Medications used to treat Cushing’s
April 5, 2022
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