Spironolactone can cause various neurological side effects such as lethargy, mental confusion, ataxia, dizziness, headache, drowsiness, postural hypotension, and depression.1–5 According to the package insert, somnolence and dizziness have been reported to occur in some patients, but frequency of these events is not mentioned.1 Greenblatt et al reviewed medical records of 788 hospitalized patients taking spironolactone.5 Adverse reactions that were attributed to spironolactone occurred in 164 (20.8%), including neurological disturbances (2.0%) and dehydration (3.4%). Bozkurt et al analyzed data on 104 patients who were started on spironolactone for heart failure and reported hypotension occurred in 7/104 (7%).6
Caution is advised when driving or operating machinery until the response to initial treatment has been determined.1 When starting to take spironolactone, users should avoid activities that would be dangerous if they became dizzy until it is established that spironolactone is well tolerated.
According to the manufacturer’s package insert, people taking spironolactone should be aware of increased volume loss and the potential for dehydration.1 Patients taking spironolactone should be careful when physically exerting themselves to avoid dehydration, especially in hot climates.
References
- Spironolactone [package insert]. New York, NY: Pfizer Labs, Inc; 2018.
- Lubbos HG, Hasinski S, Rose LI, Pollock J. Adverse effects of spironolactone therapy in women with acne. Arch Dermatol 1998; 134 (9): 1162-1163.
- Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: A retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol 2000; 43 (3): 498-502.
- Yemisci A, Gorgulu A, Piskin S. Effects and side-effects of spironolactone therapy in women with acne. J Eur Acad Dermatology Venereol 2005; 19 (2): 163-166.
- Greenblatt DJ, Koch-Weser J. Adverse reactions to spironolactone. A report from the Boston Collaborative Drug Surveillance Program. JAMA 1973; 225 (1): 40-43.
- Bozkurt B, Agoston I, Knowlton AA. Complications of inappropriate use of spironolactone in heart failure : when an old medicine spirals out of new guidelines. J Am Coll Cardiol 2003; 41 (2): 211-214.
