Does vilazodone (an antidepressant medication) cause gynecomastia?

Vilazodone and Gynecomastia

Vilazodone does not commonly cause gynecomastia. Based on available evidence, there is no established association between vilazodone and gynecomastia in the current medical literature.

Medication-Induced Gynecomastia - What We Know

• Gynecomastia is commonly associated with specific medications, particularly those that affect hormone balance or have estrogen-like effects 1
• Approximately 10-25% of all gynecomastia cases are drug-induced 1
• Medications with strong evidence for causing gynecomastia include:
  • Spironolactone (associated with greater risk of gynecomastia compared to eplerenone) 2
  • Ketoconazole 1
  • Hormonal agents (estrogens, hCG, anti-androgens) 1
  • 5-α reductase inhibitors 1

Antidepressants and Gynecomastia

• Some antidepressants have been implicated in isolated case reports of gynecomastia, but the evidence is generally poor quality 1, 3
• Selective serotonin reuptake inhibitors (SSRIs) have been occasionally associated with gynecomastia in case reports, but not in large-scale studies 4, 3
• The comprehensive review of vilazodone's clinical efficacy, safety, and tolerability does not mention gynecomastia as a reported adverse effect 5

Vilazodone-Specific Evidence

• In clinical trials and post-marketing surveillance of vilazodone, gynecomastia has not been identified as a significant adverse effect 5
• The most common adverse effects of vilazodone include:
  • Gastrointestinal disturbances (diarrhea, nausea)
  • Headache
  • Dizziness
  • Insomnia
  • Sexual dysfunction 5

Clinical Considerations

• When evaluating potential medication-induced gynecomastia, consider:

  • Timing of onset in relation to medication initiation 3
  • Presence of other common causes (aging, obesity, liver disease, hormonal disorders) 2
  • Other medications the patient may be taking that have stronger associations with gynecomastia 1

• Medications definitely associated with gynecomastia that should be considered first include:

  • Spironolactone (25-100 mg daily) 2
  • Cimetidine 1
  • Ketoconazole 1
  • Hormonal medications 1

Conclusion

Based on current evidence, vilazodone has not been established as a cause of gynecomastia. If a patient develops gynecomastia while taking vilazodone, other causes should be investigated, including other medications, underlying medical conditions, or physiologic factors.