Spironolactone
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
- Spironolactone
- Spironolactone: From Hypertension and Heart Failure to Hypotrichosis Simplex of the Scalp
Spironolactone: From Hypertension and Heart Failure to Hypotrichosis Simplex of the Scalp
One-Sentence Summary
Spironolactone is an aldosterone-blocking diuretic, originally used for hypertension, heart failure and aldosterone-excess conditions such as primary aldosteronism. The TxGNN model predicts it may be effective for hypotrichosis simplex of the scalp, a hereditary hair-loss disorder. There are currently 0 clinical trials and 0 publications for this specific indication, so the prediction rests on the model score alone.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Hypertension, congestive heart failure, primary aldosteronism (from the knowledge graph; the Singapore licence records contain no indication text) |
| Predicted New Indication | Hypotrichosis simplex of the scalp |
| TxGNN Prediction Score | 99.26% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 7 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Spironolactone is known to block the mineralocorticoid (aldosterone) receptor, which explains its use in hypertension and heart failure. It also has anti-androgenic activity, meaning it blocks the androgen receptor and reduces androgen synthesis. This is the most plausible link to hair loss, because it is the basis for using spironolactone in androgen-driven hair loss such as female pattern hair loss.
The mechanistic fit for this particular prediction is weak. Hypotrichosis simplex is a hereditary disorder linked to gene variants (for example CDSN, APCDD1 and RPL21), not to androgen activity. The high score probably reflects the drug's network proximity to other hair-loss conditions in the knowledge graph, not a direct biological rationale. It should be treated as a hypothesis, not a finding.
A different hair-loss entity in the same prediction list, general alopecia (TxGNN score 97.8%), has stronger support. It has a completed Phase 2 trial (NCT00175617, n=40) comparing spironolactone with topical minoxidil in female pattern hair loss, although no results were provided. That is a better-grounded direction than the top-ranked prediction.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
Currently no related literature available.
Singapore Market Information
Seven oral spironolactone products hold valid single-ingredient licences in Singapore, and none are cancelled. The licence records contain no approved indication text. The five listed below are a selection of the seven.
| Authorization Number | Product Name | Dosage Form |
|---|---|---|
| SIN02222P | Aldactone Tablet 25 mg | Tablet |
| SIN16711P | Spiridon Tablets 25 mg | Tablet |
| SIN16710P | Spiridon Tablets 50 mg | Tablet |
| SIN16709P | Spiridon Tablets 100 mg | Tablet |
| SIN02153P | Spirolon 25 Tablet 25 mg | Film-coated tablet |
Safety Considerations
- Contraindications flagged in the knowledge graph (these come from drug-disease relationship data, not from package insert text): kidney disease, anuria, potassium deficiency, diabetes mellitus, diabetic ketoacidosis, gout, hyperuricaemia, hepatic coma and hepatic encephalopathy, pancreatitis, systemic lupus erythematosus, hyperparathyroidism, hypercalcaemia, nephrocalcinosis, phosphorus metabolism disease, osteitis fibrosa, neonatal jaundice, and pyoureter.
- Drug interactions: 100 interactions were found; the first 20 were reviewed. The only Major one among them is loperamide. Moderate interactions include:
- corticosteroids (hydrocortisone, dexamethasone, betamethasone, triamcinolone, budesonide)
- metformin
- SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin)
- exenatide
- bupropion
- morphine
Please refer to the package insert for the official warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction has no supporting trials or literature, and the mechanism is a poor fit for a hereditary, non-androgen-driven hair disorder. The anti-androgen rationale applies better to androgenetic alopecia, which is a separate indication.
To proceed, the following is needed:
- Any clinical or genetic evidence linking spironolactone to hypotrichosis simplex, or a decision to evaluate the better-supported alopecia indication instead
- Results or publication of NCT00175617 (spironolactone vs topical minoxidil in female pattern hair loss) if the alopecia direction is pursued
- Detailed mechanism of action data
- Package insert warnings and contraindications for Singapore-registered products
- A safety plan covering potassium and kidney function monitoring and key drug interactions, especially in women of childbearing potential given the anti-androgenic effects
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.