Newer Antidepressants and Gabapentin for Hot Flashes: An Individual Patient Pooled Analysis

Loprinzi, Charles L.; Sloan, Jeff A.; Stearns, Vered; Slack, Rebecca; Iyengar, Malini; Diekmann, Brent; Kimmick, Gretchen; Lovato, James; Gordon, Paul; Pandya, Kishan J.; Guttuso, Thomas; Barton, Debra L.; Novotny, Paul J.

doi:10.1200/jco.2008.19.6253

Cited by 162 publications

(103 citation statements)

References 25 publications

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“…Compared with placebo, medications such as paroxetine, fluoxetine, sertraline, and venlafaxine were associated with significant improvement in hot flashes. 129,130 The most effective oral doses appear to be as follows: paroxetine, 10 to 25 mg/d; fluoxetine, 20 mg/d; sertraline, 100 mg/d; and venlafaxine, 75 mg/d. 131,132 Gabapentin, at For personal use.…”

Section: Management Of Vasomotor Symptomsmentioning

confidence: 99%

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Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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). © 2011 Mayo Foundation for Medical Education and ResearchB reast cancer is the leading cause of cancer death in women in the United States who are aged 20 to 59 years. 1 In 2010, an estimated 207,090 new cases of breast cancer were identified in the United States. 2 Although breast cancer risk increases with age, approximately 35% of breast cancers occur during the reproductive and perimenopausal years. 3 The 5-year relative survival rate for women of all ages with breast cancer diagnosed between 1999 and 2005 is 89%. 3 Of the premenopausal breast cancers diagnosed, approximately 58% are both estrogen receptor (ER) and progesterone receptor (PR) positive, 6% are ER positive only, 17% are PR positive only, and 20% are both ER and PR negative. 4 The management and treatment of breast cancer in premenopausal women can affect menstruation, reproduction, and gynecologic health. Breast cancer treatment can have a marked affect on fertility in women who have delayed childbearing and have fewer remaining reproductive years. Among premenopausal women with breast cancer, more than 50% wish to retain their fertility. 5 AUB = abnormal uterine bleeding; E2 = estradiol; EA = endometrial ablation; EC = endometrial cancer; ER = estrogen receptor; FDA = Food and Drug Administration; GnRH = gonadotropin-releasing hormone; IUD = intrauterine device; LNG = levonorgestrel; NSAID = nonsteroidal anti-inflammatory drug; PR = progesterone receptor; SHBG = sex hormone-binding globulin gynecologic issues and conditions are prevalent in reproductive-age women. In the general population, more than 30% of reproductive-age women fulfill criteria for the diagnosis of menorrhagia, 6 25% have symptomatic fibroids, 7 and nearly 67% have an underlying uterine disorder with potential to cause abnormal uterine bleeding (AUB). 8 Among premenopausal women with breast cancer, management of menstrual disorders, contraception, vasomotor symptoms, and fertility presents a challenge. Common and effective hormonal options are less well studied in this population because of significant concern about recurrence of breast cancer. Herein,we present the challenges and discuss management options for young women with breast cancer who present with various common gynecologic conditions.Articles for this review were identified by searching the PubMed database with no date limitations. PREMENoPAUSAL SEx STERoIDS AND THEIR PHARMACoLoGyPhysiologically, premenopausal women with regular cycles have cyclic variation in levels of estradiol (E2) (15-350 pg/ mL [to convert to pmol/L, multiply by 3.671]) and progesterone (0.2-27 ng/mL [to convert to nmol/L, multiply by 3.18]). These "free" (unbound) hormones are biologically active and can enter a target cell and activate its receptor.

