Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Estrogens, gestagens, or estrogen-gestagen combinations can be employed as postcoital oral contraceptives. High dose estrogens, such as 5 mg of ethinyl estradiol (EE) daily for 5 days started at the latest 72 hours after unprotected coitus have been proved quite effective with a failure rate of about 1%. However, in about half of the women nausea and in one=third vomiting occurred. Among gestagens the highly effective 19=testosterone preparations are notable. Most experiences pertain to norgestrel (Razemat) as well as to the twice as effective levonorgestrel (D-(-)-norgestrel) LNG. After unprotected coitus, 0.6 mg of LNG taken within 12 hours but possibly even after 1-3 hours is effective. It is common to use a combination of 0.25 mg of LNG and 0/05 mg of EE (Tetragynon). 2 tablets are taken within 48 hours after unprotected intercourse and 2 more 24 hours later. In 4 large studies in Canada and the US with a total of 1540 women who were given instead of LNG the double dose of the half so effective Razemat, the pregnancy rate was 0.9% (14 pregnancies) and the corrected failure rate was 0.65% after excluding women with several unprotected exposures. Assuming a probability of pregnancy of up to 30% after unprotected intercourse depending on the day of the menstrual cycle, the action of the gestagen=estrogen preparation can be regarded as reliable. The side effects are less frequent compared with the high-dose EE therapy. In an Austrian study of 50 women taking Tetragynon, 11 women had nausea, 2 had breast tension, and 4 had vomiting. The duration of bleeding lasted an average of 2 days longer after the taking the pill. 2 women who vomited 2 hours after taking the 1st Tetragynon dose became pregnant. Therefore, in case of nausea it is recommended that an antiemetic be given, and in case of vomiting, the 1st dose of Tetragynon has to be repeated to assure an effective action.
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PMID:[The postcoital pill]. 150 66

The term "pregnancy interception" covers all fertility control methods that interfere with implantation of the fertilized egg, either by inhibiting its transport or implantation or by eliminating the already implanted blastocyst. A few researchers beginning in 1960 used high doses of estrogen in the immediate postovulatory period to prevent implantation. It was discovered that administration had to occur soon after coitus to be effective. Estrogens were administered orally for 5 days beginning in the 72 hours following unprotected intercourse in the ovulatory phase. Secondary effects were common: vomiting in 40% of cases, menometrorrhagia in 30%, and almost constant breast discomfort. About 10% of pregnancies in case of failure of the method were ectopic. The mechanism of action is still not understood. A combined treatment of 50 mcg ethinyl estradiol and a 19-norsteroid progestin has been used since 1975. It must be administered in the 48 hours following coitus and repeated 12 hours later. The duration of treatment and quantity of hormones are significantly reduced, but the secondary effects are similar to those of estrogens used alone, and the failure rate is 2%. Some progestins can also be used alone. IUD insertion up to 7 days after the unprotected intercourse has a contragestive effect, but the risk of infection is considerable and 3% of patients develop endometritis. The risk of secondary sterility discourages use of the method, especially in nulliparas. The prostaglandins E and F are effective in early pregnancy termination, but their side effects considerably limit their use. The average duration of bleeding is acceptable, but prostaglandins cause very painful uterine contractions in 30-40% of cases. Gastrointestinal secondary effects often require termination of treatment. The recent synthesis and use of the antiprogesterone compound RU-486 offers real promise for a widely usable contragestive method. Progesterone is indispensable for the continuation of pregnancy, and inhibiting its action on the endometrium interrupts pregnancy. An antiprogesterone acts by competing directly with progesterone at the target cells. The antiprogesterone RU-486 also has dose-dependent luteolytic and antigonadotropic effects whose mechanisms are not completely understood. Clinical trials have proven the innocuity of RU-486, and its efficacy of about 90% will undoubtedly be improved. Interruption of early pregnancy is a major indication for RU-486. The duration of the pregnancy appears to be the determining factor in the percentage of success, but most researchers have had failure rates of 15% even in pregnancies of less than 5 weeks. Possible heavy bleeding or failure in case of ectopic pregnancy indicate the need for medical surveillance. A different route of administration and combination with a small dose of prostaglandin would undoubtedly raise the success rate. RU-486 may have more promise as a post-coital agent, and may potentially be the basis for development of a once-a-month pill.
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PMID:[Contragestion]. 365 95

A case of acute intestinal vascular necrosis in a 19-year-old user of oral contraceptives (OCs) is described, and hypotheses explaining the digestive complications of synthetic estrogens are reviewed. The patient had originally presented with a violent gastric pain that subsequently spread to the entire abdomen. An abrupt worsening of her condition involved cardiovascular collapse associated with a peritoneal syndrome, vomiting and dehydration, and hyperleukocytosis. Emergency opening of the peritoneum was followed by evacuation of a large quantity of fetid gas and alimentary debris, and observation of a completely necrosed stomach. A careful lavage of the entire intestinal cavity led to temporary improvement, but it became clear during an attempt at gastrectomy that further treatment would be unavailing and the patient died shortly thereafter. Estrogens were believed to be responsible for the digestive necrosis because it occurred in a young woman who had used an estrogen-rich OC for 3 years and who smoked; a hapatic biopsy confirmed the diagnosis. No traces of other risk factors such as hypertension, hyperlipidemia, diabetes, neoplasia, or obesity were observed. Recent publications indicate that OCs are responsible for a certain number of digestive problems, which may include acceleration of intestinal transit, severe diarrhea, rectorrhagia, ischemic or ulcerative colitis, intestinal infarct which is usually localized, and hepatocellular problems ranging from moderate hepatic insufficiency to malignant tumor and Budd-Chiari syndrome. OCs do not modify hemodynamic regimes, but they may cause elevation of fibrinogen and thrombin, diminution of antithrombin III acitivty, increased platelet adhesivity, and decreased fibrinolysis leading to hypercoagulability. These modifications in hemostasis occur in all OC users and are not statistically correlated with occurence of thrombotic accidents. OCs are probably responsible for parietal vascular lesions; experimental injection of synthetic estrogens is associated with both arterial and venous lesions. The most characteristic anomaly is at the level of the intima, with proliferation of smooth muscle cells and increased conjunctive tissue fibers associated with proliferation of the media or the endothelium. The absence of lipid deposits, the simultaneous appearance of arterial and venous lesions, and other evidence argues against and atheromatous origin of parietal lesions. A significant correlation has been found between high levels of anti-synthetic ethinyl estradiol antibodies and the presence of vascular lesions. It is hypothesized that these circulating immune complexes penetrate the vascular walls of OC users and produce lesions, which may depend on factors such as smoking.
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PMID:[Digestive complications of oral contraceptives: a case of extensive digestive necrosis in a young woman]. 647 54

