Endometriosis Drug Summary

Drug	Dosage	Remarks
Danazol	Individualized dose depending on severity of endometriosis 200-800 mg/day PO divided 6-12 hourly started at menstrual cycle onset x 3-6 months up to 9 months	Adverse Reactions Effects due to inhibition of pituitary-ovarian axis (menstrual disturbances, amenorrhea, sweating, hot flushes, libido changes, vaginal dryness and irritation, decreased breast size, nervousness); Androgenic effects (increased hair growth, acne, oily skin, mood changes, deepening of voice, weight gain, effects on serum lipids [ie decreased HDL and TG, increased LDL] and rarely liver damage); Other effects (GI disturbances, headache, dizziness, fatigue, muscle spasm, tachycardia, hypertension) Special Instructions Gestrinone: If a dose is missed, take dose as soon as possible and maintain dose sequence; if ≥2 doses are missed, discontinue and restart on the first day of a new menstrual cycle after a negative pregnancy test Contraindicated in patients with severe hepatic, renal or cardiac dysfunction, porphyria, thromboembolic disease, undiagnosed genital bleeding and androgen-dependent tumors Use with caution in conditions that may worsen fluid retention (eg CV, hepatic and renal disorders) and in patients with migraine, epilepsy, DM or polycythemia Liver function should be monitored regularly during therapy
Gestrinone	2.5 mg/day PO on day 1 and 4 of the menstrual cycle Succeeding doses should be taken on the same 2 days as day 1 and 4 each week x 6 months

Drug	Dosage	Remarks
Dienogest	2 mg PO 24 hourly taken at the same time each day without interruption Start on any day of the menstrual cycle	Adverse Reactions GI effects (GI disturbances, change in weight/appetite); Breast effects (enlargement, secretion, discomfort); Androgenic effects (acne, mental depression, changes in libido, hair loss, hirsutism, irregular menstrual bleeding); Dermatologic effects (allergic rash, pruritus, erythema multiforme, erythema nodosum, urticaria); Other effects (asthenia, malaise, headache, migraine, change in vaginal secretions, fluid retention, edema, fatigue, alterations in lipid profile) Androgenic effects and lipid changes are more likely with Norethisterone Special Instructions Avoid use in patients with unexplained vaginal bleeding, history or current high risk of arterial disease, severe hepatic impairment, breast or genital tract carcinoma unless progestogen is part of the management Use with caution in women with hypertension, cardiac or renal impairment, asthma, epilepsy, migraine, history of depression, or other conditions aggravated by fluid retention High doses should be used with caution in patients at risk for thromboembolism
Dydrogesterone	10-30 mg/day PO divided 12-24 hourly from day 5-25 of cycle or administer continuously Duration: 3 months
Lynestrenol	5 mg PO 24 hourly Duration: At least 6 months
Medroxyprogesterone	10 mg PO 8 hourly Start on day 1 of the menstrual cycle Duration: 3 months or 50 mg IM weekly or 100 mg IM every 2 weeks Duration: At least 6 months
Nomegestrol	5 mg PO 24 hourly from day 16-25 of the menstrual cycle
Norethisterone (Norethindrone)	5 mg PO 24 hourly x 2 weeks then increase dose by 2.5 mg/day at 2-week intervals until 15 mg/day is reached Duration: 6-9 months or 10 mg PO 24 hourly x 2 weeks Increase dose by 5 mg/day at 2-week intervals until 30 mg/day is reached Duration: 6-9 months or 5 mg PO 12 hourly starting on day 1-5 of the menstrual cycle May increase dose to 10 mg PO 12 hourly if spotting occurs Resume initial dose when spotting ceases Duration: 4-6 months or 5 mg PO 24 hourly from day 5-25 of the menstrual cycle x 6 months or continuously from day 5 starting with 2.5 mg PO 24 hourly and increasing by 2.5 mg every 2-3 weeks Duration: 4-6 months

*Various combinations of estrogens and progestogens are available. Please see the latest MIMS for specific formulations and prescribing information.

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.