| Nonestrogen hormones |
| Progestins | Medroxyprogesterone acetate(Provera) | 20 mg daily | Yes | Improvement of 48 percent over placebo | Nausea, vomiting, constipation, somnolence, depression, breast tenderness, and uterine bleeding; concern about increased risk of venous thromboembolism, cardiovascular events, and breast cancer |
| Megestrol (Megace; brand available only as an oral suspension) | 20 mg twice daily | Yes | Improvement of 47 percent over placebo in breast cancer survivors |
| Tibolone‡ | 1.25 to 5.0 mg | Yes | Improvement of 35 to 50 percent over placebo | Headache, weight gain, and uterine bleeding; unknown effects on venous thromboembolic events, cardiovascular disease, and breast and uterine cancers |
| Antidepressants |
| SSRIs | Citalopram (Celexa) | 30 mg | No | No benefit over placebo | Nausea, vomiting, diarrhea, insomnia, somnolence, anxiety, decreased libido, dry mouth, worsening depression, mania, suicidality, the serotonin syndrome, and the withdrawal syndrome; paroxetine and possibly other SSRIs decrease the activity of cytochrome P-450 enzymes, thereby decreasing the production of active metabolites of tamoxifen (Soltamox), which may interfere with the anti–breast cancer effects of tamoxifen |
| Fluoxetine (Prozac) | 20 mg | Mixed | Improvement of 24 percent over placebo in breast cancer survivors |
| 30 mg | Mixed | No benefit among women without breast cancer |
| Paroxetine (Paxil) | 10 to 20 mg | Yes | Improvement of 30 percent over placebo in breast cancer survivors |
| 12.5 to 25 mg, controlled release | Yes | Improvement of 25 percent over placebo in women without breast cancer |
| Sertraline (Zoloft) | 25 to 100 mg | No | No benefit over placebo in breast cancer survivors |
| SNRIs | Venlafaxine (Effexor) | 75 or 150 mg | Mixed | Improvement of 34 percent over placebo in breast cancer survivors | Same side effects as for SSRIs, but minimal effect on cytochrome P-450 enzymes (only slightly inhibits conversion of tamoxifen to active metabolites); possible hypertension |
| 75 mg, extended release | Mixed | No benefit over placebo in women without breast cancer |
| Anticonvulsants |
| Gabapentin (Neurontin) | 300 mg three times daily | Yes | Improvement of 31 percent over placebo in breast cancer survivors and 23 percent over placebo in women without breast cancer | Nausea, vomiting, somnolence, dizziness, rash, ataxia, fatigue, and leukopenia |
| Alpha blockers |
| Clonidine (Catapres) | 0.1 mg transdermal | Mixed | Little to no benefit or improvement of 27 percent over placebo | Drowsiness, dizziness, hypotension, and rebound hypertension |
| Methyldopa (Aldomet; brand no longer available in the United States) | 375 to 1,125 mg daily in divided dosages | No | No benefit over placebo |