Postcoital contraception (PC) has become more effective in recent years and is recommended for women who have had unprotected coitus between the 8th and 17th days of their cycles. Vaginal douche using a spermicide solution is ineffective as it has resulted in a 37% pregnancy rate. Estrogens are far more effective: Diethylstilbestrol (DES), taken in doses of 25-50 mg daily for 5 days, e.g., 10 mg of conjugated estrogens 3 times daily, and 2.5 mg ethinyl estradiol 2 times daily for 5 days 24-72 hours after coitus, has resulted in a .5-1.5% pregnancy rate. Side effects, however, include nausea, vomiting, mastalgia, menorrhagia, extrauterine pregnancy, and adenocarcinoma in daughters of DES-treated women. Gestagens, such as .15-.40 mg of d-norgestrel taken 3 hours after coitus, can be used as a form of planned PC. In an experiment, an estrogen-gestagen preparation consisting of 50 mcg ethinyl estradiol and 500 mcg dl-norgestrel taken 12-72 hours after coitus produced a .9% pregnancy rate in 1300 menstrual cycles with few serious side effects. Copper 7 or copper-T IUDs also prevent the implantation of the fertilized egg, and, when used within 5 days after coitus, produced only 1 pregnancy in 727 cases. The ideal future PC would be a preparation that inhibits either ovulation or nidation and has limited side effects. Among some promising agents are a luteinizing hormone-releasing factor agonist as well as natural and synthetic prostaglandins; however, until their cardiovascular and gastrointestinal side effects have been ameliorated, their routine use is unlikely.
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PMID:[Postcoital contraception]. 661 4

Some form of postcoital contraception for protection against unwanted pregnancy is indispensable today especially in cases of rape, failed mechanical contraception, or 1st sexual contact without contraception. A tabletform of postcoital contraceptive would be acceptable if 100% certainty is assured and it doesn't involve adverse effects. Postcoitally administered high-dose estrogens proved effective in Macaca mulatta. Diethylstilbestrol in variable dosages with or without ethinylestradiol was used in various studies and with variable results. Pregnancy rates depended on time of coitus in cycle, contraceptive dosage, and time of administration after coitus (within 72 hours). Conjugated estrogens and various progestagens or combinations of both have been tried with variable success. Another form of postcoital contraception is IUD insertion within 7 days following unprotected coitus. Advantages of this method are the time factors and absence of adverse effects of hormonal contraceptives. Postcoital hormonal contraceptives cause changes in the endometrium which prevent blastocyst implantation. They alter tubal function affecting zygote movement towards the uterus. They have an antiovulatory effect and may be luteolytic. Estrogens have more severe side effects than progestagens. Nausea, vomiting, mastodynia, fluid retention, and vaginal bleeding can result from estrogens. Progestagens can cause irregular bleeding. Combination of both can cause menstrual irregularity. Postcoital hormonal contraceptives are contraindicated in heart and liver diseases, thrombosis, and pregnancy (teratogenic and carcinogenic effects on offspring). Pregnancy despite postcoital contraception results in extrauterine pregnancy in 10% of patients. The most important reservations in evaluating publications on this subject are: 1) lack of control group; 2) estimation of pregnancy probability is not reliable because of study population used; 3) patient fertility cannot be ascertained; and 4) reliability of information provided by patient. Conclusion from literature studies is that postcoital hormonal contraception is of value but effectiveness is not proven. More research is needed and indications are that other less radical drugs may be found in near future.
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PMID:[Postcoital contraception]. 725 97

The observation that estrogens in sufficient dosage given postcoitally may prevent implantation of the ovum have led to studies regarding practical clinical application. Estrogens that appear effective in humans include stilbestrol and ethinyl estradiol orally and estrone parenterally. Mestranol should also be effective as well as ORF-3858. Any estrongenic substance in sufficient dosage would probably prevent implantation. Effective period of administration is only between time of fertilization and implantation or 4 to 6 days following coitus. Test dosages have been 25-50 mg stilbestrol or .5-2 mg esthinyl estradiol daily for 5 days. It is now considered that 2-5 mg ethinyl estradiol would be more effective. In over 100 midcycle exposures there have been no pregnancies. Others have reported failures with inadequate dosage. Injectable estrone, 2-20 mg on alternate days for 3 doses, has also been reported effective. The process of implantation is discussed. Endometrial biopsies have usually revealed a "retarded endometrium," a possible mode of action. Side effects have been those usually associated with estrogens: nausea, vomiting, breast soreness, prolonged menses.
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PMID:Post-coital oral contraception. 1225 49