Medications Used to Treat Cushing’s

[~MaryO~]

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