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Spironolactone is a drug used to decrease water retention, acting as a potent diuretic (which increases urine volume and frequency) 1. It is used to help treat primary hyperaldosteronism (too much aldosterone), congestive heart failure, hepatic cirrhosis, nephrotic syndrome, and hypertension, all diseases characterized or exacerbated by excessive fluid in the body. The FDA states an overt warning that spironolactone has been shown to have tumorigen potential (may cause cancer) in chronic toxicity studies in rats and should be used only in those conditions described under approved indications and usage, with unnecessary use of the drug avoided 1.
Spironolactone Mode of Action
Spironolactone specifically opposes the actions of aldosterone (a hormone regulating water and salt balance), causing increased amounts of sodium and water loss through urine, while retaining potassium 1. Spironolactone increases diuresis and consequently has antihypertensive (lowers blood pressure) properties 1.
Rosemary for Blood Pressure
Serum and urine electrolyte imbalance leading to hyperkalemia (excessive potassium) in the body can potentially precipitate heart failure when using spironolactone 1. Taking food rich in potassium or potassium supplements is contraindicated. Carcinoma of the breast has been reported, but a direct relationship is not established. Additional side effects include:
- mental confusion
- kidney failure,
- liver failure among other possible side effects
- Serum and urine electrolyte imbalance leading to hyperkalemia (excessive potassium) in the body can potentially precipitate heart failure when using spironolactone 1.
Weight Loss through Water Loss
The weight loss experienced through use of spironolactone is due exclusively to loss of water, and as such is not a long-term healthy or effective method 1. At doses allowing for weight loss the body will respond by increasing aldosterone release, thereby making some weight loss effects of spironolactone transient unless higher doses are administered 1. Hypotension (low blood pressure) and a sense of tiredness will occur in normal healthy people, especially initially and upon exercise.
Warnings for Patients Using Spironolactone for Weight Loss
Diuretics and Low Blood Pressure
It is unhealthy and potentially hazardous to take spironolactone unless recommended by a physician to treat a specifically approved clinical indication 1. The drug has no effect on body fat, the predominant contributor to excessive weight. If you suffer from a form of edema (excessive fluid retention) caused by various different hormone, heart, liver, or kidney conditions, then treatment with spironolactone will relieve the body of excess fluid 1.
Take Home Message
Losing weight and obtaining a desirable and healthy figure is a difficult to achieve and even harder to maintain, with the surest methods being modification to diet and exercise. The side effects associated with spironolactone and the electrolyte imbalance (disturbance to the salt composition in your body) can cause significant harm and at best may achieve five pounds of weight loss, beyond which severe consequences will pose great risks to your health and well-being 1.
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- FDA Spironolactone Warning
- Centers for Disease Control and Prevention. Overweight and Obesity. Adult Obesity Facts. Obesity is a common, serious, and costly disease. Page last reviewed February 27, 2020.
- US National Library of Medicine. MedlinePlus. Spironolactone. Updated 16 March 2020.
- Faconti L, Mills CE, Govoni V, et al. Cardiac effects of 6 months' dietary nitrate and spironolactone in patients with hypertension and with/at risk of Type 2 diabetes, in the factorial design, double-blind, randomized controlled VaSera trial. Br J Clin Pharmacol. 2019;85(1):169–180. doi:10.1111/bcp.13783
- Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6:1-13. doi:10.2147/CLEP.S37559
- Butler J, Anstrom KJ, Felker GM, et al. Efficacy and Safety of Spironolactone in Acute Heart Failure: The ATHENA-HF Randomized Clinical Trial. JAMA Cardiol. 2017;2(9):950–958. doi:10.1001/jamacardio.2017.2198
- Desai AS, Liu J, Pfeffer MA, et al. Incident Hyperkalemia, Hypokalemia, and Clinical Outcomes During Spironolactone Treatment of Heart Failure With Preserved Ejection Fraction: Analysis of the TOPCAT Trial. J Card Fail. 2018;24(5):313–320. doi:10.1016/j.cardfail.2018.03.002
- Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ. Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review. Am J Clin Dermatol. 2017;18(2):169–191. doi:10.1007/s40257-016-0245-x
- Yu BC, Lee MS, Moon JJ, et al. Efficacy of low-dose spironolactone on top of angiotensin receptor blockade in patients with glomerulonephritis. Kidney Res Clin Pract. 2018;37(3):257–265. doi:10.23876/j.krcp.2018.37.3.257
Brandt brings together 10 years experience in the biomedical sciences. He completed a MPH degree in epidemiology, completed a BS in Molecular Biology, BA in Anthropology and went through medical school. Over last 7 years he has worked in pharmaceutical clinical R&D and has published in medical journals.