Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey (UMDNJ), New Brunswick, NJ, USA.
Ann Pharmacother. 2013 Jan;47(1):e6. doi: 10.1345/aph.1R491. Epub 2013 Jan 16.
To describe what we believe is the first reported case of synergistic gynecomastia during treatment of depressive and anxiety disorders when sertraline was added to a stable medication regimen including duloxetine, rosuvastatin, and amlodipine.
A 67-year-old male with major depression, dysthymia, obsessive-compulsive disorder, social anxiety, hypertension, diabetes, and hyperlipidemia presented with new-onset gynecomastia and breast tenderness. Mammography revealed bilateral gynecomastia (fibroglandular tissue posterior to the nipples bilaterally) without suspicious mass, calcification, or other abnormalities. These new symptoms developed after sertraline was added to his stable medication regimen (duloxetine, alprazolam, rosuvastatin, metoprolol, amlodipine, hydrochlorothiazide/triamterene, metformin, and sitagliptin). These symptoms were dose-dependent, with gynecomastia and breast tenderness more severe as sertraline was titrated from 25 mg/day to 50 mg/day and then to 75 mg/day. When sertraline was discontinued, gynecomastia and breast tenderness rapidly resolved.
Mammoplasia and gynecomastia are associated with altered dopamine neurotransmission and/or perturbations in sexual hormones. These adverse effects may be medication induced. Selective serotonin reuptake inhibitors (sertraline), serotonin-norepinephrine reuptake inhibitors (duloxetine), rosuvastatin, and amlodipine have been reported to cause these adverse effects. This case was unique, since the patient had been on both sertraline and duloxetine previously as independent psychotropics without the development of gynecomastia. In the context of an additive drug adverse effect, the probability of sertraline as the precipitant drug was determined by both the Naranjo probability scale and the Horn drug interaction probability scale as probable.
Gynecomastia is associated with antidepressants and other medications but is rarely addressed. Gynecomastia may be antidepressant selective or may be the result of additive adverse effects. Clinicians are advised to question patients regarding this potential adverse effect. Further education of clinicians is indicated.
描述我们认为首例报道的病例，即在稳定的药物治疗方案（包括度洛西汀、瑞舒伐他汀和氨氯地平）中添加舍曲林治疗抑郁和焦虑障碍时出现协同性乳房增大。
一名 67 岁男性，患有重度抑郁症、心境恶劣障碍、强迫症、社交焦虑症、高血压、糖尿病和高脂血症，出现新发乳房增大和乳房触痛。乳房 X 光检查显示双侧乳房增大（乳头后双侧纤维腺体组织），无可疑肿块、钙化或其他异常。这些新症状是在他的稳定药物治疗方案（度洛西汀、阿普唑仑、瑞舒伐他汀、美托洛尔、氨氯地平、氢氯噻嗪/阿米洛利、二甲双胍和西他列汀）中添加舍曲林后出现的。这些症状与剂量有关，随着舍曲林从 25mg/天滴定至 50mg/天，然后至 75mg/天，乳房增大和乳房触痛更加严重。当舍曲林停药时，乳房增大和乳房触痛迅速缓解。
乳房肥大和男性乳房发育与多巴胺神经递质改变和/或性激素紊乱有关。这些不良反应可能是药物引起的。选择性 5-羟色胺再摄取抑制剂（舍曲林）、5-羟色胺-去甲肾上腺素再摄取抑制剂（度洛西汀）、瑞舒伐他汀和氨氯地平已被报道会引起这些不良反应。本例病例较为特殊，因为患者之前曾作为独立的精神药物使用过舍曲林和度洛西汀，但未出现男性乳房发育。在药物不良反应的累加作用的情况下，根据 Naranjo 概率量表和 Horn 药物相互作用概率量表，舍曲林作为引发药物的可能性被确定为可能。
乳房增大与抗抑郁药和其他药物有关，但很少被提及。乳房增大可能是抗抑郁药特有的，也可能是叠加不良反应的结果。建议临床医生询问患者是否有此潜在不良反应。需要对临床医生进行进一步的教育。
