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  • Potassium-sparing diuretic; used for edema, ascites, HTN, hypokalemia, acne vulgaris, polycystic ovary syndrome, female hirsutism, and to diagnose primary hyperaldosteronism; also improves survival and NYHA functional class, and reduces hospitalizations in NYHA Class IV heart failure.
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  • Common side effects include electrolyte abnormalities, particularly high blood potassium, nausea, vomiting, headache, rashes, and a decreased desire for sex.
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Comments:

Oral spironolactone has been used for over two decades in the dermatological setting. Although it is not generally considered a primary option in the management of female patients with acne vulgaris, the increase in office visits by post-teenage women with acne vulgaris has recently placed a spotlight on the use of this agent in this subgroup of patients.

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In case of therapy-refractory congestion, treatment is at the discretion of the treating physician, but addition of chlorthalidone 50 mg PO is recommended by the investigators as a first-line option. Note: Investigators and treating physicians are blinded to treatment allocation for this arm, but no matching placebo is provided, so patients are not. This group receives high-dose loop diuretics as an active comparator to the study intervention with acetazolamide.

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