Helfer E L, Miller J L, Rose L I
Department of Medicine, Hahnemann University School of Medicine, Philadelphia, Pennsylvania 19102.
J Clin Endocrinol Metab. 1988 Jan;66(1):208-11. doi: 10.1210/jcem-66-1-208.
Spironolactone, an aldosterone antagonist with antiandrogenic activities, is often used to treat hirsute women. Several investigators have reported beneficial effects of such treatment, but the dosages used and side-effects encountered differ in their reports. To clarify this issue, 26 consecutive premenopausal women with idiopathic hirsutism were prospectively evaluated during spironolactone treatment. Sixteen women initially received 100 mg spironolactone twice daily on days 4-21 of their menstrual cycles. In 11 women (68%), the dosage had to be decreased or the medication discontinued due to side-effects. The major side-effect, metrorrhagia with 14-day cycles, occurred in 9 women (56%). This side-effect, while not dangerous, was intolerable to these women. In one woman, spironolactone was discontinued because of urticaria and in another because of scalp hair loss. Ten women initially received 50 mg spironolactone twice daily on days 4-21 of their menstrual cycles. Two developed metrorrhagia, but no other side-effects were noted. Because of the incidence of metrorrhagia at higher dosages, we recommend that spironolactone be administered cyclically at a starting dosage of 50 mg twice daily on days 4-21 of the menstrual cycle. Alternatively, one may consider adding cyclical estrogen/progesterone therapy to continuous spironolactone therapy.
螺内酯是一种具有抗雄激素活性的醛固酮拮抗剂，常用于治疗多毛症女性。几位研究者报告了这种治疗的有益效果，但他们报告中使用的剂量和遇到的副作用有所不同。为了阐明这个问题，对26名连续的特发性多毛症绝经前女性在螺内酯治疗期间进行了前瞻性评估。16名女性在月经周期的第4 - 21天最初每天两次服用100毫克螺内酯。11名女性（68%）因副作用不得不减少剂量或停药。主要副作用是周期为14天的子宫出血，9名女性（56%）出现这种情况。这种副作用虽然不危险，但这些女性无法忍受。有一名女性因荨麻疹停用螺内酯，另一名因头皮脱发停药。10名女性在月经周期的第4 - 21天最初每天两次服用50毫克螺内酯。两名出现子宫出血，但未观察到其他副作用。由于高剂量时子宫出血的发生率，我们建议在月经周期的第4 - 21天以每天两次50毫克的起始剂量周期性服用螺内酯。或者，也可以考虑在持续螺内酯治疗的基础上增加周期性雌激素/孕激素治疗。
