A list of common medications known to cause gynecomastia are listed below. Explanation Gynecomastia is an enlargement or swelling of the breast tissue in males. If you know of other medications that should be added to this list, please let us know. We appreciate your contribution. Prolactin, hyperprolactinaemia and antipsychotic treatment: a review and lessons for treatment of early psychosis.
J Psychopharmacol ; Antipscyhotic-induced hyperprolactinemia. Pharmacotherapy ; Risk of gynaecomastia associated with cimetidine, omeprazole, and other antiulcer drugs. BMJ ; Wolfe CJ. Case report. Gynecomastia following digitalis administration. J Fla Med Assoc ; An increase in hyaluronic acid also is commented on, suggesting the presence of stromal edema [ ].
As reviewed above, mastodynia with the subsequent observation of breast swelling has been reported to be associated with numerous medications. However, mastodynia associated with or without a documented acute enlargement of the breast occurs in men not receiving any medication. All presented with breast tenderness and 15 complained of pain. A spontaneous remission in tenderness and breast size occurred over time.
As with the medication-associated reports, these signs and symptoms also suggest the presence of an acute syndrome and not the traditionally described chronic, asymptomatic gynecomastia. Overall, current data suggest that for most drugs, their implication in the genesis of palpable breast tissue remains speculative.
Although limited in scope, data implicating very high-dose cimetidine in the genesis are compelling [ 11 , 12 ]. Imatinib also may induce breast enlargement, but the circumstances in which it is used complicate interpretation [ 63 , 64 ]. Also, in a few case reports, a rechallenge test was done and was positive. In these reports, a cause and effect relationship probably was present.
Again, the potential mechanism remains unknown. Regardless of an unidentified mechanism, the high frequency of mastodynia and of single breast involvement associated with reports of drug-induced gynecomastia is impressive. These observations make it difficult to attribute their genesis to a circulating hormonally mediated mechanism, and indeed, in the majority of cases the hormone profile was within the respective reference ranges. Spironolactone is an exception. That spironolactone administration can induce breast enlargement when ingested in high doses is well documented, and although the mechanism remains uncertain, it does appear to be hormonally mediated, i.
This also may be the case with the administration of cytotoxic agents for malignancies. In addition, one was associated with finasteride where one might expect hormonal abnormalities. Overall, we suggest that the general term of gynecomastia be replaced with more specific and descriptive terminology. Initially, we suggest that the term gynecomastia or preferably andromastia be divided into two large categories: acute with or without mastodynia and chronic.
In conclusion, whether most of the medications implicated in the genesis of gynecomastia represent a true cause and effect relationship remains unknown. Generally, a hormonal etiology cannot be implicated.
The symptoms and the breast enlargement spontaneously regress or disappear entirely, and no specific treatment or further evaluation is required. This includes ultrasound, mammogram, and biopsy. Generally, it can be treated symptomatically and not interfere with the continued use of the drug, if the latter is considered to be necessary.
The breast enlargement associated with the use of spironolactone is different. It is commonly bilateral, not associated with pain or tenderness, is dose dependent and is hormonally mediated, i. Nuttall F Gynecomastia as a physical finding in normal man.
J Clin Endocrinol Metab — Carlson HE Gynecomastia. N Engl J Med — Braunstein GD Gynecomastia. Am J Med — Komine N, Takeda Y, Nakamata T Amlodipine-induced gynecomastia in two patients on long-term hemodialysis therapy.
Clin Exp Nephrol — PubMed Google Scholar. Med J Aust Pharmacotherapy — Intern Med J — BMJ CAS Google Scholar. Gut — Garcia Rodriguez LA, Jick H Risk of gynaecomastia associated with cimetidine, omeprazole, and other antiulcer drugs. BMJ — Hall WH Breast changes in males on cimetidine. N Engl J Med Leuk Lymphoma — Arch Intern Med — Br J Cancer — Jun YY Gynecomastia with marked cellular atypia associated with chemotherapy.
Arch Pathol Lab Med — Google Scholar. Urol Int — Transplant Proc — Leukemia — Lancet — Ann Pharmacother Ann Phamacother — Br Med J — Indian J Pharmacol — Wolfe CJ Case report. Gynecomastia following digitalis administration. J Fla Med Assoc — Arch Intern Med Postgrad Med J — Br J Dermatol AIDS — Breast J — Ann Pharmacother — South Med J — Indian J Dermatol Venereol Leprol — Ramot Y, Czarnowicki T, Zlotogorski A Finasteride induced gynecomastia: case report and review of the literature.
