Does spironolactone cause weight gain?

If you’re like most of us, you want to know the side effects before using any medication. When researching spironolactone’s side effects, one question that may pop into your head is, “Does spironolactone cause weight gain?” 

The short answer: No, spironolactone doesn’t typically cause weight gain. In fact, some studies suggest it may lead to mild weight loss because of its water-flushing effect. (Think: You may lose water weight.) 

However, some people anecdotally report gaining weight on spironolactone. This is usually thought to be linked to health conditions they already had, like polycystic ovary syndrome (PCOS) or heart failure, rather than the medication itself.

Keep reading to learn more about spironolactone and weight gain.

Spironolactone isn’t likely to cause weight gain. In fact, weight gain is not listed as a side effect in the prescribing information for spironolactone. Still, some people report gaining weight on the medication. So, what’s going on?  

Spironolactone can affect hormones, which can increase breast tissue in individuals assigned male at birth (typically men). So it’s possible men could increase a small amount of weight due to increased breast tissue. But the effect on total body mass has not been found to be significant enough to be listed on the FDA drug label.

Weight gain on spironolactone is more likely due to the underlying health condition being treated, rather than the medication itself. 

PCOS, for example, can cause hormone imbalance in the body, including higher-than-average levels of androgens (male sex hormones). Androgens can make it harder to lose weight. In women with PCOS, higher androgen levels are also correlated with higher intra-abdominal fat. 

PCOS can also cause insulin resistance, making it harder for the body to use sugar for energy. This can lead to changes in appetite and, indirectly, weight gain. 

Heart failure, another condition treated with spironolactone, can also cause weight gain while on the medication. 

People with heart failure can sometimes put on excess water weight. Spironolactone usually helps decrease excess water weight. So if you notice fluid retention or water weight after starting the medication, it’s probably not caused by the medication itself and is more likely due to your underlying heart failure. 

TL;DR: Spironolactone itself does not cause weight gain. If you notice weight gain, it may be the result of your chronic health condition(s) that need to be addressed, rather than directly due to the effects of spironolactone.

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Spironolactone can cause weight loss largely due to its diuretic effect. But that does not mean spironolactone is a weight loss drug. 

The way spironolactone works is by flushing out extra fluids from the body (specifically, water and sodium). In theory, this means you could lose weight while on spironolactone, but it would be water weight — not fat loss. 

Research does suggest spironolactone may cause mild weight loss in people with heart failure. But the data is less clear on whether or not spironolactone contributes to weight loss in PCOS. 

Spironolactone isn’t a magic weight loss solution. When studies show the medication can cause weight loss, it’s usually a small amount and mostly from shedding excess water weight. 

Water weight naturally fluctuates, and to experience long-lasting weight loss, it’s often better to focus on losing fat than water weight. 

Some people may gain weight on spironolactone while others may lose it. Here are some of the reasons for weight changes on spironolactone:  

• Breast tissue growth. Some people may experience minor weight gain on spironolactone due to one of the side effects of the drug: breast tissue growth in men (aka gynecomastia). While it’s possible this side effect could cause minor weight changes, it is unlikely to be that big of a contributor to weight gain. 

• Underlying health conditions. Conditions for which spironolactone is used can cause weight gain in and of themselves. These include PCOS and heart failure. 

• Reduction in excess water weight. One of spironolactone’s jobs is to help get rid of excess fluid from the body. This can lead to a reduction in water weight, which can cause temporary weight loss. 

At this point, you’ve probably figured out what spironolactone is used for. But here’s a review of what this medication does in the body and what conditions it treats. 

Spironolactone is a prescription medication approved by the US Food and Drug Administration (FDA). 

It’s a diuretic — aka “a water pill” — that helps flush extra fluid and sodium from the body, without causing you to lose too much potassium. (This is important because other diuretic medications can cause you to lose potassium. Your body needs potassium to ensure normal function of your muscles, nerves, and heart.) 

Spironolactone is used to treat different health conditions. It is FDA-approved for the treatment of:

• Add-on therapy for high blood pressure (hypertension) 

• Certain types of heart failure

• Primary hyperaldosteronism (a type of hormone disorder that can cause high blood pressure)

• Swelling from certain health conditions, like kidney or liver damage

Sometimes, your healthcare provider might prescribe this medication off-label. Meaning, it’ss used to treat a condition that’s different from those approved by the FDA. 

Since spironolactone blocks the effects of androgens, or male sex hormones, it might be prescribed off-label for conditions like: 

• Polycystic ovary syndrome (PCOS)

• Hirsutism (excess hair growth on the face, chest, and back)

• Acne

• Female pattern hair loss 

Spironolactone usually comes as tablets in 25 mg, 50 mg, and 100 mg strengths. 

As a prescription medication, you can only get spironolactone with an Rx from a licensed healthcare provider. 

Like any medication, spironolactone comes with some side effects and risks. Possible side effects include:

• Hyperkalemia (or high potassium), which is why some healthcare providers want you to get bloodwork while on the medication

• Low blood pressure, especially if combined with other blood pressure medicines

• Other electrolyte disturbances, such as changes in your sodium or magnesium levels

• Gynecomastia (or enlarged breasts)

• Breast tenderness

Additional adverse effects are possible but are less likely. 

