What happens when you take spironolactone with licorice?
Spironolactone (Aldactone, CaroSpir) is a mineralocorticoid receptor antagonist. It blocks the hormone aldosterone at its receptor in the kidney, which lowers blood pressure and helps the body hold onto potassium while letting go of sodium and water. Real licorice activates that very same receptor from a different angle, so the two end up working against each other.
- You take spironolactone, which sits on the mineralocorticoid receptor in the kidney and keeps aldosterone from switching it on.
- You also take real licorice (Glycyrrhiza glabra or Glycyrrhiza uralensis), which contains glycyrrhizin. Your body converts glycyrrhizin into glycyrrhetinic acid.
- Glycyrrhetinic acid blocks a kidney enzyme called 11-beta-hydroxysteroid dehydrogenase type 2, whose normal job is to inactivate cortisol in kidney tissue.
- With that enzyme inhibited, cortisol builds up locally and starts stimulating the same mineralocorticoid receptor that spironolactone is trying to keep quiet.
- The net effect is a tug-of-war: licorice pushes toward sodium and water retention, higher blood pressure, and potassium loss, while spironolactone pushes the other way. Licorice can partially neutralize the drug's blood-pressure-lowering and diuretic effect, a state doctors call pseudoaldosteronism or apparent mineralocorticoid excess.
Why is this important?
This matters because licorice exposure is often hidden, and because the two substances cloud the signals doctors rely on to judge whether spironolactone is working.
The first issue is blunted blood-pressure control. A patient who is stable on spironolactone may notice blood pressure creeping up or swelling returning after adding licorice, even though nothing about the prescription changed.
The second is confused potassium monitoring. Spironolactone tends to raise potassium; licorice tends to lower it. Taking both can make potassium readings harder to interpret and harder to predict.
The third is hidden exposure. Many people do not realize they are taking a pharmacologically active substance. Licorice turns up in digestive blends, adrenal or cortisol-support formulas, throat lozenges and cough syrups, traditional Chinese medicine formulas (gan cao appears in many recipes), and authentic European, Dutch, Italian, and Scandinavian candy.
Finally, licorice can cause trouble on its own. Even without any medication, regular intake of real licorice has been linked to high blood pressure, low potassium, fluid retention, and heart-rhythm problems. In someone on spironolactone, those effects layer on top of an already complex picture.
What should you do?
The core principle is simple: treat licorice as a medication-relevant exposure, not a snack, and make changes with your prescriber rather than on your own.
Before you change anything:
- Tell your prescriber and pharmacist about every licorice-containing product you take, including teas, candies, lozenges, and herbal or adrenal-support blends.
- Read labels for Glycyrrhiza, licorice extract, or glycyrrhizin before assuming a product is safe.
- If you take licorice for digestive symptoms, ask your pharmacist about deglycyrrhizinated licorice (DGL), which has the glycyrrhizin removed and does not cause pseudoaldosteronism.
Every day while on spironolactone:
- Avoid glycyrrhizin-containing licorice root supplements, licorice teas, and adrenal-support blends.
- Check candy carefully. Most U.S. "licorice" candy (such as Twizzlers) is flavored with anise and contains no glycyrrhizin, while authentic European-style licorice usually does.
- Keep an eye on the symptoms your spironolactone is meant to control, such as blood pressure or swelling.
After any change (starting, stopping, or switching licorice products):
- If your blood pressure or swelling worsens unexpectedly on stable spironolactone, ask about hidden licorice sources before assuming the drug stopped working.
- Let your doctor decide whether you need a potassium check or any dose review; do not adjust your spironolactone yourself.
Which specific products are affected?
The interaction applies to any product that delivers real glycyrrhizin from licorice root.
