Can you take spironolactone and isotretinoin together?

Spironolactone and isotretinoin (Accutane, Clarus, Epuris) are both used for acne, and they work in different ways. People often ask if they can take both at the same time. The short answer: it is sometimes done, but only with a plan from a clinician.

What each medicine does

• Spironolactone blocks the effect of androgen hormones on the skin. It is used for hormonal acne in adult women. It can take a few months to show results.
• Isotretinoin is an oral retinoid. It shrinks oil glands and treats severe or stubborn acne. It is a strong medicine and needs close follow-up.

Because they act in different ways, they do not cancel each other out.

What is known

There is no simple rule that bans the two together. There is also little high-quality research on the combination. Most of what clinicians know comes from case reports and small studies, plus what we know about each drug alone.

In many cases, a clinician will choose one medicine first and see how you respond. Sometimes spironolactone is used to keep skin clear after an isotretinoin course. Sometimes it is used before, if isotretinoin is not yet right for you.

Possible overlap of side effects

Taking both can add up some effects:

• Dry skin, lips and eyes. Isotretinoin is the main cause. Spironolactone can add to the dryness for some people.
• Dizziness. Spironolactone lowers blood pressure a little. Stand up slowly.
• Menstrual changes. Spironolactone can cause spotting or irregular periods.
• Mood. Isotretinoin has been linked to low mood in some people. Tell your clinician about any change.

Monitoring

Your clinician may order blood tests while you take either or both medicines.

• Potassium. Spironolactone can raise potassium. A high level can affect the heart rhythm. Your clinician decides how often to test, based on your age, health and other medicines.
• Liver tests. Isotretinoin can raise liver enzymes in some people.
• Blood fats (lipids). Isotretinoin can raise cholesterol and triglycerides.

Tell your clinician about every medicine and supplement you take. Some of them also raise potassium. Examples are certain blood pressure pills, potassium supplements and salt substitutes that contain potassium.

Pregnancy rules for both

Both medicines carry serious pregnancy risks. This is the most important part of this article.

• Isotretinoin can cause serious birth defects. If you can become pregnant, you must follow the manufacturer's pregnancy prevention program. This includes pregnancy tests and reliable birth control.
• Spironolactone can affect the development of a male baby. It is not recommended during pregnancy.

If you are pregnant, planning a pregnancy or breastfeeding, tell your clinician before you start either medicine. If you think you may be pregnant while taking either, stop and contact your clinician right away.

Tips if your clinician prescribes both

• Take each medicine as prescribed. Do not change a dose yourself.
• Keep every blood test appointment.
• Use a plain moisturizer, lip balm and sunscreen every day.
• Keep a short list of your medicines and bring it to each visit.
• Tell your pharmacist and other doctors that you take isotretinoin and spironolactone.

Cost and coverage

Coverage for both drugs differs by province and by plan. Ask your private insurer or provincial drug plan about each one.

When to message your clinician

Message your Care Team if:

• you feel dizzy, faint or very weak, or your heart seems to beat unevenly;
• you have muscle weakness or cramps that are new;
• your skin or eyes turn yellow, or your urine turns dark;
• you have a severe headache, vision changes or low mood;
• your periods change a lot;
• you have missed a blood test;
• you are pregnant or think you might be. Stop both medicines and contact your clinician right away.

Call 911 or go to emergency if you faint, have chest pain or an irregular heartbeat that does not settle.