Gynecomastia is an enlargement or swelling
of the breast tissue in males. It is most commonly caused by too much
influence from estrogen and not enough testosterone. In addition to
breast enlargement, most male patients will experience breast tenderness and/or
pain. In some cases, patients can also have nipple discharge. If
the medication is removed, the enlarged breast tissue will regress over time
and return to normal.
following medications are most commonly known to increase the risk for
gynecomastia (breast enlargement and tenderness) in males. If known or
reported the incidence is also provided.
Known to Cause Gynecomastia:
- Eplerenone (Inspra) [up to 1%]
- Spironolactone (Aldactone)
- Typical or First Generation
- Atypical or Second Generation
(Abilify; Abilify Discmelt)
sublingual tablets (Saphris)
(Zyprexa; Zydis, Zyprexa Relprevv)
(Invega; Invega Sustenna)
(Seroquel; Seroquel XR)
- Digoxin (Lanoxin) [<1%]
- Efavirenz (Sustiva)
- Estrogen use
- Ethanol (Alcohol)
- Ketoconazole (Nizoral) [<1%]
mechanisms by which these medications are known to cause this this effect are different
and/or may not be fully known. We do know that antipsychotics contribute
to this side effect through their antagonism of the dopamine receptors in the
central nervous system, which causes an increase in prolactin secretion from
the pituitary. Eplerenone and spironolactone have varying degrees of
binding to the androgen and progesterone receptors with eplerenone being the
least likely to inhibit it. Ketoconazole is known to inhibit androgen
synthesis thus creating an imbalance that favors breast tissue growth.
If you know of other medications that should be
added to this list, please let us know. We appreciate your contribution.
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