Potassium Monitoring Is Unnecessary for Healthy Women Taking Spironolactone for Acne

Spironolactone, a potassium-sparing diuretic with antiandrogen effects, has been used for 30 years. More recently, it has been shown to effectively treat hormonally mediated acne in women. Spironolactone recipients with congestive heart failure, hypertension, or renal disease can develop hyperkalemia, but its occurrence in healthy patients with acne is unclear.

Investigators retrospectively compared rates of hyperkalemia in 974 healthy young women taking spironolactone for acne or for endocrine disorders with associated acne (e.g., polycystic ovarian syndrome). They also examined the cases of 1165 healthy young women (taking and not taking spironolactone) to derive baseline rates in this population. Exclusion criteria were cardiovascular disease, renal failure, and the use of medications involving the renin-angiotensin-aldosterone system.

Among 1802 measurements, there were 13 mildly elevated potassium results, yielding a hyperkalemia rate of 0.72%. This rate was equivalent to the 0.76% baseline rate in the comparison group. Repeat testing in 6 of the 13 patients demonstrated normal values, suggesting that the hyperkalemia may have been transient or erroneous. In the remaining seven patients, no action was taken. All 13 patients remained asymptomatic and continued spironolactone.