| SSRIs |
| Fluoxetine (Sarafem)‡ | 10 to 20 mg per day | $ 91 | First-choice agents for the treatment of PMDD; at present, only fluoxetine is labeled for this indication. | Insomnia, drowsiness, fatigue, nausea, nervousness, headache, mild tremor, sexual dysfunction |
| Sertraline (Zoloft) | 50 to 150 mg per day | | 76 | Clearly effective in alleviating behavioral and physical symptoms of PMS and PMDD | |
| Paroxetine (Paxil) | 10 to 30 mg per day | | 78 | | |
| Fluvoxamine (Luvox) | 25 to 50 mg per day | | 88 (69–79) | For intermittent therapy, administer during luteal phase (14 days before menses). | |
| Citalopram (Celexa) | 20 to 40 mg per day | | 67 | | |
| Diuretics |
| Spironolactone (Aldactone) | 25 to 100 mg per day during luteal phase | | 16 (6) | Clearly effective in alleviating breast tenderness and bloating | Antiestrogenic effects, hyperkalemia |
| NSAIDs |
| Naproxen sodium (Anaprox) | 275 to 550 mg twice daily | | 60 (37–50) | Effective in alleviating various physical symptoms of PMS but not breast tenderness | Nausea, gastric ulceration, renal dysfunction |
| Use with caution in women with preexisting gastrointestinal or renal disease. |
| Any NSAID should be effective. |
| Androgens |
| Danazol (Danocrine) | 100 to 400 mg twice daily | | 149 (120) | Somewhat effective in alleviating mastalgia when taken during luteal phase | Weight gain, decreased breast size, deepening of voice |
| Continuous therapy is not recommended because of side effect profile and cost. | Monitor lipid profile and liver function. |
| GnRH agonists |
| Leuprolide (Lupron) | 3.75 mg IM every month or 11.25 mg IM every three months | | 535 | Somewhat effective in alleviating physical and behavioral symptoms of PMS | Hypoestrogenic side effects, including atrophic vaginitis, hot flashes, cardiovascular effects, and osteoporosis |
| Side effect profile and cost limit use, especially as long-term therapy (more than 6 months). |
| “Add-back” therapy with estrogen and/or progesterone is necessary if GnRH agonists are used as long-term therapy (more than 6 months). |
| Goserelin (Zoladex) | 3.6 mg SC every month or 10.8 mg SC every three months | | 470 | | |
| Nafarelin (Synarel) | 200 to 400 mcg intranasally twice daily | | 523 for 8-mL nasal spray bottle | | |
| Histrelin (Supprelin) | 10 mcg per kg per day SC | | 471 | | |