Drospirenone
A spironolactone-derived progestin with anti-androgenic and anti-mineralocorticoid (potassium-sparing) activity. Used in combined pills (Yasmin/Yaz) and progestin-only pills; favoured where anti-androgenic effect on acne is desired.
01 Overview
Drospirenone is an atypical progestin derived from spironolactone. It combines progestogenic activity with anti-androgenic and anti-mineralocorticoid effects, which counter estrogen-related fluid retention and improve acne and mild hirsutism. It is the progestin in Yasmin, Yaz and the progestin-only Slynd.
Because of its potassium-sparing action it can raise serum potassium, so caution is needed with renal impairment or other potassium-raising drugs. Combined pills containing drospirenone carry a somewhat higher VTE risk than levonorgestrel-based pills.
02 Mechanism
Progesterone-receptor agonist that also antagonises androgen and mineralocorticoid receptors, reducing sebum, fluid retention and androgenic symptoms.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Combined pill | 3–4 mg/day | Oral | 3 mg with EE (Yasmin/Yaz); 4 mg progestin-only (Slynd). |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Improved acne / anti-androgenic effectReduces acne and androgenic skin symptoms. | Clinical | ||
| Reduced fluid retentionAnti-mineralocorticoid action limits estrogen-related bloating. | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| HyperkalaemiaPotassium-sparing effect can raise serum potassium, risky with renal impairment. | Moderate | Uncommon | Clinical | |
| Venous thromboembolismCombined drospirenone pills carry higher VTE risk than levonorgestrel pills. | Severe | Uncommon | Clinical |