Pharmacologic treatments proposed for ISB: Evidence supporting these drug treatments is level II or level III.
| DRUG CLASS | STUDIED DRUG (FORMULATION AND DOSAGE) | POTENTIAL ADVERSE EFFECTS |
|---|---|---|
| Antidepressants | SSRIs (20 mg oral paroxetine once daily, 20 mg oral citalopram once daily) | Nausea, tremor, hyponatremia |
| 15–30 mg mirtazapine nightly | Sedation, weight gain, myelosuppression | |
| 150 mg oral clomipramine once daily | Orthostatic hypotension, urinary retention, constipation, worsening cognition | |
| 100–500 mg oral trazodone once daily | Sedation, orthostatic hypotension, priapism | |
| Antiandrogens | 100–500 mg IM medroxyprogesterone acetate weekly | Fatigue, weight gain, hot or cold flashes, depression, elevated blood glucose, insomnia |
| 10 mg oral cyproterone acetate once daily | Gynecomastia, galactorrhea, worsening diabetes control, depression, osteoporosis, adrenal insufficiency on withdrawal, hepatotoxicity (liver enzymes should be checked if it is used) | |
| 5 mg oral finasteride once daily | Gynecomastia, testicular pain, depression | |
| Estrogens | 0.625 mg oral conjugated estrogen once daily | Weight gain, depression, gynecomastia, venous thromboembolism |
| 0.05-0.1 mg/d estrogen transdermal patch | ||
| 1 mg oral diethylstilbestrol once daily | ||
| GnRH analogues | 7.5 mg IM leuprolide monthly | Weight gain, bone pain, osteoporosis, pituitary apoplexy (rare) |
| Antipsychotics | 1.5–3 mg oral haloperidol once daily | Sedation, extrapyramidal symptoms, falls, weight gain, ventricular arrhythmias |
| 25 mg oral quetiapine once daily | ||
| Anticonvulsants | 100–300 mg oral gabapentin 3 times daily | Sedation, depression, ataxia, tremor |
| 200 mg oral carbamazepine once daily | Sedation, depression, motor ataxia, hyponatremia, Stevens-Johnson syndrome, agranulocytosis, hepatotoxicity Use of carbamazepine requires monitoring with regular laboratory testing | |
| Cholinesterase inhibitors | 1.5–6 mg rivastigmine twice daily | Nausea, urinary incontinence, syncope Potential for emergence of hypersexuality |
| 5–10 mg oral donepezil once daily | ||
| H2 receptor blockers | 400–1600 mg/d oral cimetidine (nightly or divided doses; eg, 400 mg twice daily) | Worsening cognition, dizziness, multiple drug-drug interactions |
| β-blockers | 5–20 mg oral pindolol twice daily | Hypotension, fatigue, bradycardia, bronchospasm |
| 40–80 mg oral propranolol twice daily | ||
| Antifungals | 100–200 mg ketoconazole once daily | Sedation, headache, rash, photosensitivity, gastrointestinal upset, pruritus, hepatotoxicity |
| Potassium-sparing diuretics | 12.5 mg spironolactone once daily | Hyperkalemia, gynecomastia, change in hair growth, upper gastrointestinal ulcers, agranulocytosis |
GnRH—gonadotropin-releasing hormone, IM—intramuscular, ISB—inappropriate sexual behaviour, SSRI—selective serotonin reuptake inhibitor.