Clinical Consequences

The incidence of spironolactone-induced gynecomastia in men is dose related (Fig. 3). It is estimated that 50% of men treated with Si50 mg/day of spironolactone will develop gynecomastia. The degree of gynecomastia varies con-

SPIRONOLACTONE

24/46

37/222

30/431

25-50 75-100 150-300

FIGURE 3. Incidence of gynecomastia according to dose of spironolactone. From Juenema-tire, et al.

siderably from patient to patient but in most instances causes mild symptoms. Associated breast tenderness is common but an inconsistent feature. Regression of gynecomastia usually occurs within a few weeks after discontinuation of spironolactone. More troubling symptoms and signs in some males include reduced libido and impotence; however, the incidence of these complaints is not known. These effects are also dose-dependent and disappear after discontinuation of the drug.

Spironolactone is reported to cause hirsutism, deepening voice, and menstrual irregularity in women. The menstrual irregularities are believed to be caused by concomitant inhibition of 17-hydroxylase by spironolactone. These effects are generally mild but disturbing to the patient and may result in reduced medication compliance. Interestingly, the antiandrogenic effects of spironolactone have been exploited clinically in the treatment of familial male precocious puberty and in women for both acne and hirsutism.

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