Comprehensive medication guide to Spironolactone including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$15 copay for generic spironolactone on most commercial, Medicare Part D, and Medicaid plans; typically placed at Tier 1 with no prior authorization required.
Estimated Cash Pricing
$6–$37 retail for a 30-day supply of generic spironolactone tablets without insurance; as low as $2–$5 with a GoodRx or SingleCare coupon, or approximately $6.89 at Walmart's generic program.
Medfinder Findability Score
72/100
Summarize with AI
On this page
Spironolactone is a prescription medication classified as a mineralocorticoid receptor antagonist (MRA) and potassium-sparing diuretic. Originally developed in the late 1950s, it works by competitively blocking aldosterone receptors in the kidneys, preventing sodium and water retention while preserving potassium. It is also a nonselective androgen receptor blocker, giving it a broad range of clinical applications.
It was formerly sold under the brand name Aldactone (Pfizer, now discontinued for 25 mg and 100 mg tablets) and is currently available as the brand-name oral suspension CaroSpir (25 mg/5 mL). Generic spironolactone tablets (25 mg, 50 mg, 100 mg) are manufactured by multiple companies and widely available.
FDA-approved indications include heart failure (NYHA Class III-IV with reduced ejection fraction), hypertension (as add-on therapy), primary hyperaldosteronism, and edema associated with congestive heart failure, hepatic cirrhosis, and nephrotic syndrome. Off-label, it is widely prescribed for hormonal acne, female pattern hair loss, hirsutism, PCOS-related androgen excess, and gender-affirming hormone therapy in transgender women.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Spironolactone competitively blocks aldosterone receptors at the distal convoluted tubule and collecting duct of the kidneys. Aldosterone normally triggers sodium reabsorption (and potassium excretion) in this part of the kidney. By occupying these receptors without activating them, spironolactone prevents sodium and water retention, increases sodium excretion into urine, and retains potassium in the blood — hence the classification as a potassium-sparing diuretic.
Beyond diuresis, aldosterone at excessive levels causes cardiac and vascular inflammation, fibrosis, and remodeling. By blocking these effects, spironolactone delivers mortality benefit in heart failure beyond simple fluid removal. This is the basis of its proven survival benefit in the landmark RALES trial.
Spironolactone also binds to androgen receptors (and weakly to progesterone receptors), blocking the action of testosterone and DHT on target tissues. This anti-androgenic activity is responsible for its effectiveness in hormonal acne, hirsutism, and female pattern hair loss — conditions driven by excessive androgen stimulation of sebaceous glands and hair follicles.
25 mg — tablet
Most common starting dose for acne, hair loss, and heart failure. Generic available from multiple manufacturers.
50 mg — tablet
Common maintenance dose for acne, hirsutism, and hypertension. Well-stocked at most pharmacies.
100 mg — tablet
Used for heart failure, edema, and primary hyperaldosteronism. Some availability variation since Pfizer Aldactone discontinuation.
25 mg/5 mL — oral suspension
Brand-name CaroSpir only. More difficult to find and significantly more expensive. Not interchangeable with tablets.
Generic spironolactone tablets are generally available in the United States, but localized stock-outs occur — particularly for the 100 mg dose. The primary supply disruption is Pfizer's permanent discontinuation of brand-name Aldactone tablets in the 25 mg and 100 mg strengths. Patients who were prescribed Aldactone by brand should ask their pharmacy for generic spironolactone, which is equivalent and available from multiple manufacturers.
Demand has also increased substantially due to the boom in telehealth prescribing for hormonal acne and hair loss in women. The oral suspension (CaroSpir) is significantly harder to find and more expensive. Most patients can fill their generic tablet prescription without major difficulty, though some pharmacy-hopping may be required.
If you're having trouble finding spironolactone at your pharmacy, medfinder can call pharmacies near you to check which ones have your dose in stock, then text you the results.
Spironolactone is not a controlled substance, meaning it can be prescribed by any licensed healthcare provider with prescribing authority. No DEA number or special scheduling requirements apply. Prescriptions can be written for 30-day or 90-day supplies and transferred between pharmacies freely.
Cardiologists — for heart failure and cardiovascular indications
Nephrologists — for kidney disease, edema, and electrolyte management
Endocrinologists — for primary hyperaldosteronism and hormonal disorders
Primary Care Physicians (PCPs) — for hypertension, edema, and off-label uses
Dermatologists — for hormonal acne and female pattern hair loss
OB/GYN Physicians — for PCOS-related androgen symptoms, acne, hirsutism
Nurse Practitioners (NPs) and Physician Assistants (PAs) — across all specialties
Telehealth access is widely available for spironolactone, particularly for acne and hair loss indications. Platforms including Curology, Hers, Apostrophe, and Oana Health offer online consultations and can prescribe spironolactone for dermatologic and hormonal conditions. General telehealth services (Teladoc, MDLive, Amazon Clinic) can prescribe it for hypertension management in established patients.
