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Drug Treatments for Polycystic Ovary Syndrome

Table 1
Medications Used to Treat Manifestations of Polycystic Ovary Syndrome

FDA APPROXIMATE
MANIFESTATIONS MAIN ADVERSE TYPICAL
MEDICATION DESCRIPTION PREGNANCY MONTHLY
TREATED EFFECTS DOSAGE
CATEGORY COST*

First-line

Clomiphene Ovulation induction Infertility X Multiple 50 to 100 $52 (generic)


(Clomid)† agent pregnancy/ovarian mg per and $128
hyperstimulation, day6–8 (brand) for 100
thromboembolism, mg per day for
visual disturbances 5 days

Eflornithine Inhibits hair growth Hirsutism C Mild skin irritation 13.9% $46 (brand) for
(Vaniqa)‡ cream one 30-g tube
applied to
face twice
per day9

Metformin Insulin-sensitizing Hirsutism; B GI upset, lactic 1,500 to $73 (generic)


(Glucophage)§ agent infertility; insulin acidosis, increase in 2,250 mg and $107
resistance; homocysteine levels per day10–16 (brand) for 850
menstrual mg twice per
irregularities day

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FDA APPROXIMATE
MANIFESTATIONS MAIN ADVERSE TYPICAL
MEDICATION DESCRIPTION PREGNANCY MONTHLY
TREATED EFFECTS DOSAGE
CATEGORY COST*

Oral — Hirsutism; X Nausea, headache, Varies Varies


contraceptives§|| menstrual spotting,
irregularities thrombophlebitis,
deep venous
thrombosis

Pioglitazone Insulin-sensitizing Hirsutism; C CHF, may cause 30 mg per $199 (brand)


(Actos)§ agent infertility; insulin weight gain day14,17,18
resistance

Rosiglitazone Insulin-sensitizing Hirsutism; C CHF, hepatotoxicity, 2 to 8 mg $113 (brand)


(Avandia)§ agent infertility; insulin edema, increase in per day for 4 mg per
resistance; homocysteine levels (beneficial day
menstrual effects are
irregularities dose
related)19–21

Spironolactone Antiandrogenic Hirsutism; C Hyperkalemia, 50 mg per $61 (generic)


(Aldactone)§ antimineralocorticoid menstrual nausea, breast day to 100 and $97
irregularities tenderness to 200 mg (brand) for 50
per day22,23 mg twice per
day

Second-line

Acarbose Insulin-sensitizing Hirsutism; B GI upset 150 mg per $94 (brand)


(Precose)§ agent menstrual day24 (for
irregularities menses
regulation)

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FDA APPROXIMATE
MANIFESTATIONS MAIN ADVERSE TYPICAL
MEDICATION DESCRIPTION PREGNANCY MONTHLY
TREATED EFFECTS DOSAGE
CATEGORY COST*

Desogestrel/ethinyl Oral contraceptive Hirsutism X Increased total 0.15 mg $31 (brand)


estradiol (Apri)§¶ cholesterol and low- desogestrel
density lipoprotein plus 30 mcg
cholesterol; ethinyl
thromboembolism, estradiol per
stroke, MI day

Finasteride 5-alpha-reductase Hirsutism X Hypersensitivity 5 mg per $148 (generic)


(Propecia)§ inhibitor reaction, decreased day25 and $100 to
libido $343 (brand)

Flutamide Nonsteroidal Hirsutism D Thrombocytopenia, 250 mg $140 (generic)


(formerly Eulexin)§ antiandrogen used leukopenia, liver once or for 250 mg per
mostly in prostate toxicity, hot flashes twice per day
cancer day25

Letrozole Nonsteroidal Infertility C Osteoporosis, 2.5 mg per $340 (brand)


(Femara)§ competitive inhibitor of thromboembolism, day6
aromatase; inhibits MI, hot flashes,
conversion of adrenal arthralgias
androgens

Sibutramine Centrally acting Hirsutism C Tachycardia, 10 mg per $116 (brand)


(Meridia)§ appetite suppressant hypertension, day26
headache, dry mouth

CHF = congestive heart failure; FDA = U.S. Food and Drug Administration; GI = gastrointestinal; MI = myocardial infarction; PCOS = polycystic ovary
syndrome.

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*— Estimated monthly cost (unless otherwise noted) to the pharmacist based on average wholesale prices (rounded to the nearest dollar) in Red Book.
Montvale, N.J.: Medical Economics Data; 2008. Cost to the patient will be higher, depending on prescription filling fee.

†— FDA-approved for female infertility caused by PCOS.

‡— Not studied specifically in women with PCOS; therefore, effectiveness is unknown.

§— Not FDA-approved for treatment of manifestations of PCOS.27

ǁ— Based mostly on anecdotal evidence; cyproterone acetate plus ethinyl estradiol (drug not available in the United States) has been extensively studied.

¶— Studied in adolescents with PCOS.

Information from references 6 through 27.

Copyright © 2009 by the American Academy of Family Physicians.


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