March 28, 2023

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I’m here with dr. julie harper president-elect of the american act knee and rosacea society to talk about an old and relatively inexpensive oral drug for acne spironolactone cardiologist when they use it as part of guideline directed medical therapy for heart failure are very particular about potassium levels what about in acne patients well first of all our

Acne population is going to be significantly different at the outset than that population that you’re talking about it’s considered to be a very safe drug by the way it is can include it in our own acne guidelines from the american academy of dermatology as a treatment option for people with acne we did have an article published about two years ago in 2015 that

Specifically looked at whether or not we need to be checking potassium while people are on sparano actin it’s an interesting study everybody in the study was pretty young and healthy they had to be between ages 18 and 45 they couldn’t have this cardiovascular risk factors that you’re talking about but at least in that particular study there wasn’t a difference

In potassium level between those on spironolactone and the control group and so the conclusion from that study is we don’t need to be routinely testing but again that was that population of people who are young and healthy and who are taking the drug for acne the people together right so in your own practice i do not routinely check potassium there are there

Are times that we should of course if you have somebody who’s older if you have somebody that you have on a higher dose and to me a higher dose would be like 150 or 200 milligrams a day then i think probably you should be checking it if they have hypertension and they’re on other medications like ace inhibitors you should be checking but in the vast majority

Of patients i do not check labs routinely first bernal acton no any labs i don’t check any labs it was interesting at this particular hawaii dermatology seminar there was some disagreement there there are some physicians who feel more comfortable checking baseline labs not so much looking at baseline potassium but looking at baseline renal function but even

There because of my patient population where i’m using which i think of is being young and healthy and we can do review of systems and we can do a good patient history and i think uncover a lot of this those types of risk factors without doing lab but there is some controversy there on whether or not to check baseline labs looking at kidney and liver function

And where do you find out more suitable spironolactone in your own practice i used to run a lactone a lot and it’s a drug that the longer i practice the more i use it you know versus the the converse of that i would say it’s not very often my first line drug it might be in an individual who comes in who perhaps is mid-30s and and i know that she has something

That looks or acts hormonal so it’s that lower face acne it’s worse at certain times of the month she doesn’t have a lot of comedonal acne it’s mostly inflammatory acne i might start with it there but more often than not this is a drug that is an add-on to other therapies that we’ve already done maybe she’s already been on a systemic antibiotic and great topical

Medications and we’re just not getting the results that we want then i would either replace or add this drug in and how high will you go dosing i love to start low sometimes i’ll start as low as 25 milligrams a day if i can start that low a lot of times my final dose will be 50 milligrams a day where we tighter titrate the dose up based on side effect probably

My max most of the time is 100 milligrams i just don’t think i if that’s not even about safety i just don’t think i need higher doses than that there’s a difference – between safety and tolerability of the drug as we push that dose up much higher then people are gonna have unscheduled breakthrough bleeding they’re gonna have breast swelling and tenderness and

Those are side effects that might limit the use of the drug so when i can i like to keep the dose down at 100 milligrams or less probably probably my most common would be 50 milligrams a day and we’re talking about a drug for when right it’s interesting this has been studied there was a study in japan i think it was around 2006-2007 so not a real new study but

They enrolled some men in the study early on and they had to shut the clock that part of the study down pretty quickly because those men did develop gynecomastia so unfortunately this is a great drug but only for women and is it suitable to use it in women that are nursing very interesting so that is not something that i do commonly but it is a safe option and

So often when women are nursing we have a tendency to under treat them we’re afraid to treat them i would say when possible in somebody who’s nursing you should great topical medications because just about all of those are safe to use when a woman is nursing but if you have someone with really severe acne and you need a systemic alternative it is interesting

That supernal acton is compatible with lactation but the world health organization says that the american academy of pediatrics say that we should keep in mind though two things if the dose is high enough that the woman is diary sink which would be unlikely it might cut down on milk supply and then number two this is a drug that can cause breast swelling and

Tenderness and a nursing woman may not appreciate that so those are things to counsel the patient about is there an increased risk of dvt that’s a great question because we worry about that when we’re giving other hormonal treatments for acne like birth control pills but not so it with frontal acton this is an alternative that you can use in a person who might

Have a tendency toward a hypercoagulable state this would be a safe drug to use and you’ve mentioned that you ideally like to use it in conjunction with oral contraceptives well i not always there are times like what we just talked about there are times when a woman has a contraindication to a birth control pill and i could certainly still use this i just have

To talk about potential side effects and i want to make sure she doesn’t get pregnant while she’s on it if she does that she simply simply stops the medication because most of the risk is gonna be later first trimester so when she finds out she’s pregnant she stops the drug now have that conversation up front most the time you want to clarify that they’re not

Trying to get pregnant and it’s nice if they’re doing something to prevent but that’s not always possible and i don’t think that’s a reason to withhold the drug very interesting an old drug but still a very good drug that’s right nice talking to you thank you

Transcribed from video
Spironolactone holds its own for treating women’s acne By MDedge news and insights for busy physicians