Spironolactone

The anti-androgens include the androgen receptor blockers spironolactone, cyproterone acetate, and flutamide. Spironolactone is an aldosterone antagonist that also blocks the androgen receptor (72). Oral spironolactone reduces sebum excretion by 45-50%. It is taken 25-100 mg orally twice a day. Patients frequently experience breast tenderness and menstrual irregularities with spironolactone. These side effects increase with the dosage of spironolactone, and can be minimized by using an oral contraceptive. If a woman becomes pregnant with a male fetus, spironolactone as an anti-androgen may lead to feminization of the male genitalia and endocrine dysfunctions (78). Spironolactone can also cause mild elevations of potassium, and should therefore be used with caution in patients with renal or cardiac disease (79,80). For patients taking ethinyl estradiol/drospirinone (Yasmin®) in conjunction with spironolactone, this risk of hyperkalemia is increased.