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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Progress in new drug developments is discussed in relation to newly registered drugs and drugs in the animal and/or clinical research stage. Of central nervous system drugs new neuroleptics, antidepressants, tranquilizers, psychotropics, antiparkinson and anticonvulsant agents are discussed in terms of chemical structure, pharmacokinetics and toxicity. Likewise for anti-infective drugs such as antibiotics, antifungal, and antiparasitic agents. New synthetic antiinflammatory glucocorticoids are being developed and tested for toxicity and clinical effect. Estrogen and gestagen research continues but few new substances with more effective action than currently-used compounds have been found. Initial clinical testing of Tibolon shows it to prevent postmenopausal osteolysis and hot flashes. ST-1435 is still being tested as an implantable contraceptive. It causes amenorrhea and reduces plasma estradiol and progesterone. No progress is seen in research on nonhormonal substances with contraceptive action, except for prostaglandins although no new derivatives with high tissue selectivity for uterine smooth muscle, nor early applicable abortifacients, have been found. Metenprost is being studied as a self-administered abortifacient: in one study 98% of completed abortions were seen with 30-40% adverse effects (nausea, vomiting, fever). DL204-IT and L-11,204 are triazoloisoindole and triazoloisoquinolone derivatives which have been tested in various dosages and dosage forms on animals in various pregnancy stages. Optimum contraceptive action occurs in the early blastocyst stage. The plant extracts Zoapatanol and Montanol show dose-dependent inhibition of implantation in animal studies but the contraceptive action mechanism is not known. Oxendolone shows an unmistakable antiandrogenic effect. Action mechanism is assumed to be inhibition of the 5 alpha-reduction of testosterone. It has a long plasma half-life in rats (3.6 days). It has been clinically tested in Japan (weekly intramuscular injection of 200-400 mg) in prostatic hypertrophy. Longterm studies are not yet available.
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PMID:[Progress in the area of drug development. 15]. 613 42

Postcoital contraceptives, the so-called "morning after pill," are agents used as emergency treatment to prevent pregnancy after unprotected intercourse or contraceptive accidents. In the 1960s and early 1970s high doses of estrogens were used in 5-day courses such as diethylstilbestrol 25-50 mg a day or ethinyl estradiol 0.5-5 mg a day begun within 72 hours after coitus. Although effective, a considerable drawback of the associated nausea and vomiting as well as an increased risk of menstrual disturbance during the treatment cycle. Norgestrel alone in various dosages has been used postcoitally. Quingestanol has been used as a continuing postcoital agent in Latin America but proved unacceptable owing to nausea and irregular bleeding. In China "visiting pills" have been devised containing anordrin. In the West regimens of this sort have been superseded by the Yuzpe treatment of 100 mcg ethinylestradiol and 0.5 mg levonorgestrel initially, repeated after precisely 12 hours. The treatment must be initiated within 72 hours of exposure. Postcoital contraceptives act by combinations of mechanisms--the function of the corpus luteum is disrupted, tubal motility may be affected, and changes in endometrial biochemistry prevent ovoimplantation. In a multicenter trial involving 602 women Yuzpe reported a pregnancy rate of 1.6%. Other workers show comparable figures of 0-3%. The primary side effects of the current hormonal method are nausea, which occurs in 61% of cases, and vomiting, 20% of cases. Both are mild and of short duration. All postcoital methods carry a risk of ectopic pregnancy should the treatment fail. 3 ectopic pregnancies were recorded with diethylstilbestrol and 1 recently with the Yuzpe regimen. There have been no reports of thromboembolic complications. If a hormonal form of postcoital treatment fails, the theoretical possibility of the pregnancy being harmed cannot be ruled out. The patient needs to be counseled about this, and careful records should be kept. Also important is the taking of an accurate menstrual and coital history to exclude exposures earlier in the menstrual cycle. Lippes and coworkers showed the efficacy of copper IUDs as postcoital agents. These can be used up to 5 days from intercourse. An IUD is preferred if hormones are contraindictated, if exposure was more than 72 hours beforehand, if the woman desires the most effective method, and if she wants the IUD for longterm contraception. Postcoital contraception, however defined, raises ethical questions. Postcoital methods could be classed as contraceptive rather than abortive within the maximum period (defined by medical scientific consensus) that may elapse between intercourse and nidation.
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PMID:Postcoital contraception. 613 82

Five study centers enrolled 1,311 women seeking postcoital contraception methods. Ethinyl estradiol was administered at 5 mg/day and conjugated estrogens at 30 mg/day for five consecutive days starting within 72 hours of unprotected coitus. Eleven pregnancies occurred in the 976 women who had a single unprotected coitus at midcycle. Based on published information, 69 pregnancies would have been expected if no contraceptives were used. Although both treatments were effective in preventing pregnancy, ethinyl estradiol seemed to be more effective. At the two centers alternately prescribing both drugs, none of 137 women treated with ethinyl estradiol became pregnant, while six of the 132 given conjugated estrogens became pregnant. Women whose treatment commenced on the first postcoital day seemed to have lower pregnancy rates than those whose medication was delayed to the second or third postcoital day regardless of which drug was used. Side effects were mainly limited to nausea that occurred in 70% and vomiting that was experienced by 33% of all women treated.
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PMID:Ethinyl estradiol and conjugated estrogens as postcoital contraceptives. 625 Dec 88

