What happens when you take spironolactone with licorice?
Spironolactone (Aldactone, CaroSpir) is a mineralocorticoid receptor antagonist. It blocks aldosterone at its receptor in the kidney's collecting duct, lowering blood pressure and helping the body retain potassium while excreting sodium and water.
Licorice root (Glycyrrhiza glabra or Glycyrrhiza uralensis) contains glycyrrhizin, which is metabolized to glycyrrhetinic acid. Glycyrrhetinic acid inhibits the enzyme 11-beta-hydroxysteroid dehydrogenase type 2 (11-beta-HSD2), which normally inactivates cortisol in the kidney. When that enzyme is blocked, cortisol accumulates and stimulates the same mineralocorticoid receptor that spironolactone is trying to block. The result is sodium retention, water retention, rising blood pressure, and potassium excretion - a syndrome called pseudoaldosteronism or apparent mineralocorticoid excess.
The two substances pull on the same lever in opposite directions. Licorice activates the receptor; spironolactone blocks it. In practice, licorice partially neutralizes spironolactone's antihypertensive and diuretic effect.
Why is this important?
The clinical pattern from the medical literature is reasonably consistent: patients on stable spironolactone who add licorice may see their blood pressure climb, their edema return, or their potassium drift back down despite continued therapy. Conversely, in rare cases, spironolactone is actually used to treat licorice-induced pseudoaldosteronism, because it directly antagonizes the receptor that cortisol is improperly stimulating - so the two drugs can offset each other.
The reason this matters for the everyday spironolactone user is that licorice exposure is often hidden. People take licorice for:
- Digestive complaints (heartburn, peptic ulcer disease, IBS)
- Adrenal-fatigue or cortisol-support blends
- Sore throat (licorice extract in cough syrups and throat lozenges)
- Traditional Chinese medicine formulas (gan cao is in many recipes)
- Authentic European licorice candy and Dutch drop
Many patients do not realize these products contain a pharmacologically active substance. Long-term, high-dose licorice intake has caused hypertension, hypokalemia, edema, and arrhythmia even in people not taking any other medication. In a spironolactone user, it both worsens blood pressure control and adds confusion to potassium monitoring.
What should you do?
Treat licorice as a medication-relevant exposure, not a snack.
- Avoid licorice root supplements, licorice tea, and adrenal-support blends that contain Glycyrrhiza glabra or G. uralensis while you are on spironolactone.
- Read candy labels. Most U.S. "licorice" candy (such as Twizzlers) is flavored with anise and contains no glycyrrhizin. Authentic European, Dutch, Italian, and Scandinavian licorice almost always contains real glycyrrhizin.
- Check throat lozenges, cough syrups, and digestive blends for Glycyrrhiza, licorice extract, or DGL.
- If you need licorice for digestive use, choose deglycyrrhizinated licorice (DGL). DGL has had the glycyrrhizin removed and does not cause pseudoaldosteronism. Brands include Enzymatic Therapy DGL, Natural Factors DGL, and Rhizinate.
- Tell your prescriber and pharmacist about any licorice product you take.
- If your blood pressure or edema worsens unexpectedly on stable spironolactone, ask about hidden licorice sources before changing your drug dose.
- If licorice-induced hyperkalemia rebound or paradoxical potassium swings occur, get a serum potassium check before adjusting anything.
Which specific products are affected?
The interaction applies to all glycyrrhizin-containing licorice: licorice root tea (Yogi Egyptian Licorice, Traditional Medicinals Organic Licorice Root), bulk licorice root powder, traditional Chinese medicine formulas containing gan cao, Japanese kampo formulas, throat coat blends, and authentic licorice candy. Deglycyrrhizinated licorice (DGL) is not affected.
The drug side of the interaction includes all mineralocorticoid receptor antagonists: spironolactone (Aldactone, CaroSpir), eplerenone (Inspra), and finerenone (Kerendia), plus combination products such as spironolactone/hydrochlorothiazide (Aldactazide).
The bottom line
Licorice activates the mineralocorticoid receptor that spironolactone is trying to block, so the two work against each other - licorice can blunt the blood-pressure-lowering and diuretic effect of spironolactone. Avoid glycyrrhizin-containing licorice products while on spironolactone, and use DGL if you need licorice for digestive symptoms.