Cholesterol effect of spironolactone

Recently, as part of the lab tests done during an occupational physical exam, a 33-year-old female nurse in good condition had a fasting total cholesterol of 340 mg/dL. Apparently, the spironolactone (Aldactone) she takes for acne can cause adverse lipid values. How common is this adverse effect? And how often do dermatologists use spironolactone for acne?
—Joseph J. Kennedy, DO, Robins, Iowa

Spironolactone is occasionally used for the treatment of acne as an antiandrogen. Yemisci et al performed an open-label, prospective study to evaluate the effects and side effects of spironolactone therapy in women with acne (J Eur Acad Dermatol Venereol. 2005;19:163-166). Thirty-five consecutive patients were treated with spironolactone 100 mg/day, 16 days each month for three months. The authors noted clinically significant improvement in 24 patients (85.7%). No response was seen in four patients. All nonresponding patients had received previous unsuccessful therapies. Mean number of lesions and mean dehydroepiandrosterone levels of the 24 patients with clinical improvement decreased significantly after treatment. There was no change in the mean total testosterone levels before and after treatment.

An increase in cholesterol with spironolactone is fairly unusual. The literature suggests that the effect of spironolactone on lipid levels is usually minimal. Therefore, I would recheck this level and look for other possible etiologies.
—Jeffrey M. Weinberg, MD (117-8)

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