What dosing range of spironolactone do you prescribe for hormonal acne?  

First of all, remember that all acne is hormonal, and probably just about any woman with acne can benefit from spironolactone. My dosage range is 25mg-100mg per day, either QD or divided BID (for the higher doses). I have preferred to start low and pull the dose up after a few weeks. We do know that...

I most commonly prescribe 50-100mg daily, but I may titrate up to 150mg occasionally as needed. I prefer QAM dosing to minimize diuresis in the evening. I find that starting at 25mg and up-titrating by 25mg weekly leads to better tolerability, especially when it comes to orthostasis and dizziness.

I prescribe 100mg tabs and tell patients to split it and take 1/2 (50mg) for the first 1-2 weeks. If no side effects (lightheadedness mainly) then increase to 100mg daily. Most patients in my experience clear well on 100mg and tolerate. Some folks can’t tolerate this dose but might do ok on 50...

100 qd with food. AEs are really rare.

I start at 50mg x 7 days and if tolerating (no dizziness etc) then I increase to 100mg thereafter. Most of my patient's do well at 100mg but I do increase the dose until the patient is clear if needed.