Treatment		Oral dosage	Evidence of benefit	Outcome*	Side effects†
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