Medication	Description	Manifestations treated	FDA pregnancy category	Main adverse effects	Typical dosage	Approximate monthly cost*
First-line
Clomiphene (Clomid)†	Ovulation induction agent	Infertility	X	Multiple pregnancy/ovarian hyperstimulation, thromboembolism, visual disturbances	50 to 100 mg per day^6–8	$52 (generic) and $128 (brand) for 100 mg per day for 5 days
Eflornithine (Vaniqa)‡	Inhibits hair growth	Hirsutism	C	Mild skin irritation	13.9% cream applied to face twice per day⁹	$46 (brand) for one 30-g tube
Metformin (Glucophage)§	Insulin-sensitizing agent	Hirsutism; infertility; insulin resistance; menstrual irregularities	B	GI upset, lactic acidosis, increase in homocysteine levels	1,500 to 2,250 mg per day^10–16	$73 (generic) and $107 (brand) for 850 mg twice per day
Oral contraceptives§\|\|	—	Hirsutism; menstrual irregularities	X	Nausea, headache, spotting, thrombophlebitis, deep venous thrombosis	Varies	Varies
Pioglitazone (Actos)§	Insulin-sensitizing agent	Hirsutism; infertility; insulin resistance	C	CHF, may cause weight gain	30 mg per day^14,17,18	$199 (brand)
Rosiglitazone (Avandia)§	Insulin-sensitizing agent	Hirsutism; infertility; insulin resistance; menstrual irregularities	C	CHF, hepatotoxicity, edema, increase in homocysteine levels	2 to 8 mg per day (beneficial effects are dose related)^19–21	$113 (brand) for 4 mg per day
Spironolactone (Aldactone)§	Antiandrogenic antimineralocorticoid	Hirsutism; menstrual irregularities	C	Hyperkalemia, nausea, breast tenderness	50 mg per day to 100 to 200 mg per day^22,23	$61 (generic) and $97 (brand) for 50 mg twice per day
Second-line
Acarbose (Precose)§	Insulin-sensitizing agent	Hirsutism; menstrual irregularities	B	GI upset	150 mg per day²⁴ (for menses regulation)	$94 (brand)
Desogestrel/ethinyl estradiol (Apri)§¶	Oral contraceptive	Hirsutism	X	Increased total cholesterol and low-density lipoprotein cholesterol; thromboembolism, stroke, MI	0.15 mg desogestrel plus 30 mcg ethinyl estradiol per day	$31 (brand)
Finasteride (Propecia)§	5-alpha-reductase inhibitor	Hirsutism	X	Hypersensitivity reaction, decreased libido	5 mg per day²⁵	$148 (generic) and $100 to $343 (brand)
Flutamide (formerly Eulexin)§	Nonsteroidal antiandrogen used mostly in prostate cancer	Hirsutism	D	Thrombocytopenia, leukopenia, liver toxicity, hot flashes	250 mg once or twice per day²⁵	$140 (generic) for 250 mg per day
Letrozole (Femara)§	Nonsteroidal competitive inhibitor of aromatase; inhibits conversion of adrenal androgens	Infertility	C	Osteoporosis, thromboembolism, MI, hot flashes, arthralgias	2.5 mg per day⁶	$340 (brand)
Sibutramine (Meridia)§	Centrally acting appetite suppressant	Hirsutism	C	Tachycardia, hypertension, headache, dry mouth	10 mg per day²⁶	$116 (brand)