- Premenstrual Syndrome

Premenstrual Syndrome

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Posted Thursday 27 September 2007 - 14:46 PM by Deborah Chan

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Condition*

First Line Drugs

Choice 1*

ATC Code (read only) Choice 2

ATC Code (read only) Choice 3

ATC Code (read only)

Second Line Drugs

Choice 1

ATC Code (read only) Choice 2

ATC Code (read only) Choice 3

ATC Code (read only)

For Pregnant Women, Suggest:

Choice 1

ATC Code (read only) Choice 2

ATC Code (read only) Choice 3

ATC Code (read only) Comments/Instructions

1. Predominantly psychological symptoms

i. clomipramine
25-75 mg, once daily
$0.24-0.67/day

or alprazolam
0.25 mg, qid from day 18 of cycle until day 2 of next cycle
$0.31/day

ii. Selective serotonin reuptake inhibitors (SSRIs)

fluvoxamine 
50-100 mg, once daily
$0.78-1.41/day

or paroxetine 
10-30 mg, once daily
$0.80-1.69/day

or fluoxetine 
20 mg, once daily
$1.08/day

or sertraline 
50-150 mg, once daily
$1.60-3.35/day

2. Predominantly physical symptoms

i. Cyclic mastalgia,

see Mastalgia - cyclic and noncyclic

ii. Feet swelling and bloating

spironolactone
100 mg, hs from day 14 of cycle to first day of menstruation
$2.97/2 weeks

iii. Sleep hygiene,

see Insomnia

iv. Premenstrual headache

acetaminophen
325-650 mg, every 4 h
$0.04-0.08/day

or ASA
325-650 mg, enteric- coated or plain, every 4 h
$0.04-0.08/day

or ibuprofen
200-400 mg, qid
$0.07-0.15/day

3. Mixed psychological and physical symptoms

i. spironolactone
100 mg, hs from day 14 of cycle to first day of menstruation
$0.21/day

or clomipramine
25-75 mg, once daily
$0.24-0.67/day

or alprazolam
0.25 mg, qid from day 18 of cycle until day 2 of next cycle
$0.31/day

ii. SSRIs

fluvoxamine
50-100 mg, once daily
$0.78-1.41/day

or paroxetine
10-30 mg, once daily
$0.80-1.69/day

or fluoxetine
20 mg, once daily
$1.08/day

or sertraline
50-150 mg, once daily
$1.60-3.35/day

Second-line therapies:

Mixed psychological and physical symptoms

i. Hormone therapy

Oral contraceptive pill, see Contraception, oral - combination therapy

OR the combination of

estrogen transdermal
100 µg, twice a week
$22.16/cycle

AND

norethindrone acetate
5 mg, once daily on days 19-26 of cycle
$5.98/cycle

ii. Gonadotropin-releasing hormone agonists

leuprolide
3.75 mg IM; once monthly on day 2 to 6 after onset of menses
$304.50/month

iii. Androgens

danazol
200 mg, bid
$3.38/day

Additional instructions and notes

-There is no convincing evidence that dietary modification, relaxation or behavioural therapy is effective.

-Progestins, which were popular in the 1980s, have not been shown to be effective.

-Current reports do not support the use of evening primrose oil.

Reference

First Line Drugs

APO-CLOMIPRAMINE TABLETS 25MG (N06AA04)

ALDACTONE 100 MG (C03DA01)

ACETAMINOPHEN CAPLET 500MG (N02BE01)

Second Line Drugs

ESTRADIOL (A06AB06)

NORETHINDRONE ACETATE ()

CYCLOMEN 200MG (G03XA01)

Reference

http://oscarmcmaster.org:25300/oscarResource-Pl...

Comments/Instructions

1. Predominantly psychological symptoms

i. clomipramine
25-75 mg, once daily
$0.24-0.67/day

or alprazolam
0.25 mg, qid from day 18 of cycle until day 2 of next cycle
$0.31/day

ii. Selective serotonin reuptake inhibitors (SSRIs)

fluvoxamine
50-100 mg, once daily
$0.78-1.41/day

or paroxetine
10-30 mg, once daily
$0.80-1.69/day

or fluoxetine
20 mg, once daily
$1.08/day

or sertraline
50-150 mg, once daily
$1.60-3.35/day

2. Predominantly physical symptoms

i. Cyclic mastalgia,

see Mastalgia - cyclic and noncyclic

ii. Feet swelling and bloating

spironolactone
100 mg, hs from day 14 of cycle to first day of menstruation
$2.97/2 weeks

iii. Sleep hygiene,

see Insomnia

iv. Premenstrual headache

acetaminophen
325-650 mg, every 4 h
$0.04-0.08/day

or ASA
325-650 mg, enteric- coated or plain, every 4 h
$0.04-0.08/day

or ibuprofen
200-400 mg, qid
$0.07-0.15/day

3. Mixed psychological and physical symptoms

i. spironolactone
100 mg, hs from day 14 of cycle to first day of menstruation
$0.21/day

or clomipramine
25-75 mg, once daily
$0.24-0.67/day

or alprazolam
0.25 mg, qid from day 18 of cycle until day 2 of next cycle
$0.31/day

ii. SSRIs

fluvoxamine
50-100 mg, once daily
$0.78-1.41/day

or paroxetine
10-30 mg, once daily
$0.80-1.69/day

or fluoxetine
20 mg, once daily
$1.08/day

or sertraline
50-150 mg, once daily
$1.60-3.35/day

Second-line therapies:

Mixed psychological and physical symptoms

i. Hormone therapy

Oral contraceptive pill, see Contraception, oral - combination therapy

OR the combination of

estrogen transdermal
100 µg, twice a week
$22.16/cycle

AND

norethindrone acetate
5 mg, once daily on days 19-26 of cycle
$5.98/cycle

ii. Gonadotropin-releasing hormone agonists

leuprolide
3.75 mg IM; once monthly on day 2 to 6 after onset of menses
$304.50/month

iii. Androgens

danazol
200 mg, bid
$3.38/day

Additional instructions and notes

-There is no convincing evidence that dietary modification, relaxation or behavioural therapy is effective.

-Progestins, which were popular in the 1980s, have not been shown to be effective.

-Current reports do not support the use of evening primrose oil.