Pharmacologic Therapy

A. Fluoxetine (Sarafem) and sertraline (Zoloft) have been approved for the treatment of PMDD. SSRIs are recommended as initial drug therapy in women with PMS and PMDD. Common side effects of SSRIs include insomnia, drowsiness, fatigue, nausea, nervousness, headache, mild tremor, and sexual dysfunction.

B. Fluoxetine (Sarafem) 20 mg or sertraline (Zoloft) 50 mg, taken in the morning, is best tolerated and sufficient to improve symptoms. Fluoxetine or sertraline can be given during the 14 days before the menstrual period.

C. Benefit has also been demonstrated for citalopram (Celexa) during the 14 days before the menstrual period.

D. Diuretics. Spironolactone (Aldactone) is the only diuretic that has been shown to effectively relieve breast tenderness and fluid retention. Spironolactone is administered only during the luteal phase.

E. Prostaglandin Inhibitors. Nonsteroidal anti-inflammatory drugs (NSAIDs) are traditional therapy for primary dysmenorrhea and menorrhagia. These agents include mefenamic acid (Ponstel) and naproxen sodium (Anaprox, Aleve).

References: See page 184.

Prescription Medications Commonly Used in the Treatment of Premenstrual Syndrome (PMS)

Drug class and representative agents

mendatio ns

Side effects

SSRIs

Fluoxetine (Sarafem)

10 to 20 mg per day

First-choic e agents for the treatment of PMDD. Effective in alleviating behav-

Insomnia, drowsiness, fatigue, nausea, nervousness, headache, mild

Sertraline (Zoloft)

50 to 150 mg per day

Paroxetine (Paxil)

10 to 30 mg per day

ioral and physical symptoms of PMS and PMDD Administer during luteal phase (14

tremor, sexual dysfunction

Fluvoxami ne (Luvox)

25 to 50 mg per day

(Celexa)

20 to 40 mg per day

days before menses).

Diuretics

Spironolac tone

(Aldacton e)

25 to 100 mg per day luteal phase

Effective in alleviating breast tenderness and bloating.

Antiestrog enic effects, hyperkale mia

Drug

class and

represen-

Recom-

tative

mendatio

Side ef-

agents

Dosage

ns

fects

NSAIDs

Naproxen

275 to 550

Effective

Nausea,

sodium

mg twice

in alleviat-

gastric

(Anaprox)

daily

ing vari

ulceration,

ous physi-

renal dys

cal symp-

function.

toms of

Use with

PMS. Any

caution in

NSAID

women

Mefenami

250 mg tid

should be

with pre-

c acid

with meals

effective.

existing

(Ponstel)

gastroin-

testinal or

renal dis-

ease.

Androgens

Danazol

100 to 400

Somewhat

Weight

(Danocrin

mg twice

effective

gain, de-

e)

daily

in alleviat

creased

ing

breast

mastalgia

size,

when

deepening

taken dur

of voice.

ing luteal

Monitor

phase.

lipid profile

and liver

function.

GnRH agonists

Leuprolide

3.75 mg

Somewhat

Hot

(Lupron)

IM every

effective

flashes,

month or

in alleviat-

cardiovas

11.25 mg

ing physi-

cular ef

IM every

cal and

fects, and

three

behavioral

osteoporo

months

symptoms

sis

of PMS

Side effect

profile and

cost limit

use.

Goserelin

3.6 mg SC

(Zoladex)

every

month or

10.8 mg

SC every

three

months

Nafarelin

200 to 400

(Synarel)

mcg

intranasall

y twice

daily

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