironolactone and risk of incident breast cancer in women older than 55 years: retrospective, matched cohort study. BMJ. 2012. https://doi.org/10.1136/bmj.e4447
Bommareddy K, Hamade H, Lopez-Olivo MA, et al. Association of Spironolactone Use With Risk of Cancer: A Systematic Review and Meta-analysis. JAMA Dermatology. 2022. https://doi.org/10.1001/jamadermatol.2021.5866
Antoniou T, Gomes T, Mamdani MM, et al. Trimethoprim-sulfamethoxazole induced hyperkalaemia in elderly patients receiving spironolactone: nested case-control study. BMJ. 2011. https://doi.org/10.1136/bmj.d5228
Antoniou T, Hollands S, Macdonald EM, et al. Trimethoprim-sulfamethoxazole and risk of sudden death among patients taking spironolactone. CMAJ. 2015. https://doi.org/10.1503/cmaj.140816
Ganie MA, Khurana ML, Eunice M, et al. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. The Journal of Clinical Endocrinology & Metabolism. 2004. https://doi.org/10.1210/jc.2003-031780
Ganie MA, Khurana ML, Nisar S, et al. Improved efficacy of low-dose spironolactone and metformin combination than either drug alone in the management of women with polycystic ovary syndrome (PCOS): a six-month, open-label randomized study. The Journal of Clinical Endocrinology & Metabolism. 2013. https://doi.org/10.1210/jc.2013-1040
Mazza A, Fruci B, Guzzi P, et al. In PCOS patients the addition of low-dose spironolactone induces a more marked reduction of clinical and biochemical hyperandrogenism than metformin alone. Nutrition, Metabolism and Cardiovascular Diseases. 2014. https://doi.org/10.1016/j.numecd.2013.04.016

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