Glycyrrhizin-containing licorice to be cautious with:
- Licorice root teas (for example, Yogi Egyptian Licorice, Traditional Medicinals Organic Licorice Root)
- Bulk licorice root powder and capsules
- Traditional Chinese medicine formulas containing gan cao, and Japanese kampo formulas
- Throat-coat blends and licorice-containing cough syrups and lozenges
- Authentic European, Dutch, Italian, and Scandinavian licorice candy
The drug side of this interaction includes all mineralocorticoid receptor antagonists: spironolactone (Aldactone, CaroSpir), eplerenone (Inspra), and finerenone (Kerendia), plus combination products such as spironolactone with hydrochlorothiazide (Aldactazide).
Generally not a concern: deglycyrrhizinated licorice (DGL), because the glycyrrhizin has been removed; and most U.S. "licorice" candy like Twizzlers, which is anise-flavored and contains no glycyrrhizin.
The science behind it
The mechanism and the clinical picture are well described in the medical literature.
A 2019 review in Frontiers in Endocrinology (Sabbadin and colleagues) lays out how glycyrrhizin's active metabolite inhibits 11-beta-hydroxysteroid dehydrogenase type 2, allowing cortisol to activate the mineralocorticoid receptor and produce a pseudoaldosteronism syndrome of higher blood pressure, sodium retention, and potassium loss. The same review notes that this is why licorice can work against drugs aimed at that receptor.
A narrative review of licorice-induced pseudoaldosteronism (Yoshino and colleagues, PMC8484325) summarizes the clinical risk factors and confirms that the effect is driven by glycyrrhizin and its metabolites acting on the same pathway.
On the mechanistic side, an interventional study by Quaschning and colleagues (Hypertension, 2001) showed that blocking the aldosterone receptor can normalize vascular function in licorice-induced hypertension, demonstrating directly that the two act on a shared receptor system. This is the same logic by which spironolactone can be used to treat licorice-induced pseudoaldosteronism, and the same reason licorice can blunt spironolactone when taken alongside it.
Frequently Asked Questions
Is Twizzlers-type candy a problem with spironolactone?
Generally no. Most U.S. "licorice" candy such as Twizzlers is flavored with anise and contains no glycyrrhizin, so it does not trigger this interaction. The concern is real licorice root, which is common in authentic European-style candy. Check the label if you are unsure.
Can I still use licorice for heartburn or an upset stomach?
Ask your pharmacist about deglycyrrhizinated licorice (DGL). DGL has had the glycyrrhizin removed, so it does not cause pseudoaldosteronism and does not work against spironolactone in this way.
How would I know if licorice is interfering with my spironolactone?
Signs can include blood pressure creeping back up, swelling returning, or potassium readings shifting despite no change in your prescription. If that happens, mention any licorice products to your doctor before changing your dose.
If spironolactone is sometimes used to treat licorice toxicity, can they just cancel each other out safely?
They do act on the same receptor in opposite directions, which is why doctors sometimes use spironolactone to treat licorice-induced pseudoaldosteronism. But you should not rely on that to balance a hidden licorice habit; it makes your therapy unpredictable. Let your doctor manage both deliberately.
Does licorice tea count, or only supplements?
Licorice root tea counts. Brewed licorice root delivers glycyrrhizin just as supplements and candy do, so the same caution applies.
Should I stop my spironolactone if I have been eating licorice?
No. Do not stop or change your spironolactone on your own. Stop the licorice product and tell your doctor or pharmacist, who can decide whether any monitoring or dose review is needed.
Key takeaways
- Licorice activates the same mineralocorticoid receptor that spironolactone blocks, so real licorice can partially blunt the drug's blood-pressure and diuretic effect.
- The culprit is glycyrrhizin; deglycyrrhizinated licorice (DGL) does not cause this problem.
- Licorice hides in teas, candy, lozenges, cough syrups, and herbal or adrenal-support blends, so read labels.
- Most U.S. "licorice" candy like Twizzlers is anise-flavored and is not a concern.
- If blood pressure or swelling worsens unexpectedly, consider hidden licorice before assuming the drug failed, and review changes with your doctor or pharmacist rather than adjusting the dose yourself.