Diuretic

Drug Dosage Remarks
Spironolactone 25-200 mg/day PO in 1 or 2 divided doses preferably in combination with oral contraceptives (OCs) Adverse Reactions
  • CNS effects (headache, drowsiness, ataxia, mental confusion); GI effects (cramps, diarrhea); Metabolic effects (mild acidosis, hyponatremia, hyperkalemia and transient increases in BUN)
Special Instructions
  • Avoid in patients with hyperkalemia, anuria or severe renal impairment, Addison’s disease, DM
  • Use with caution in patients at increased risk of developing hyperkalemia and acidosis, patients with DM, renal and hepatic impairment

Insulin-Sensitizing Drug

Drug Dosage Remarks
Metformin 500 mg PO 8 hourly or
850 mg PO 12 hourly
Max dose: 2,500 mg/day
or
1,500-2,000 mg PO 24 hourly with evening meal
Consider treatment for at least 6 months
Max dose: 2,000 mg/day		 Adverse Reactions
  • Transient GI effects (anorexia, nausea/vomiting); vitamin B12 deficiency; lactic acidosis may occur but extremely rare
Special Instructions
  • Administer with meals
  • Should not be given to patients with severe renal impairment or infection, alcoholism, acute or chronic metabolic acidosis, acute or chronic disease causing hypoxia
  • Monitor vitamin B12 serum concentration every 2-3 years with prolonged use and for signs and symptoms of lactic acidosis

Oral Contraceptives

Drug Dosage Remarks
Cyproterone acetate/ethinyl estradiol Cyproterone acetate 2 mg/ethinyl estradiol 0.035 mg
1 tab PO 24 hourly on days 1-21 of the menstrual cycle followed by
7 drug-free (inactive tab) days		 Adverse Reactions
  • GI effects (abdominal pain, nausea); CNS effects (headache, depressed and altered mood); Hormonal effects (changes in libido, breast pain and tenderness); Other effect (weight gain)
  • Rarely, increased risk of venous and arterial thromboembolism, malignant hepatic tumors leading to intra-abdominal hemorrhage
Special Instructions
  • Use should be confined to androgen-dependent disorders in women since risk of thromboembolism is greater than with second generation OCs
  • Avoid in patients with history or present thrombosis including risk factors, DM with vascular involvement, severe hepatic disease, malignant conditions of genital organs or breasts if sex-steroid related, undiagnosed vaginal bleeding, pregnancy
  • Use with caution in patients with DM, SLE, chronic inflammatory bowel disease, hemolytic uremic syndrome, migraine, family history of thromboembolic disease
Desogestrel/ethinyl estradiol Desogestrel 0.15 mg/ethinyl estradiol 0.02 mg
Desogestrel 0.15 mg/ethinyl estradiol 0.03 mg
1 tab PO 24 hourly on days 1-21 of the menstrual cycle followed by
7 drug-free (inactive tab) days		 Adverse Reactions
  • GI effects (nausea, abdominal pain); Other effects (mood changes, headache, breast tenderness, increased body weight, erythema nodosum and multiforme)
Special Instructions
  • Avoid in patients with venous or arterial thromboembolism, DM with vascular changes, hepatic impairment, history or current breast cancer, undiagnosed vaginal bleeding, pancreatitis
  • Use with caution in patients with SLE, inflammatory bowel disease, hemolytic uremic syndrome, epilepsy, renal impairment, CV disease-related risk factors, depression
Drospirenone/ethinyl estradiol Drospirenone 3 mg/ethinyl estradiol 0.02 mg
Drospirenone 3 mg/ethinyl estradiol 0.03 mg
1 tab PO 24 hourly on days 1-21 of the menstrual cycle followed by
7 drug-free (inactive tab) days		 Adverse Reactions
  • Hormonal effects (sore breasts, enlargement of breasts, painful/irregular menstruation); Other effects (weight gain, emotional, headache, abdominal pain, acne, clots in blood vessel of the leg/lungs)
Special Instructions
  • Avoid in patients with history or present thrombosis, DM with damaged blood vessels, severe hepatic disease, malignant conditions of genital organs or breasts, undiagnosed vaginal bleeding, history or currently has stroke/heart attack, pancreatitis
  • Use with caution in patients with DM, SLE, inflammatory bowel disease, hemolytic uremic syndrome, epilepsy, breast cancer; long periods of immobilization or serious accidents during treatment may increase risk of venous thrombosis

Other Dermatologicals

Drug Dosage Remarks
Oral
Finasteride 2.5-5 mg PO 24 hourly Adverse Reactions
  • Decreased libido, angioedema, depression, hypersensitivity reactions, orgasm dysfunction
Special Instructions
  • Use with caution in patients with hepatic impairment
Drug Available Strength Dosage Remarks
Topical
Eflornithine 13.9% cream Apply 12 hourly Adverse Reactions
  • Dermatologic effects (acne, skin rash, redness, burning, stinging); CNS effect (headache)
Special Instructions
  • Do not apply on infectious wounds and burns

Other Drugs Affecting Hormonal Regulation

Drug Dosage Remarks
Cyproterone acetate Women of childbearing age:
Commence treatment on first day of cycle (first day of bleeding)
100 mg PO 24 hourly from first-tenth day of cycle, together with progestogen-estrogen-containing preparation from first to twenty-first day of cycle
May be reduced to 25-50 mg during first 10 days following clinical improvement
Women receiving cyclical combined therapy: Keep to a particular time of the day for tablet-taking, 7-day tablet-free interval is observed after 21 days
Start next course of combined treatment exactly 4 weeks after first course of treatment
Hysterectomized patients or postmenopausal women: 25-50 mg PO 24 hourly for 21 days, followed by 7 drug-free days		 Adverse Reactions
  • GI effects (hepatic toxicity, benign and malignant liver tumors which may lead to intra-abdominal hemorrhage); Other effects (spotting, increased weight, depressed mood, thromboembolic events, single or multiple meningiomas)
Special Instructions
  • Not to interrupt tablet-taking if spotting occurs during treatment; withdraw treatment if hepatotoxicity is confirmed
  • Avoid in patients with Dubin-Johnson syndrome, Rotor syndrome, wasting diseases, severe chronic depression, severe diabetes with vascular changes, sickle-cell anemia, history of jaundice or persistent pruritus during previous pregnancy, herpes of pregnancy, presence or history of meningioma, previous or existing liver tumors, thromboembolic processes, liver diseases, pregnancy and lactation
  • Use with caution in patients with shortness of breath, deep venous thrombosis, pulmonary embolism, myocardial infarction, history of CVA or advanced malignancies, diabetes

Progestogen

Drug Dosage Remarks
Medroxyprogesterone 2.5-10 mg PO 24 hourly for 5-10 days
Initiate anytime during the cycle but usually started during the latter half of the cycle (days 16-21)
Repeat for 3 consecutive cycles		 Adverse Reactions
  • CNS effects (insomnia, dizziness, headache, depression); GI effects (nausea/vomiting, anorexia, cholestatic jaundice); Other effects (fatigue, breast tenderness, fluid retention, weight gain/loss)
  • Potentially fatal: Thrombophlebitis and pulmonary embolism
Special Instructions
  • Avoid in patients with thromboembolic disorders, cerebral apoplexy, severe hepatic dysfunction, undiagnosed vaginal bleeding, incomplete abortion, hormone-dependent carcinoma
  • Use with caution in patients with depression, DM, epilepsy, asthma, migraine, hypertension, renal or cardiac dysfunction
  • Monitor patient closely for loss of vision, proptosis, diplopia and thromboembolic disorders

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information. 

Related MIMS Drugs