Alcohol and Spironolactone — what you need to know

Taking spironolactone and wondering if that glass of wine is OK? Short answer: small amounts of alcohol may be tolerated by some people, but there are real risks you should know about before you drink. Spironolactone is a potassium-sparing diuretic used for blood pressure, heart failure, acne, and hormone-related issues. It affects blood pressure, electrolytes (especially potassium), and can cause dizziness—things alcohol can make worse.

Why they can interact

Alcohol is a vasodilator and can lower blood pressure. Spironolactone can also lower blood pressure and cause lightheadedness. Drinking while on spironolactone increases the chance you’ll feel dizzy, faint, or fall—especially when you first start the drug or after a dose change. Spironolactone raises potassium levels. Severe hyperkalemia (high potassium) can be dangerous for the heart. Heavy drinking can dehydrate you or damage kidneys and liver over time, which makes it harder for your body to control potassium and remove drugs. If you already take other medicines that raise potassium (ACE inhibitors, ARBs, some NSAIDs), the combined effect can be risky.

Practical advice you can use

1) Talk to your prescriber. Before drinking, ask whether spironolactone is a concern in your specific case—especially if you have kidney or liver disease, heart failure, or take other meds that affect potassium.

2) Get blood tests. Have your potassium and kidney function checked after you start spironolactone or after any dose change. Many clinicians check labs within a week or two of starting, then periodically. If your potassium is high, avoid alcohol until your doctor says it’s safe.

3) Avoid heavy or binge drinking. Occasional light drinking may be okay for some people, but heavy drinking raises dehydration, blood pressure swings, and organ damage risks. Those effects increase the chance of dangerous potassium shifts and fainting.

4) Watch for warning signs. Stop drinking and seek care if you have severe dizziness, fainting, palpitations, muscle weakness, or numbness—these could be signs of low blood pressure or high potassium.

5) Skip potassium supplements and salt substitutes unless approved. Some salt substitutes contain potassium and can push your levels too high when combined with spironolactone.

6) Be careful with activities. If you drink while starting spironolactone, avoid driving or operating machinery until you know how the combo affects you—dizziness and slowed reaction times are common culprits in accidents.

If you want a clear next step: ask your clinician whether a short break from alcohol is wise when starting or changing your spironolactone dose, get blood tests to check potassium and kidney function, and avoid heavy drinking. Those steps keep you safer and make it easier to enjoy a social drink without surprises.