Call to Monitor Potassium Levels in Female Spironolactone Patients
Hormonal acne is very common, affecting a large percentage of people, especially during the teenage years and early adulthood.
Many people associate acne with puberty, but it can continue into adulthood. In this case, adult acne in women is more common than men.
Women are more prone to acne due to hormonal fluctuations, especially during menstruation and pregnancy.
Doctors often prescribe spironolactone, a hormonal medication, to females with acne as treatment.
What is spironolactone?
Spironolactone is an oral medication that has gained popularity in recent years as an effective treatment for acne, especially in adult women.
Spironolactone belongs to the class of drugs called aldosterone antagonists—blocking the eff ects of aldosterone.
Aldosterone is a crucial hormone for women’s bodies, assisting to regulate fluids, electrolyte balance, and blood pressure.
Hormonal acne on the jawline, chin, and lower face is often caused by changes in androgen hormones. Spironolactone can help control these hormones.
Spironolactone is also a medication used to treat heart failure and high blood pressure.
Go Bananas: Potassium in Your Body
Spironolactone is a potassium-sparing diuretic.
Diuretics are medicines that make you pee more. But unlike other diuretics, spironolactone does not cause you to lose potassium.
When taking spironolactone, monitoring your potassium level is important.
Potassium is an important mineral. It helps control heart rhythm, muscle function, and nerve activity. However, too much potassium can be harmful.
Too much potassium can be dangerous, leading to symptoms such as:
- Muscle weakness
- Irregular heartbeat
- In severe cases, cardiac arrest.
Most women tolerate spironolactone; however, it does come with potential side effects, one of which is an increase in potassium levels—a condition known as hyperkalaemia.
The Problem
Because spironolactone can affect potassium levels, it’s important for your doctors to monitor these levels regularly, especially when starting the medication.
Current guidelines recommend checking potassium levels within the first week of starting spironolactone, particularly for patients with risk factors such as:
- Older age
- Kidney problems
- Heart conditions
- Use of other medications that increase potassium levels (e.g., ACE inhibitors, angiotensin receptor blockers, or potassium supplements).
Even for young, healthy women without these risk factors, monitoring your potassium levels as a precautionary measure is recommended.
This is especially true given the limited research on spironolactone’s long-term safety for acne treatment.
The Solution
Doctors might prefer to check and monitor potassium levels as part of your routine treatment plan.
More than a third of women with acne who take spironolactone check their potassium levels regularly during medical visits.
Patients should start checking their potassium levels within one week of beginning spironolactone treatment.
Patients with heart failure or high blood pressure should check their potassium levels. This should be done within 4 weeks of starting the medication.
But there continues to be limited research on potassium level monitoring.
Investigation into Potassium Level Checks
A study by the American Academy of Dermatology looked at data from the Turven Health MarketScan Commercial Claims Database. This data was collected between 2017 and 2020.
The study focused on females aged 12 and older with acne. It checked if they received regular potassium level tests after being prescribed spironolactone.
The study included participants for at least 180 days. This was before and after they started spironolactone for a 90-day treatment.
The Results
The study of 33,234 females treated with spironolactone had potassium monitoring as part of their treatment checks.
Of this number, 5.5% had potassium monitoring in the first 7 days and 10.7% within 14 days.
55.9% had potassium monitoring in 90 days and 73% in 180 days.
Older women (45 and older) were more likely to have their potassium levels checked compared to young women (12 to 19 years old) with 43.3% and 22.4% respectively.
Overall, 31.1% of women had their potassium levels checked at least once during their treatment period.
Call to Action
The results showed that potassium levels are rarely monitored within the first week of beginning treatment, or even the first few weeks.
This is alarming for patients as it goes against the spironolactone and medical guidelines.
Without proper treatment monitoring, spironolactone can cause health complications.
Dermatologists and healthcare clinicians are regularly encouraged to close the gap in care by regularly completing potassium level checks for their patients.
Practical Advice for Patients
If you’re considering or currently taking spironolactone for acne, here’s what you can do to stay safe and informed:
- Discuss Your Medical History: Be upfront with your dermatologist about any health conditions, medications, or supplements you’re taking. This will help them assess your risk of hyperkalaemia and determine how often your potassium levels should be checked.
- Ask About Monitoring: If your doctor doesn’t mention potassium monitoring, don’t hesitate to bring it up. It’s your right to be fully informed about your treatment plan.
- Attend Follow-Up Appointments: Regular check-ups are essential for monitoring your progress and catching any potential issues early in appointments and blood tests.
- Know the Symptoms: While hyperkalaemia often has no symptoms, be aware of warning signs like muscle weakness, fatigue, or an irregular heartbeat.
What Can Be Done to Improve Patient Safety?
The results of this study highlight the need for better following of guidelines. It also shows the importance of better education for dermatologists and people with acne.
Here are some key steps that can help:
- Timely Monitoring: Dermatologists should ensure that potassium levels are checked within the first week of starting spironolactone, particularly for patients with risk factors. This aligns with current guidelines and helps catch any early signs of hyperkalaemia.
- Individualised Care: Not all patients need the same level of monitoring. Dermatologists should assess each patient’s individual risk factors and tailor their monitoring plan accordingly based on age and other health issues.
- Patient Education: Patients should be informed about the importance of potassium monitoring and encouraged to report any unusual symptoms, such as muscle weakness or palpitations.
- Updated Guidelines: While current guidelines provide a good starting point, they could be strengthened to emphasise the importance of early and regular potassium monitoring, particularly for acne patients.
- Further Research: More studies are needed to better understand the long-term safety of spironolactone for acne treatment, including its effects on potassium levels in different patient populations.
The Dermatologists View
Dr Philip Tong is an expert dermatologist and Co-Chair of the All About Acne board.
He believes this study shows a gap in practice. This gap could delay the early detection of high potassium levels.
“This underscores the need for updated guidelines and better education on timely potassium testing to enhance patient safety and care quality,” Dr Tong explains.
Conclusion
Women who have hormonal acne later in life often get spironolactone as treatment. However, they may not have regular checks for potassium levels.
This is worrying as early detection of high potassium can decrease the risk of complications.
As spironolactone becomes a popular treatment, we should improve and support regular potassium checks in your treatment plan.
Reference: Lai J, Zaenglein A, Barbieri J. Timing of potassium monitoring in females treated for acne with spironolactone is not optimal: A retrospective cohort study. Journal of the American Academy of Dermatology. 2024. Doi:10.1010/j.jaad.2024.07.1446
