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  • Chief Cushie

Dr. Friedman uses several medications to treat Cushing’s syndrome that are summarized in this table. Dr. Friedman especially recommends ketoconazole. An in-depth article on ketoconazole can be found on goodhormonehealth.com. 

 Drug  How it works  Dosing  Side effects 
Ketoconazole  (Generic, not FDA approved in US)  blocks several steps in cortisol biosynthesis  Start 200 mg at 8 and 10 PM, can up titrate to 1200 mg/day 
• Transient increase in LFTs 
• Decreased testosterone levels 
• Adrenal insufficiency 
Levoketoconazole (Recorlev)  L-isomer of Ketoconazole  Start at 150 mg at 8 and 10 PM, can uptitrate up to 1200 mg  nausea, vomiting, increased blood pressure, low potassium, fatigue, headache, abdominal pain, and unusual bleeding 
Isturisa (osilodrostat)  blocks 11-hydroxylase  2 mg at bedtime, then go up to 2 mg at 8 and 10 pm, can go up to 30 mg  Dr. Friedman often gives with spironolactone or ketoconazole. 
• high testosterone (extra facial hair, acne, hair loss, irregular periods)  • low potassium 
• hypertension 
Cabergoline (generic, not FDA approved)  D2-receptor agonist  0.5 to 7 mg 
• nausea,  • headache  • dizziness 
Korlym (Mifepristone)  glucocorticoid receptor antagonist  300-1200 mg per day 
• cortisol insufficiency (fatigue, nausea, vomiting, arthralgias, and headache) 
• increased mineralocorticoid effects (hypertension, hypokalemia, and edema 
• antiprogesterone effects (endometrial thickening) 
Pasireotide (Signafor)  somatostatin receptor ligand  600 μg or 900 μg twice a day  Diabetes, hyperglycemia, gallbladder issues 

For more information or to schedule an appointment with Dr. Friedman, go to goodhormonehealth.com

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