Spironolactone-digoxin synergizes gynecomastia: A case report

Gynecomastia refers to a proliferation of breast tissue in the males that causes imbalances in estrogen and androgen levels, resulting in increased or unopposed estrogen action on breast tissue, where underlying aetiology might be physiological or pathological. Approximately 10 to 25% cases of gynecomastia are in associated with drugs. There are many drugs (Spironolactone, Furosemide, Digoxin etc.) capable to induce gynecomastia on individual basis, but practically it is not seen often. Simultaneously, when two or more similar drugs (capable to induce gynacomastia) are administered concomitantly, it is seen often for its synergistic side effect as a drug induced gynecomastia. In the present case study, a 65 years old male patient who had been taking Digoxin and Spironolactone for Ischemic Heart Disease (IHD) with Left Ventricular Failure (LVEF) in the past one year. On his regular follow up, it has been observed/noticed that the patient has developed a gynecomastia. Hence, it is presumed that the drug induced gynecomastia may be due to synergistic side effect of Spironolactone and Digoxin per se.