Spironolactone (Aldactone), 100 mg to 200 mg daily, has antiandrogenic effects that may enhance treatment of androgen-excess syndromes, particularly severe hirsutism. Combination therapy with an oral contraceptive or with dexamethasone appears to have a beneficial effect. Side effects are transient. The drug should be avoided during pregnancy and in women who have a family history of breast cancer, although there is no proven association between spironolactone and breast malignancy.
PIP: Spironolactone (Aldactone) appears to have potential as a treatment for androgen-excess syndromes, including hirsutism. In both men and women, spironolactone decreases the rate of testosterone production and increases its metabolic clearance. The 1st indication that this agent has an effect on hirsutism was serendipitous--an incidental finding in a patient who was being treated for hypertension. Subsequent studies have largely confirmed that women who are administered spironolactone exhibit no further progression in hair darkening and coarsening, a slowed growth rate of existing hair, and decreased hair shaft diameter. When combined with dexamethasone or an oral contraceptive, spironolactone seems to increase the intervals between hair growth treatments. It has been suggested, but not documented, that spironolactone could correct hyperandrogenic ovulation. This use should be avoided, however, due to potential anti-androgenic effects on the fetus. Minor side effects of treatment with spironolactone include time-limited lethargy, stomach upset, and menstrual irregularity. There is concern, however, that this agent may stimulate the breast and contribute to the development of breast cancer. Thus, it should not be used by patients with a family history of breast malignancies. In addition, the drug should not be used in pregnancy and users of reproductive age should be supplied with an effective contraceptive method. The present dosage recommendation is 100-200 mg of spironolactone/day in 2 divided doses combined with either 35 mcg ethinyl estradiol and 0.5 mg of norethindrone or with 50 mg of ethinyl estradiol and 1 mg of ethynodiol diacetate.