Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne

Abstract

pironolactone is an androgen receptor antagonist that is an effective treatment for hormonally mediated acne. [1][2][3][4] Although generally well tolerated, spironolactone use is associated with hyperkalemia among patients with heart failure taking additional drugs that interfere with potassium excretion. 5 However, the prevalence of spironolactoneinduced hyperkalemia among young women taking spironolactone for acne is unclear. To date, there have been 4 small-scale clinical studies, 6-9 each fewer than 100 patients, that have measured serum potassium as a secondary outcome in patients taking spironolactone for acne. Three studies 6-8 yielded zero cases of hyperkalemia, and one study 9 showed a 13.7% rate of mild hyperkalemia, which was defined as a se-rum potassium measurement of 4.8 to 5.3 mEq/L (to convert potassium level to millimoles per liter, multiply by 1.0).Although the US Food and Drug Administration recommends frequent potassium monitoring in patients taking spironolactone, it is unclear whether this guideline is applicable to healthy patients taking spironolactone for acne. If the rate of hyperkalemia in this population is low and clinically insignificant, the cost of regular potassium monitoring may exceed the benefit of capturing these cases. In addition, concerns over hyperkalemia and frequent laboratory testing may contribute to health care spending and discourage the use of this effective drug. The objective of this retrospective study was to measure the rate of hyperkalemia in a large population IMPORTANCE Spironolactone has been shown to be an effective treatment option for hormonally mediated acne but can cause hyperkalemia. The prevalence of hyperkalemia among healthy young women taking spironolactone for acne is unclear.OBJECTIVE To measure the rate of hyperkalemia in healthy young women taking spironolactone for acne or for an endocrine disorder with associated acne.

Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study

“…Furthermore, all patients who experienced xerosis were applying tretinoin, which can also cause xerosis [6] . The infrequent side effect of hyperkalemia, with the majority being mild, is consistent with that reported by Plovanich et al [3] . In our short-term study, there were no patients who developed estrogen-dependent cancers, consistent with previous data published by Biggar et al [10] .…”

K+larity for Spironolactone

“…As supported by the findings in this study, 7 there is great intervariability among physicians' frequency of potassium monitoring. Studies such as this one are important in that they standardize care and thereby reduce unnecessary spending.…”

“…Despite the intriguing results of this study 4 and others, their small sample size undermines the findings. Finally, Plovanich et al 7 provide us with a large, welldesigned study to assuage our fears of hyperkalemia. Their results showing no increased risk of hyperkalemia in patients with acne prescribed spironolactone will surely change the way many clinicians practice.…”

“…Their results showing no increased risk of hyperkalemia in patients with acne prescribed spironolactone will surely change the way many clinicians practice. However, it should be noted that the patients with acne in their study 7 included only "young healthy females," and those with cardiac disease, renal disease, or prescribed medications potentiating the risk of hyperkalemia were excluded. While the physician may feel reassured that he or she does not need to check potassium levels in otherwise healthy individuals, one should do a thorough review of a patient's medications and medical history to ensure safety with spironolactone use.…”

Common Adverse Drug-Drug Interactions in Dermatology: Oral Therapies

“…The necessity of potassium monitoring in this population is questionable, as recent evidence suggests that the rate of hyperkalemia in healthy young women taking spironolactone is equal to the baseline rate of hyperkalemia in this population. 42 Nevertheless, when clinically appropriate, alternative antibiotics and antihypertensive agents should be chosen for these patients.…”