Table 2. Management Strategies for Common Adverse Events With Androgen Deprivation Therapy.

Adverse eventa	Signs and symptoms	Guidance for managing
Hot flash	Redness, especially in face, neck, and chest (erythematous skin); sudden feeling of heat and sometimes a red, flushed face and sweating	Stay cool. At night, a “chill pillow” filled with water or other cooling material might help. Use fans during the day. Wear lightweight, looser-fitting clothes made with natural fibers such as cotton Try deep, slow abdominal breathing (6 to 8 breaths per minute). Practice deep breathing for 15 minutes in the morning, 15 minutes in the evening, and when a hot flash starts Acupuncture Other treatments may help provide relief such as: Low-dose depression drugs like venlafaxineb Gabapentin, an antiseizure drug
Asthenia/fatigue	Severely overtired; whole-body tiredness, tired legs, tired eyes, malaise	For fatigue, exercise daily. Walking, swimming, bicycling, and dancing are all good choices. Drink plenty of fluids, eat a healthy diet, and exercise regularly (30 minutes per day, 5 days per week with an emphasis on resistance training) Other treatment options include stimulants
Diarrhea/constipation	Diarrhea: frequent, loose, watery stools and belly pain. Constipation: Fewer than three stools a week, lumpy or hard stools, and/or straining to have bowel movements	For diarrhea and constipation, consider over-the-counter medications and recommend avoiding trigger foods HCPs should withhold treatment for patients with severe symptoms until improving Refer for dietitian/nutrition consult
Joint stiffness/arthralgia	Aching and sore joints; tenderness, swelling, or stiffness in or around a joint	Consider over-the-counter analgesics or other pain relievers

Note. HCP = health-care provider. Information from Johnson & Carroll (2011); Pandya et al. (2005); Terrie (2016).

^aConsider intermittent ADT in patients who cannot tolerate symptoms of continuous therapy. Note that relugolix is not approved for intermittent therapy.

^bVenlafaxine is not approved for the management of menopausal hot flashes.