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Section: Management Of Vasomotor Symptomsmentioning

confidence: 99%

“…123,130,131 Women who take tamoxifen should avoid medications that inhibit the CYP2D6 enzyme, which is responsible for the metabolism of tamoxifen to its active metabolite, endoxifen. Specifically, tamoxifen, sertraline, paroxetine, and fluoxetine all inhibit the activity of the cytochrome P450 (CYP) 2D6 enzyme.…”

Section: Management Of Vasomotor Symptomsmentioning

confidence: 99%

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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show abstract

“…Not only frequency is reduced, but also the severity and bother, and not only in depressed or anxious women (44), with venlafaxine and paroxetine the most effective (45). Caution is advised in the use of paroxetine in patients receiving treatment for breast cancer since it markedly interferes with the metabolism of tamoxifen.…”

Section: Menopausal Hot Flushesmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Flushing: current concepts

Huguet

Grossman

2017

European Journal of Endocrinology

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Objective: Flushing can be defined as a sensation of warmth accompanied by erythema that most commonly is seen on the face and which occurs in episodic attacks. Such a problem can be clinically problematic, since many conditions and drugs can be related to flushing, and while often there appears to be no underlying organic disease, it is important to exclude disorders since they may be life-threatening conditions. Design and methods: We performed a search in MEDLINE using the terms 'flushing' in combination with 'carcinoid syndrome', 'pheochromocytoma', 'mastocytosis', 'menopausal hot flush' and 'treatment'. European and American guidelines relating to neuroendocrine tumours, mastocytosis and menopause were reviewed. Results: In this review, we discuss the main causes of flushing and propose an algorithm based on pathogenesis, which can be used to guide the clinical evaluation process. We also review recent significant developments in the assessment and treatment of the carcinoid syndrome and menopausal hot flushes, which should guide the clinical practice regarding this common but sometimes confusing condition. Conclusions: When evaluating flushing, a precise systematic approach is needed to exclude potentially serious underlying causes, although despite this, the cause of the disorder is not always found. If symptoms are not progressive, the patient should be advised about its apparently benign nature in order to avoid unnecessary studies or initiating treatments of minimal benefit.

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“…SSRI=serotonin selective reuptake inhibitor; SNRI=serotonin norepinephrine reuptake inhibitor **Potent inhibitor of CYP2D6-consider avoiding in patients on tamoxifen Multiple studies and two systematic reviews found that selective serotonin reuptake inhibitors (SSRIs), such as paroxetine and citalopram, and serotonin norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine, decrease vasomotor symptoms in patients with breast cancer compared to placebo [73][74][75]. In patients on tamoxifen, however, avoidance of moderately-potent inhibitors of CYP2D6 such as paroxetine and fluoxetine (Table 2), which may decrease the efficacy of tamoxifen, should be avoided if possible.…”

Section: Vasomotor Symptomsmentioning

confidence: 99%

Endocrine Therapy in Older Women with Early-Stage Hormone Sensitive Breast Cancer

Hsu¹,

Sud²

2017

J Gerontol Geriatr Res

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Breast cancer is the most common cancer affecting women worldwide, with the highest risk in those aged 70 and over. Most older women (80% to 85%) have hormone receptor positive breast cancer and thus the use of endocrine therapy is common in this population. Typically, women receive endocrine therapy for at least 5 years to reduce the risk of cancer recurrence and decrease breast-cancer mortality. However, adherence to hormonal therapy may be an issue, particularly in older women, as side effects may lead to early discontinuation and/or non-adherence. Older women on endocrine therapy are often cared for by primary care physicians and geriatricians and therefore, an understanding of oral endocrine therapy, as well as its potential side effects, is essential for treating physicians. This review describes the benefits of endocrine therapy in patients with resected breast cancer, compare different hormonal therapies with regards to side-effects and discuss management strategies with a particular focus on the concerns of older breast cancer patients on endocrine therapy. Mrs. Smith is a 75-year-old woman whose family doctor noted a 3 cm to 4 cm lump in her left breast during a routine physical exam. She has no palpable lymph nodes. Her family doctor sends her for a mammogram which reveals a 2.6 cm spiculated mass in the left upper outer quadrant. Biopsy reveals an invasive ductal carcinoma.

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Newer Antidepressants and Gabapentin for Hot Flashes: An Individual Patient Pooled Analysis

Abstract: Some newer antidepressants and gabapentin, within 4 weeks of therapy initiation, decrease hot flashes more than placebo.

Cited by 162 publications

References 25 publications

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

MANAGEMENT OF ENDOCRINE DISEASE: Flushing: current concepts

Endocrine Therapy in Older Women with Early-Stage Hormone Sensitive Breast Cancer

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