Dermatologists love prescribing this drug, which can clear up acne in weeks — but some users say it made them anxious, dizzy, and pee all the time

• Spironolactone was designed to manage conditions like high blood pressure and heart failure.
• Because it can also help regulate hormones, it's often prescribed to treat acne.

When Courtney Sims started taking spironolactone a little over two years ago, she wasn't alone.

"I would say almost 70% of my friends take spironolactone and had really good results from it," Sims, 29, told Insider. Some "don't necessarily struggle with acne but just want that glow that spironolactone gives them," she said.

It's not just Sims' friends: As the rate of adult acne continues to rise, certain medications and treatments have gained cult followings. Spironolactone (known on TikTok as "spiro") is chief among them — even though it wasn't developed to clear up skin.

Spironolactone's main function is to manage conditions like high blood pressure and heart failure by regulating a hormone called aldosterone, which balances sodium and water levels in the kidneys.

Social media is flooded with before-and-after time-lapses and reviews that claim it was the only effective treatment after a lifetime of dealing with cystic acne.

In fact, it is something of an open secret among dermatologists, according to Dr. Ronda Farah, an associate professor of dermatology at the University of Minnesota Medical School. While "spiro" is not FDA-approved to treat acne, it is an appealing medication because of the "multiple positive things" it can do, Farah said — from clearing skin to regrowing hair on the scalp.

But there are some side effects. We spoke to three people, including Sims, about their experiences on the drug, and the unexpected symptoms they believe others should know about.

On spironolactone, you may need to pee — a lot

Spironolactone is a diuretic, so one of the most common side effects Farah's seen in patients is needing to pee more often. In her experience, none of her patients stopped the medication because of that.

For some, it's too much. "Not only did it not clear my skin, it caused frequent urination and anxiety," said Maria Marlowe, 36, who quit the medication after three months. "I felt like I was getting up from my desk once an hour to go."

Other reported side effects include dizziness, anxiety, and fatigue

Jen Darnell, 40, who was prescribed spironolactone to treat oily skin, said the medication did make her skin less oily — but she started developing "huge, painful cystic acne" on her jawline and neck.

But "the worst was the anxiety and fatigue," said Darnell, who took spironolactone at night because of the tiredness she'd feel — only to "wake up in the middle of the night with anxiety and a rapid heartbeat." Her heart "felt like it was coming out of her chest," an experience she hadn't had before taking the medication.

Sims, who initially noticed clearer skin once she upped her medication dosage, said she also experienced multiple side effects, including fatigue, dehydration, trouble sleeping, dizziness, and even fainting.

"I got up to go to the bathroom and right as I stood up I just knew something was very off," said Sims."I'm pretty sure I blacked out — I just fell backward, hit the floor, woke up, and my mom came over screaming 'Oh my God, are you okay?'"

Lowering your dose or going off spironolactone can also bring your acne back

Unlike Accutane, spironolactone is meant to be taken long-term. That's why lowering your dose or stopping entirely can cause your acne to return, Farah explained.

In Sims's case, she tried lowering her dosage first, but she says the acne came back "so much worse" than before, which led her to quit the medication altogether.

It's now been two months since she "cold-quit" and she reported her skin is "completely cleared and back to normal." She believes it's because spironolactone made her already dryness-prone skin feel even drier.

Some side effects can be temporary, but more serious ones mean you should talk to your doctor

"I typically tell my patients it's going to take three months to see an initial response," said Farah, who also encourages patients to reach out to their dermatologists if they experience an acne flare-up or other side effects on the medication so they can adjust the dosage.

For some, the benefits of spironolactone don't outweigh the side effects. While Darnell's skin became less oily after starting on spironolactone, in the end, she went off it: "I'd rather have a slick forehead and huge pores."