The efficacy of oral contraceptives (OCs) is influenced by any factor that affects circulating blood levels of exogenous estrogen or progesterone or that interferes with their action at a cellular level. Inadvertent pregnancies are not uncommon in combined pill users, and are usually due to errors of tablet taking. Estrogen-progestogen combinations work mainly by hypothalamic suppression; basal plasma levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) are usually repressed and their cyclical surges eliminated. Progestogen-only formulations have much less effect on central control and depend more on effects on the cervical mucus, endometrium, and possibly tubal function. Significant increases in FSH and LH levels may occur in the pill-free week among combined pill users. Reduction in dosage of some newer preparations appears to reduce the margin of error and, in low-dose progestogen-only pills, progestogen may reach inadequate levels for contraceptive effect before the expected time of the next pill. Higher failure rates in the 1st rather than in subsequent treatment cycles are mainly due to user failure, but method failures also may be more common, possibly because hypothalamic suppression increases over the 1st few cycles. 3 studies on pituitary and ovarian function in women who deliberately missed pills at specific stages showed an increase in breakthrough ovulation. Other clinical factors which may affect pill efficacy included vomiting, diarrhea, changing to a lower dose formulation, obesity, and drug interaction, especially with the antituberculosis drug rifampicin, some anticonvulsants, and antibiotics. Breakthrough ovulation from drug interaction is more likely to occur when OCs are administered early or late in the cycle. Analogously, the most hazardous times to miss pills are at the beginning or end of a monthly course.
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PMID:Why do inadvertent pregnancies occur in oral contraceptive users? Effectiveness of oral contraceptive regimens and interfering factors. 641 29

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

The study purpose was to obtain additional clinical experience with 200 mcg of ethinyl estradiol combined with 2 mg dl-norgestrel as an emergency postcoital contraceptive. Half the dosage was administered immediately upon entry into the study and the remainder 12 hours later. A total of 28 clinics in Canada agreed to participate in the study, but 4 withdrew before entering any cases. Participants were either health services of educational institutions, Planned Parenthood facilities, or hospital based women's clinics. A 24 month enrollment period was chosen, but the largest numbers of subjects were enrolled during a total of 14 months. A total of 692 subjects were enrolled. The total dosage administered was 200 mcg of ethinyl estradiol and 2 mg of dl-norgestrel. 3 of the 24 participating clinics provided 60.1% of the enrolled cases. 120 of the 692 subjects had been pregnant at least once before. 95 of these were regularly cycling, and 25 were irregularly cycling. Subjects were divided into 2 groups, those having regular menstrual cycles and those with irregular cycles. Regular cycles were defined as no more than +or- 5 days variation in cycle length from cycle to cycle. There were 496 regularly cycling women (71.8%) and 194 (28.0%) with irregular cycles. In 2 cases data were lacking regarding cycle regularity. An almost equal number of study subjects were treated within the 1st 24 hours (42.4%) and the subsequent 24 hours (35.6%) following exposure. A further 20.1% were treated between 48 and 72 hours following exposure. A midcycle exposure (MCE) for regularly cycling subjects was calculated from the average cycle length, minus 14 days +or- 3 days. Of 451 who were regularly cycling and for whom data were available, 101 were exposed prior to midcycle, 217 at midcycle, and 133 after midcycle. 11 pregnancies were reported from 6 of the participating clinics. 4 of these women had been pregnant at least once previously. 9 had regular cycles, and 2 had irregular cycles. 4 of the 9 regularly cycling women reported other unprotected coital exposures more than 72 hours prior to treatment during their treatment cycle. 42.4% of the subjects experienced no side effects. Nausea and/or vomiting occurred in 51.7% of the subjects and was absent in 48.3%. Other side effects were infrequent. the combination of 200 mcg ethinyl estradiol and 2 mg of dl-norgestrel appears to be an effective method of postcoital contraception with failure rates comparable to those reported for the estrogens used alone.
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PMID:A multicenter clinical investigation employing ethinyl estradiol combined with dl-norgestrel as postcoital contraceptive agent. 704 Jan 17

