Primary Dysmenorrhea. Alleviation by an Inhibitor of Prostaglandin Synthesis and Action

Schwartz, Ann F.; Zor, U.; Hr, Lindner; Naor, Shachar

doi:10.1097/00006254-197506000-00019

Cited by 36 publications

(18 citation statements)

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“…Flufenamic acid appears to be the first NSAID used specifically as a PG synthetase inhibitor for the treatment of dysmenorrhea (69). This report on the use of a PG synthetase inhibitor and PG antagonist for the treatment of dysmenorrhea was published in 1974.…”

Section: Nsaids In Dysmenorrheic Therapymentioning

confidence: 99%

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Prostaglandins and Nonsteroidal Antiinflammatory Drugs in Dysmenorrhea

Çhan¹

1983

Annu. Rev. Pharmacol. Toxicol.

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INTRODUCTIONDysmenorrhea, commonly known as menstrual pain or cramps, is classifi ed into primary and secondary dysmenorrhea. Generally, primary dysmenorr hea has its inception at the onset of or soon after menarche and characteris tically has no identifiable macroscopical pathology. In contrast, secondary dysmenorrhea usually has its onset in adulthood and is associated with specific pelvic pathology. Some of the causes of secondary dysmenorrhea are endometriosis, uterine polyps, pelvic inflamm atory diseases, uterogeni tal anatomical anomaly, and intrauterine device. Primary dysmenorrhea is by far the more prevalent form.The incidence and prevalence of primary dysmenorrhea have not been established, but it has been estimated that as many as 50% of women of reproductive age, particularly nulliparas, suffer from dysmenorrhea at one time or other. In approximately 10% of these dysmenorrheic subjects, the symptoms are disabling enough to cause incapacitation for one to two days a month (1-4). Primary dysmenorrhea is the most common gynecologic complaint. Because of its cyclic recurring nature, the medical and socioeco nomic impact of dysmenorrhea is enormous. It is the greatest single cause of lost work hours and school days among women (5-8), with more than 140 million work hours estimated to be lost annually (4). With increasing numbers of women entering the work force, dysmenorrhea may cause an even greater economic loss to society. 131Annu. Rev. Pharmacol. Toxicol. 1983.23:131-149. Downloaded from www.annualreviews.org Access provided by University of California -Davis on 02/03/15. For personal use only. Quick links to online content Further ANNUAL REVIEWS 132 CHAN Despite the prevalence of dysmenorrhea, until very recently, medicine has made very little headway either toward the understanding of the patho physiology of dysmenorrhea or the discovery of a specifi c and effective therapy for this female malady. The introduction of oral contraceptives in the 19608 marked the advent of the first effective therapeutic agent for the treatment of primary dysmenorrhea. Oral contraceptives, however, are not specific agents for dysmenorrhea. Until that time, treatments for dys menorrhea were primarily symptomatic, involving strong analgesics, an tidepressants, alcohol, and a variety of home remedies. These therapeutic approaches have not been successful, because of either lack of efficacy or unacceptable side effects. The first rational therapy for dySmenorrhea ap peared on the medical scene as late as the mid 19708, when the relationship between prostaglandin (pG) and dysmenorrhea was recognized and the newer nonsteroidal anti-in1lamm atory drugs (NSAIDs) with PG synthetase inhibitory activity were being introduced to the general medical practice.This review focuses on the etiologic role of PO in primary dysmenorrhea and therapeutic suppression of uterine PG production as a specifi c therapy for dysmenorrhea. PATHOPHYSIOLOGY OF PRIMARY DYSMENORRHEAMany theories have been proposed for the cause of dysmenorrhea. These inc...

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Section: Nsaids In Dysmenorrheic Therapymentioning

confidence: 99%

“…Flufenamic acid (69,79,80), mefe namic acid (79,81,82,87), and tolfenamic acid (73) have been shown to be effective in dysmenorrhea. The fenamates have a PG-antagonistic prop erty on smooth muscles (83)(84)(85)(86)(87)(88) including the myometrium (86-88).…”

Section: The Fenamatesmentioning

confidence: 99%

Prostaglandins and Nonsteroidal Antiinflammatory Drugs in Dysmenorrhea

Çhan¹

1983

Annu. Rev. Pharmacol. Toxicol.

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“…Mild analgesics are extensively used in conditions that occur in outpatients, in whom relatively few objective studies have been carried out. Cooper & Beaver (1974) have described a method suitable for use in outpatients experiencing pain associated with dental procedures and Schwartz, Zor, Luidner & Noar (1974) have evaluated the action of anti-inflammatory drugs in the relief of dysmenorrhoea. However, in the most common indications for mild analgesics, namely non-migrainous headache, apart from a few controlled studies by investigators such as Lance &Curran (1964) andDiamond &Baltes (1971), agreement on the efficacy and tolerance of different drugs is based on uncontrolled, general clinical experience.…”

Section: Introductionmentioning

confidence: 99%

Non‐migrainous headache for the evaluation of oral analgesics.

Graffenried¹,

Nüesch²

1980

Brit J Clinical Pharma

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1 Eight double-blind, randomized, placebo-controlled, single-dose, cross-over studies were carried out to evaluate the usefulness of testing the acute analgesic effect of drugs in out-patients with non-migrainous headache. 2 The reference compounds were either (1) aspirin, (2) a combination of aminopyrine, caffeine and butalbarbital (Optalidon®), and (3) a combination of (2) with dihydroergotamine (Tonopane).3 The test compounds were (1) proquazone, (2) fluproquazone and (3) and (4), new formulations of Optalidon® and Tonopan® in which the aminopyrine was replaced by propyphenazone. They were all found to be active. 4 A significant, dose-response relationship was established for aspirin (250, 500 and 1000 mg). 5 It is concluded that the non-migrainous headache model is a practical, reproducible and sensitive method for the investigation of the acute efficacy of analgesics.

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“…The inhibitory action of the fenamates on the synthesis and biological action of PGF2" was demon strated by several authors [Vane, 1971;Levy and Lindner, 1971]. A clinical trial with fenamates was successful in primary dysmenorrhea in which PGF2" plays an important role [Schwartz et al} 1974]. In a previous study [Vardi et al, 1976] we found that fenamates were effective in alle viating migrainous attacks.…”

Section: Discussionmentioning

confidence: 89%