Int J Trichology — Australas J Dermatol Ferrando J, Grimalt R, Alsina M et al Unilateral gynecomastia induced by treatment with 1 mg of oral finasteride.
Arch Dermatol — J Urol Rossi L, Bonuccelli U, Marcacci G et al Gynecomastia in epileptics treated with phenobarbital, phenytoin and fluoresone: two case reports.
Ital J Neurol Sci — J Eur Acad Dermatol Venereol Zylicz Z Painful gynecomastia: an unusual toxicity of gabapentin? J Pain Symptom Manage —3. Ann Intern Med Diagn Interv Radiol — Clin Infect Dis — Scand J Infect Dis — Antivir Ther — Manfredi R, Calza L, Chiodo F Gynecomastia, lipodystrophy syndrome, and dyslipidemia occurring or worsening during antiretroviral regimens other than protease inhibitor-based ones. J Acquir Immune Defic Syndr — Liu H, Liao G, Yan Z Gynecomastia during imatinib mesylate treatment for gastrointestinal stromal tumor: a rare adverse event.
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Am J Med e1. Abe K, Mitsuka T, Kanamori S et al Gynecomastia associated with low-dose methotrexate therapy for rheumatoid arthritis. Mod Rheumatol — Pandhi D, Gupta R, Singal A Gynaecomastia with oligospermia: an unusual complication of low-dose methotrexate for pustular psoriasis. Clin Exp Dermatol — JAMA Sahin M, Yilmaz H, Gursoy A et al Gynaecomastia in a man and hyperoestrogenism in a woman due to ingestion of nettle Urtica dioica.
N Z Med J U Clyne CAC Unreviewed reports: unilateral gynecomastia and nifedipine. Drug Saf — Lancet J Clin Psychiatry J Neurol Neurosurg Psychiatry — Malaga I, Sanmarti FX Two cases of painful gynecomastia and lower extremity pain in association with pregabalin therapy. Epilepsia — Tosi S, Cagnoli M Painful gynecomastia with ranitidine.
Clin Endocrinol — Post JJ Gynaecomastia associated with combination antiretroviral therapy including protease inhibitors for human immunodeficiency virus infection. Bellati G, Ideo G Gynaecomastia after spironolactone and potassium canrenoate.
Ann Intern Med — On February , a year-old male patient attended the surgical out patient department with complaints of dyspnea on exertion for the last 1 year. Dyspnea was progressive in nature and sometimes associated with palpitations. On examination, a diastolic murmur was present in the mitral area and the pulse was irregular.
After an electrocardiogram and echocardiography, he was diagnosed as a case of rheumatic heart disease along with mitral stenosis, mild tricuspid regurgitation and atrial fibrillation. At the 3-month follow-up visit, he complained of a lump in his left breast. On examination, a firm, painless lump of 5 cm size was present in the subalveolar region of his left breast whereas the right breast was found to be normal. There was no evidence of any other lump in the body or of testicular enlargement.
The hemogram, liver function tests and renal function tests were within normal limits. As the symptom of dyspnea worsened, a decision was made for surgical intervention. The patient underwent mitral valve replacement and, postoperatively, amiodarone was substituted for digoxin. At the same time, furosemide was also stopped.
On follow-up visits, it was observed that the lump decreased in size and was barely detectable at 4 months after discontinuation of the suspected drugs. The Drug Interaction Probability Scale is designed to assess the probability of a causal relationship between a potential drug interaction and an event. The conditions causing gynecomastia can be physiological and pathological. Physiological causes include neonatal due to transplacental transfer of maternal estrogens , puberty high estrogen to androgen ratio in early stages of puberty and ageing increased adipose tissue and increased aromatase activity.
Pathological causes include hypogonadism e. In the present case, patient's age precluded the physiologic causes of gynecomastia neonatal, puberty-associated or ageing-related.
Liver dysfunction was also ruled out by normal Liver Function Test. Hypogonadism was also unlikely as all the secondary sexual characters were normal. Hence, the patient's medications were reviewed and suspected drugs were stopped. If the gynecomastia would not have been reversed after stopping digoxin and furosemide, further investigations could have required exclusion of other causes such as malignancy or thyroid dysfunction, according to the standard algorithm.
The mechanism of digoxin-induced gynecomastia is believed to be a direct action at estrogen receptors due to similarity in the structure of digoxin and estrogen. As digoxin and furosemide are frequently used concurrently, it is important to recognize their possible interaction.
Early recognition of the ADR and removal of the offending drug can save the patient from unnecessary investigations and anxiety and also reduce the medical expenses.
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