These side effects include:

• Gastrointestinal issues, such as abdominal cramps or pain, diarrhea, cramping, nausea, vomiting, and, in some cases, gastric bleeding

• Decreased sex drive (aka low libido) 

• Difficulty getting or keeping an erection

• Irregular periods or postmenopausal bleeding

• Leg cramps

When spironolactone is prescribed in women, it is usually done alongside hormonal birth control. There are a couple of reasons for this:

• Spironolactone can increase the risk of birth defects, especially in the early stages of development. (That’s why it’s not recommended to get pregnant while on the medication.)

• Hormonal birth control can decrease certain side effects of spironolactone, such as menstrual irregularities and breast tenderness. 

For complete details about spironolactone side effects, see the drug label. Not sure if a symptom is a side effect? Talk to your healthcare provider. Experiencing a serious concern? Seek immediate medical attention. Planning on becoming pregnant? Tell your provider so spironolactone can be safely stopped before conception.

If you are taking spironolactone and gaining weight, it’s always a good idea to contact your healthcare provider. They can help you figure out what might be causing the increased weight and come up with a plan to address it. 

There are also other science-backed methods to prevent or reduce weight gain while on spironolactone. 

Eat a balanced diet

This tip may sound cliché, but it’s a classic for a reason: eating a nutritious diet can help you lose weight and keep it off. For the most success, keep the following recommendations from the most recent Dietary Guidelines for Americans in mind:

• Eat more fruits, vegetables, and whole grains. But try to avoid eating large amounts of high-potassium foods like bananas and potatoes, especially if your levels are high. Consuming too much potassium while on spironolactone can raise potassium in your body to dangerous levels. If you are concerned about your potassium levels while on the medication, you can ask your healthcare provider to check them periodically. 

• Add lean protein to most meals. Some good sources of protein include poultry, beans, peas, peanuts, soy, eggs, and seafood.

• Limit foods and drinks high in sodium, saturated fats, and added sugars. These include sodas, fast food, baked goods, and canned soups. Really fancy French fries and a burger? Make ‘em at home to dial down the heavy oils and extra salt. Eating too much salt can result in swelling, especially for those with conditions such as heart failure. This swelling can result in weight gain.

• Swap out ultra-processed foods for whole foods whenever possible. Instead of potato chips, snack on some nuts and air-popped popcorn. Another good trade is candy for a frozen banana dipped in some dark chocolate. 

Move your body

Getting regular physical activity can help prevent weight gain on spironolactone and in general. Plus, it is essential for losing weight and keeping it off. 

Aim for at least 150 minutes of moderate aerobic activity (e.g. biking, brisk walking) per week, as recommended by the Centers for Disease Control and Prevention (CDC). You should also incorporate strength training at least twice per week. 

Depending on the reason spironolactone is prescribed, regular exercise may also help treat your underlying health condition. Working out can help manage PCOS symptoms and may prevent future heart problems. 

Always clear changes to your exercise routine with your healthcare provider, especially if you have issues with heart health. 

Prioritize sleep 

Sleep is important for your overall health, but it can also help prevent spironolactone weight gain. This is because sleep helps regulate the hormones that control appetite and metabolism. 

Without enough shut-eye, your body will make less leptin — the hormone that tells your body it’s full — and more ghrelin — the hunger hormone. This can cause you to feel hungrier and lead to overeating. 

Getting less sleep can also cause inflammation in the body, which is a risk factor for obesity and other health conditions. Those who live with PCOS often have chronic mild inflammation levels in their body all the time as a result of the disease. This can make hormone imbalances worse, leading to weight gain. 

So how much beauty sleep should you aim for each night? While the exact number depends on your age, most adults should try to catch 7–9 hours of zzz’s per night.  

Manage stress

High levels of cortisol, the stress hormone, have been shown to increase belly fat and raise blood sugar levels — two factors that can lead to weight gain.  

Over the long term, high cortisol levels can promote cravings for “comfort foods,” which are typically higher in fat and sugar. This can increase the chances of overeating and, as you probably guessed, weight gain. 

Stress can also increase inflammation and cause damage in the body, which may lead to excess weight.

The good news? There are plenty of ways you can manage your stress, including:

• Mindfulness exercises

• Deep breathing

• Seeing a mental health professional (e.g. therapist) 

• Journaling 

• Meditation

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So, can spironolactone cause weight gain? No, the medication itself hasn’t been shown to have this effect. In some cases, spironolactone may even cause weight loss by eliminating excess water from the body. Here’s what to keep in mind when it comes to spironolactone and weight gain. 

• Weight gain isn’t listed as a side effect of spironolactone on the drug’s prescribing information. Spironolactone is unlikely to cause weight gain directly. 

• If you experience weight gain on spironolactone, it’s likely the result of an underlying health condition, such as PCOS or some forms of heart failure. (The drug is often prescribed off-label for the former and FDA-approved for the latter.) 

• Spironolactone may cause slight, temporary weight loss likely because it flushes salt and liquid from the body, which can lead you to lose water weight. 

• It’s always a good idea to consult your healthcare provider if you’re experiencing unexpected symptoms, such as weight gain while taking spironolactone. This is especially true when you notice weight gain in certain areas, like breast tissue. 

• To prevent and stop weight gain on spironolactone (and in general), consider lifestyle changes, including getting enough sleep, moving your body regularly, and eating a balanced diet.