A case is described wherein a 29 year old woman was admitted to the hospital because of the possibility of a hepatic tumor; symptoms included abdominal pain, diffuse hepatic enlargement and absence of uptake in an area of the right hepatic lobe. After a normal pregnancy and delivery 11 years earlier the patient used oral contraceptives (OCs) composed of norethindrone with mestranol until 8 years before entry; 5 years before admission she resumed use of an OC containing norethindrone and ethinyl estradiol. She smoked 1.5 packages of cigarettes and drank 1 glass of wine daily, and there was no history of nausea, vomiting, melena, jaundice, dark urine, light stools, hepatitis, or blood transfusions. Benign lesions which are known to be caused by OCs fall into 2 groups: designated focal nodular hyperplasia and liver-cell adenoma. The evidence linking the latter with OCs is more convincing since in case-controlled studies the risk of development of adenomas has been shown to increase with the estrogen strength of the OCs and duration of use; in women who have been taking OCs over 7 years the relative risk is 500 times that for matched control nonusers. The vascular complications of OC therapy include Budd-Chiari syndrome, peliosis hepatis, and periportal sinusoidal dilatation. The patient in this case was diagnosed to have periportal and midzonal hepatic sinusoidal dilatation association with OC medication. She underwent an operation on her liver which proved to be successful combined with cessation of OC use. The mechanism by which OCs cause these lesions is not known. In 5 of 13 cases similar to the one described here clinical and biochemical abnormalities resolved and 1 patient had a follow-up liver biopsy that revealed normal findings 10 months after cessation of OC therapy; there is no evidence to suggest that sinusoidal dilatation is irreversible.
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PMID:Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 40-1982. Tender hepatomegaly in a 29-year-old woman. 711 Feb 74

Postcoital contraceptives are available for adolescent use in the US. They include combination oral contraceptives (OCs), high dose estrogens, danazol, and IUDs. Mifepristone (RU-486) is currently not available in the US but is used in France, the UK, and Sweden. Postcoital contraception is especially important for adolescents who have a very high pregnancy rate due to poor contraceptive use. Administration of 2-5 mg ethinyl estradiol (EE) for 5 days beginning within 72 hours of unprotected intercourse yields pregnancy rates ranging from 0-0.92%. EE-related side effects include nausea, vomiting, sore breasts, and irregular menstrual bleeding. DES should not be used, since it is associated with reproductive tract anomalies and vaginal cancers in exposed offspring. Conjugated estrogens have not been used in adolescents for postcoital contraception. The Yuzpe regimen consists of 2 tablets of a combined OC with 200 mg EE and 2 mg dl-norgestrel administered within 72 hours of unprotected intercourse followed by the same dose 12 hours later. Common side effects are nausea and vomiting. Its pregnancy rate is 1.8%. Levonorgestrel-containing OCs can also be used. Administration of 800-1200 mg danazol up to 120 hours after unprotected intercourse protects against pregnancy in about 98% of cases. Copper IUDs have a high efficacy rate when used as postcoital contraception (99.9%), but public opinion, medicolegal considerations, financial costs, and potential for infection impede IUD as a postcoital contraceptive in the US. RU-486 is best known as an abortifacient. It is also a potential postcoital contraceptive. Two UK studies find that RU-486 used as a postcoital contraceptive has a very low pregnancy rate and fewer side effects than the Yuzpe regimen and danazol. It is much more costly than currently used postcoital contraceptives (600 mg of RU-486 cost US$ 68, while Ovral costs US$ 0.48-2.24). Nevertheless, RU-486 may replace the higher doses of OCs as a postcoital contraceptive method.
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PMID:Postcoital contraception: present and future options. 774 40

Even though the oral contraceptive (OC) pill is the most effective reversible contraceptive, many OC users still conceive. Common reasons for OC failure are missed pills, drug interactions, and malabsorption caused by vomiting or diarrhea. The first report of OC failure linked to simultaneous use of another drug was in 1971. The drug was rifampicin, which was used to treat tuberculosis. Broad-spectrum antibiotics may inhibit OC efficiency through several mechanisms. Antibiotics destroy the bacteria which hydrolyse sulphate and glucuronide conjugates (metabolites of ethinyl estradiol). Thus, the enterohepatic recirculation of ethinyl estradiol that normally occurs is prevented, resulting in a reduction in plasma concentration of ethinyl estradiol. Antibiotic-induced diarrhea may increase urinary or fecal excretion of the OC. The antibiotic (e.g., rifampicin) may increase liver degradation of the OC hormones. There may even be other possible mechanisms. Experimental evidence for many of the commonly accepted mechanisms is lacking. Drug interactions are more common in users of the low dose estrogen OCs. In a review of drug interactions during 1968-1984, penicillins and tetracyclines were associated with 70% of cases. OCs with 30 mcg ethinyl estradiol comprised the greatest number of reports. Less than 10% of adverse drug reactions are reported to the Committee on Safety of Medicines via the yellow card plan. Dentists should advise female patients using OCs about reduced efficiency of the OCs while taking an antibiotic. They should follow the recommendations of the UK Family Planning Association. Dentists could routinely provide all female patients prescribed an antibiotic an information pamphlet that provides detailed advice and recommendations on the use of alternative methods. They have a professional obligation to know the physiology of reproduction, the pharmacology of drug interactions with the OC, and contraceptive methods.
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PMID:Oral contraceptives and antibiotics: important considerations for dental practice. 780 51


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