Drug not causing gynaecomastia is?
Correct Answer: Pyrazinamide
Description: Reference: KDT, Essentials of Medical Pharmacology, 7th ed., Pgs. 561, 650 & 792.
Spironolactone is not favoured because of its hormonal side effects (gynaecomastia, impotence, menstrual irregularities).
Cimetidine (but not other H2 blockers) has antiandrogenic action (displaces dihydrotestosterone from its cytoplasmic receptor), increases plasma prolactin and inhibits degradation of estradiol by liver. High doses given for long periods have produced gynaecomastia, loss of libido, impotence and temporary decrease in sperm count.
The most important drawback of ketoconazole is its hormonal effects. It decreases androgen production from testes, and displaces testosterone from protein binding sites. Gynaecomastia, loss of hair and libido, and oligozoospermia may occur when the drug is used for a few weeks. Menstrual irregularities occur in some women due to suppression of estradiol synthesis.
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