No. Spironolactone is not classified as a controlled substance by the DEA. It has no abuse potential or dependence risk, and no special DEA scheduling restrictions apply to prescribing, dispensing, or filling spironolactone prescriptions.
Because it is not a controlled substance, spironolactone can be: prescribed in larger quantities (90-day supplies); refilled without count limitations; prescribed by any licensed prescriber with prescribing authority (physicians, NPs, PAs); and prescribed via telehealth without the additional restrictions that apply to Schedule II-V medications. Prescription transfers between pharmacies are also straightforward.
Hyperkalemia (elevated blood potassium) — the most important electrolyte side effect
Dizziness and orthostatic hypotension (lightheadedness on standing)
Frequent urination (diuretic effect)
Nausea, stomach cramps, or diarrhea
Headache and drowsiness
Gynecomastia and breast tenderness (especially in men at higher doses)
Menstrual irregularities in women (10-50% at moderate doses, nearly all at high doses)
Severe hyperkalemia — irregular heartbeat, muscle weakness, chest pain, tingling (call 911)
Worsening kidney function — decreased urination, leg swelling, fatigue
Severe electrolyte imbalances — hyponatremia, hypomagnesemia
Severe allergic reaction — hives, difficulty breathing, facial swelling (call 911)
Boxed Warning: Tumorigenicity — found in high-dose animal studies; clinical significance in humans at therapeutic doses is not established
Know what you need? Skip the search.
Eplerenone (Inspra)
More selective MRA with no androgenic side effects. FDA-approved for heart failure and hypertension. Less potent (requires 4x the dose) and more expensive. Preferred in men to avoid gynecomastia.
Amiloride (Midamor)
ENaC channel blocker with potassium-sparing effect. Effective for hypertension and edema but less potent than spironolactone. No anti-androgenic effects; affordable and well-tolerated.
Triamterene (Dyrenium)
Another ENaC blocker, often combined with hydrochlorothiazide (Dyazide/Maxzide). Useful for edema management. Minimal antiandrogenic effects.
Finerenone (Kerendia)
Non-steroidal MRA with high selectivity. FDA-approved for CKD associated with type 2 diabetes. No sex hormone effects. Much more expensive; not a first-line spironolactone substitute.
Prefer Spironolactone? We can find it.
ACE Inhibitors (lisinopril, enalapril, ramipril)
majorBoth raise potassium via different mechanisms. Combined use significantly increases hyperkalemia risk, especially with renal impairment. Monitor potassium closely.
ARBs (losartan, valsartan, irbesartan)
majorSame hyperkalemia risk profile as ACE inhibitors. Requires regular potassium and creatinine monitoring when combined.
Potassium supplements / salt substitutes
majorDangerous hyperkalemia risk. Avoid unless specifically directed by physician. Salt substitutes (NoSalt, Nu-Salt) contain potassium chloride.
Lithium
majorSpironolactone reduces renal clearance of lithium, causing increased blood levels and toxicity risk. Monitor lithium levels closely.
NSAIDs (ibuprofen, naproxen)
moderateReduces diuretic and antihypertensive efficacy; increases hyperkalemia risk. Avoid long-term or high-dose use. Acetaminophen is safer alternative.
Digoxin
moderateSpironolactone may increase digoxin levels by reducing its renal clearance. Monitor digoxin levels after initiating spironolactone.
Trimethoprim (Bactrim/Septra)
moderateTrimethoprim blocks potassium excretion in the kidney. Combined with spironolactone, significant hyperkalemia risk. Consider alternative antibiotics.
Heparin/Low molecular weight heparin
moderateBoth agents independently increase potassium. Monitor electrolytes closely in hospitalized patients on both.
Spironolactone is a versatile, affordable, and generally well-tolerated medication with over six decades of clinical use. Its FDA-approved indications span cardiovascular, renal, and endocrine medicine, and its anti-androgenic properties have made it indispensable in dermatology and women's health. Generic spironolactone is one of the most cost-effective prescriptions available, with out-of-pocket costs as low as $2 per month with discount cards.
The primary supply challenge in 2026 is Pfizer's discontinuation of brand-name Aldactone tablets. Generic spironolactone from multiple manufacturers remains available in the United States, and most patients can fill their prescriptions with modest effort. The critical safety considerations are monitoring potassium levels (especially in patients taking ACE inhibitors, ARBs, or with kidney disease) and avoiding potassium supplements and salt substitutes.
If you're having trouble finding spironolactone in stock, medfinder calls pharmacies near you to check availability and texts you the results — helping you find your medication without the phone-tree frustration.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini