Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0600142 (hot flushes)
 1,242 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A novel micellar, nanoparticle emulsion containing 17beta-estradiol is currently available as a daily topical treatment for moderate-to-severe vasomotor symptoms associated with menopause. Applied daily to the lower extremities, the emulsion delivers 0.05 mg estradiol systemically and provides an 85% reduction in hot flash frequency versus baseline by 12 weeks of therapy. When specifically surveyed, most patients felt that this cosmetic-like delivery system was convenient and preferable to transdermal patches. Local skin reactions, all mild, were seen in 4%, and there was a low incidence of side effects that included breast pain, endometrial thickening and headache. Contraindications include those common to all estrogen-containing therapies. This formulation provides patients with a cosmetic-like treatment option that is effective and safe, delivers stable systemic estradiol levels, and may promote overall treatment compliance.
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PMID:Estradiol topical emulsion for the treatment of moderate-to-severe vasomotor symptoms associated with menopause. 1980 62

Tibolone, which is indicated for the relief of climacteric symptoms and the prevention of osteoporosis in postmenopausal women, has a tissue-specific mode of action different to that of conventional hormone replacement therapy (HRT). A large proportion of Asian postmenopausal women experience symptoms that most frequently include musculoskeletal pain, insomnia, forgetfulness, hot flushes and sexual dysfunction, and there is a need to address their specific requirements. Recent studies show that, in comparison to HRT, tibolone is as effective in alleviating menopausal symptoms and preventing bone loss, has a greater positive effect on sexual dysfunction and is associated with less vaginal bleeding, but it is rarely mentioned in guidelines for menopausal treatment. Levels of awareness amongst women about treatments for menopausal symptoms vary between Asian countries but, even in countries where awareness is high, HRT usage is much lower than in the West. To provide a practical approach to the use of tibolone in Asian postmenopausal women, a panel of experts in the management of menopause from 11 Asia Pacific countries has developed recommendations for its use, based on the evidence from clinical studies published since 2005. However, as much of the clinical data reviewed are from international studies, the recommendations and the treatment algorithm presented here are widely applicable.
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PMID:Updated clinical recommendations for the use of tibolone in Asian women. 2044 20

Gabapentin (GP) and pregabalin (PB) are structurally related compounds and their predominant mechanism of action is the inhibition of calcium currents via high-voltage-activated channels containing the a2d-1 subunit. A2delta ligands are approved for the treatment of pain of diabetic neuropathy and post-herpetic neuralgia in adults and as adjunctive therapy of partial seizures in children. Recently, pregabalin has been approved for treatment of anxiety disorders in Europe. Besides their already approved indications both drugs are promising treatment options for a number of different serious and debilitating diseases, as fibromyalgia, neuropathic pain of spinal cord injury, hot flushes, and essential tremor. In the present review, the unique mechanism of action of the above drugs is critically analyzed and evidence for their future use is provided. Gabapentin and pregabalin can be treatment options for these disorders, however, a clear comparison between the two drugs can not be performed, since there is no direct comparison study. The most common side effects are dizziness and somnolence which are also the most frequent reasons for withdrawal. Recommendations for future studies should include assessment of ideal titration period for GP and PB to reduce incidence of somnolence and dizziness and increase tolerability, cost-effectiveness and dose-response analysis of PB and GP and direct comparison of the two drugs.
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PMID:A2delta ligands gabapentin and pregabalin: future implications in daily clinical practice. 2059 59

Acupuncture has become a popular complementary treatment in oncology, particularly as patients seek non-pharmacological alternatives to provide symptom control. A considerable body of evidence suggests that acupuncture modulates neurological processes to bring about its effects. This basic research is supported by an increasing number of positive clinical studies of varying quality. Lower quality studies have hampered the widespread acceptability of acupuncture, with some deeming the inter-personal skills of the practitioner to be more powerful than the needle or its equivalent. More recent randomised control trials (RCTs) have sought to settle this controversy, with mixed results. The literature was searched to identify, where possible, RCTs involving acupuncture and various common cancer symptoms. A potential role for acupuncture was found in the following cancer symptoms: pain, nausea and vomiting, xerostomia, hot flushes, fatigue, anxiety, depression and insomnia. Acupuncture is safe with minimal side-effects, and is clinically effective for the management of these symptoms. Continuing research using validated methodology is essential. In the interim, health professionals should be open to explore the use of acupuncture with their cancer patients.
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PMID:Acupuncture and cancer. 2060 36

In patients with non-localised prostate cancer, medical castration is generally achieved with a GnRH agonist such as triptorelin. A peripheral antiandrogen can be added during the first weeks of treatment to counteract the initial testosterone surge. Degarelix is the first GnRH antagonist to be authorised in this setting in the European Union. A randomised unblinded trial compared subcutaneous degarelix versus intramuscular leuprorelin, without the addition of a peripheral antiandrogen. Castration was achieved in almost all patients after the first month of treatment. Testosterone levels decreased within a few days with degarelix and more slowly with leuprorelin, after an initial surge, and these levels were maintained in both groups throughout the one-year study period. The more rapid fall in testosterone obtained with degarelix, without an initial surge, did not translate into lower mortality (there were only 2 cancer deaths) or fewer adverse effects during the first month of treatment. The main adverse effects in this trial were linked to castration: hot flushes and weight gain. Reactions at the injection site (pain, erythema) were far more frequent with degarelix than with leuprorelin, affecting respectively about 40% and fewer than 1% of patients. The large volume of the degarelix subcutaneous solution (3 to 4 mi) is not very practical to administer. In practice, degarelix has no tangible advantages over a GnRH agonist such as triptorelin. It is better to continue to use triptorelin, possibly with addition of an antiandrogen at the beginning of treatment.
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PMID:Degarelix. More rapid medical castration, nothing more. 2073 32

Menopause has been associated with vasomotor symptoms, vulvar-vaginal atrophy and osteoporosis. One of the goals in exploring the potential of selective estrogen receptor modulators (SERMs) was to determine if they could prevent fractures, reduce menopausal symptoms and treat vaginal atrophy, while being neutral or protective on the uterus, breast and cardiovascular system. However, no SERM to date has achieved this goal. More recently, the idea of pairing a SERM with estrogen(s), known as a tissue-selective estrogen complex (TSEC), has been studied in postmenopausal women. A TSEC combines the complementary tissue-selective activities of a SERM and estrogen(s), in an attempt to gain the benefits of each with better overall tolerability. The Selective estrogen Menopause And Response to Therapy (SMART) trials were multicentre, randomized, double-blind, placebo- and active-controlled phase 3 studies evaluating the safety and efficacy of the SERM, bazedoxifene (BZA) paired with conjugated estrogens (CEs) in healthy postmenopausal women. In the first SMART trial, BZA/CE protected the endometrium from estrogenic stimulation, relieved hot flushes and maintained bone mass, with rates of amenorrhea, breast pain and overall adverse events similar to those with placebo in more than 3400 women over two years. BZA 20 mg was the lowest effective dose of BZA in BZA/CE to protect the endometrium and maintain bone mass when paired with CE 0.625 mg and CE 0.45 mg. In SMART-2, these BZA/CE doses significantly reduced the frequency and severity of hot flushes over 12 weeks. Collectively, these data support the TSEC containing BZA/CE as a new paradigm for treating menopausal symptoms and preventing osteoporosis while protecting the endometrium from unopposed estrogenic stimulation.
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PMID:Tissue-selective agents: selective estrogen receptor modulators and the tissue-selective estrogen complex. 2095 88

Vasomotor symptoms and vulvar-vaginal atrophy are common consequences of menopause, and the only treatment approved by the US Food and Drug Administration is hormone therapy. Because both physicians and women are concerned with the tolerability and safety profile of estrogen and estrogen plus progestin treatments, alternative menopause therapies are needed. An ideal menopause treatment modality would relieve menopausal vasomotor and vulvar-vaginal symptoms, maintain bone mass, and have neutral or beneficial cardiovascular effects, without stimulating the breast or endometrium. The novel tissue-selective estrogen complex (TSEC) agent was paired with a selective estrogen receptor modulator (SERM) with estrogen(s) in an attempt to achieve a more favorable clinical profile based on the blended tissue activities of its components. This article reviews the published reports from Phase III trials of TSEC, which paired bazedoxifene (BZA) and conjugated estrogens (CEs). BZA/CE alleviated menopausal symptoms and prevented postmenopausal bone loss, had an overall good safety profile with an incidence of amenorrhea and breast pain similar to that with placebo, and did not stimulate the endometrium. The largest (N = 3397) and longest (2 years) study of this TSEC containing BZA/CE demonstrated endometrial hyperplasia rates similar to that with placebo and changes in lumbar spine bone mineral density that were significantly better than that with placebo, when a minimum dose of 20 mg of BZA was used with 0.625 or 0.45 mg of CE. Subsequent smaller studies showed that BZA/CE effectively reduced the incidence and frequency of hot flushes and significantly improved signs and symptoms of vaginal atrophy. Longer term safety with regard to cardiovascular and breast effects have not been established. Given the efficacy and safety reported in these Phase III trials, the TSEC of BZA/CE may be a promising new option for the treatment of menopause.
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PMID:Treating menopausal symptoms with a tissue-selective estrogen complex. 2153 25

Fear of death, pain, or the recurrence of the illness of tumor patients can narrow their attention to a point where a spontaneous altered state of consciousness occurs. In these cases hypnosis either in formal psychotherapy or embedded into the everyday communication with the physician can effectively complement other already known medical and psychological techniques. Although numerous studies have reported the beneficial physical and mental changes induced by hypnosis, for a long time there were not enough research to affect evidence-based medicine. New studies meeting the most rigorous methodological standards, new reviews and the characteristics of hypnosis shown by neuroimaging techniques support the acceptance of this method. Hypnosis is used and studied with adult and child tumor patients alike mostly in the areas of anxiety, pain, nausea, vomiting, quality of life, mood amelioration, immune system and hot flushes. Most of the assays describe hypnosis as an empirically validated treatment technique that in most cases surpass attention diversion, coping trainings, cognitive behavior and relaxation techniques and other regular treatments. In this paper we review these observations.
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PMID:[Possibilities of hypnosis and hypnosuggestive methods in oncology]. 2161 88

The pharmacological management of disease should involve consideration of the balance between the beneficial effects of treatment on outcome and the probability of adverse effects. The aim of this review is to explore the risk of adverse drug reactions and drug-drug interactions with treatments for postmenopausal osteoporosis. We reviewed evidence for adverse reactions from regulatory documents, randomized controlled trials, pharmacovigilance surveys, and case series. Bisphosphonates are associated with gastrointestinal effects, musculoskeletal pain, and acute-phase reactions, as well as, very rarely, atrial fibrillation, atypical fracture, delayed fracture healing, osteonecrosis of the jaw, hypersensitivity reactions, and renal impairment. Cutaneous effects and osteonecrosis of the jaw are of concern for denosumab (both very rare), though there are no pharmacovigilance data for this agent yet. The selective estrogen receptor modulators are associated with hot flushes, leg cramps, and, very rarely, venous thromboembolism and stroke. Strontium ranelate has been linked to hypersensitivity reactions and venous thromboembolism (both very rare) and teriparatide with headache, nausea, dizziness, and limb pain. The solidity of the evidence base depends on the frequency of the reaction, and causality is not always easy to establish for the very rare adverse reactions. Drug-drug interactions are rare. Osteoporosis treatments are generally safe and well tolerated, though they are associated with a few very rare serious adverse reactions. While these are a cause for concern, the risk should be weighed against the benefits of treatment itself, i.e., the prevention of osteoporotic fracture.
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PMID:Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis. 2163 97

The most frequent symptom with leiomyoma is menometrorrhagia. However, it can be responsible of pelvic pain, dysmenorrhea or urinary and digestive compression when it is particularly voluminous. These recommandations were made in order to review medical management of fibroids. If no therapy is able to have them disappear, various drugs may reduce their related symptoms. Tranexamic acid, non-steroidal anti-inflammatory drugs and high dose of oestrogen may be useful in the management of acute hemorrhagic disorders. Progestin, such as lynestrenol induces small reduction in leiomyoma volume and moderate increase in hemoglobin level before surgery. Pregnane and nor-pregnane may improve menstrual bleeding in short or mild delays. The use of Gonadotropin Releasing Hormone (GnRH) agonists can reduce menstrual bleeding with hemoglobin recovery. Add-back therapy using tibolone seems interesting since secondary effects encountered with GnRH agonists may be reduced. Levonorgestrel-releasing intrauterine system is proven to reduce increased menstrual bleeding and restore hemoglobin level. Aminoglutethimide and fadrozole have been underevaluated to conclude when letrozole seems as efficient as GnRH agonists to reduce leiomyoma volume and provide less hot flushes. Anastrozol is associated with reduction in leiomyomata volume, pain and menstrual bleeding. Mifepristone reduces the size of uterine leiomyomata, improves symptomatology, but could be associated with development of endometrial hyperplasia. SPRM evaluated in females have shown to improve leiomyoma related symptomatology. Danazol could be useful to reduce leiomyoma related symptoms in short terms. Tamoxifen and raloxifen show modest overall benefit. Because of insufficient data concerning fulvestrant, pirfenidone or interferon, their prescription cannot be recommended in patients with leiomyomata.
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PMID:[Role of medical treatment for symptomatic leiomyoma management in premenopausal women]. 2207 Oct 15


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