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David PS, Smith TL, Nordhues HC, Kling JM. A Clinical Review on Paroxetine and Emerging Therapies for the Treatment of Vasomotor Symptoms. Int J Womens Health 2022; 14:353-361. [PMID: 35300283 PMCID: PMC8921794 DOI: 10.2147/ijwh.s282396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Most women experience vasomotor symptoms (VMS) during their menopausal transition. Menopausal hormone therapy (HT) is the most effective treatment for VMS, but some women choose not to use HT or have contraindications to using HT. Non-hormonal treatment options should be offered to these symptomatic menopausal women. Multiple large randomized controlled trials have demonstrated statistically significant reductions in hot flash severity and/or frequency with the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). To date, paroxetine mesylate remains the only non-hormonal treatment that has been approved by the United States Food and Drug Administration (FDA) for the management of moderate to severe postmenopausal vasomotor symptoms. Lower doses are needed to reduce VMS than those used to treat anxiety or depression, which is beneficial since side effects are typically dose dependent. The recommended dosage is 7.5 mg once daily at bedtime. Dose dependent side effects include nausea, fatigue, and dizziness. Knowing potential medication interactions is critical such as with medications that can lead to serotonin syndrome, concomitant use with monoamine oxidase inhibitors and being aware of p450 drug metabolism is essential for patients taking drugs that utilize the CYP2D6 enzyme for metabolism including tamoxifen. This review discusses in detail the available data supporting the use of paroxetine for the treatment of VMS, including side effects and considerations regarding prescribing. A discussion of other emerging treatments is included as well, including estetrol, oxybutynin and neurokinin 3 (NK3) receptor antagonists.
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Affiliation(s)
- Paru S David
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Taryn L Smith
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Juliana M Kling
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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Sahni S, Lobo-Romero A, Smith T. Contemporary Non-hormonal Therapies for the Management of Vasomotor Symptoms Associated with Menopause: A Literature Review. TOUCHREVIEWS IN ENDOCRINOLOGY 2022; 17:133-137. [PMID: 35118459 DOI: 10.17925/ee.2021.17.2.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
Nearly 75% of all menopausal women experience bothersome vasomotor symptoms including hot flushes and night sweats. Yet vasomotor symptoms continue to be an undertreated and underdiagnosed symptom of menopause which can negatively affect a woman's overall quality of life. While hormone therapy has been widely utilized to ameliorate hot flushes, not all women are candidates for use, especially those with increased risk of cardiovascular disease, thromboembolic disease, and/or women at an increased risk of certain hormone-dependent cancers. The current literature provides strong evidence for non-hormonal therapies in women who experience vasomotor symptoms. This article reviews the evidence for the use of non-hormonal pharmacologic therapies for the treatment of menopausal symptoms including antidepressants, gabapentinoids, clonidine and anticholinergics. We also review data on emerging therapies including the latest evidence on neurokinin-1 and -3 antagonists. These therapies should be considered when hormonal options are contraindicated and/or not preferred by the patient. While there are many options available, clinicians should individualize therapy based on the patient's needs and goals while mitigating bothersome side effects.
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Affiliation(s)
- Sabrina Sahni
- Division of General Internal Medicine, Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, USA
| | - Angie Lobo-Romero
- Division of General Internal Medicine, Women's Health, Mayo Clinic Rochester, MN, USA
| | - Taryn Smith
- Division of General Internal Medicine, Women's Health, Mayo Clinic, Jacksonville, FL, USA
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Kapoor E, Faubion S, Hurt RT, Fischer K, Schroeder D, Fokken S, Croghan IT. A selective serotonin receptor agonist for weight loss and management of menopausal vasomotor symptoms in overweight midlife women: a pilot study. Menopause 2020; 27:1228-1235. [PMID: 33110038 PMCID: PMC7676489 DOI: 10.1097/gme.0000000000001599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Weight gain and vasomotor symptoms (VMS) are common complaints in midlife women going through the menopause transition. A selective serotonin 2C (5-HT2C) receptor agonist, lorcaserin, which was previously approved by the Food and Drug Administration for weight loss, has unreported observational evidence suggesting improvement in VMS with its use. The goal of this pilot study was to evaluate the efficacy of lorcaserin for weight loss and management of VMS in overweight midlife women. METHODS This was a 24-week open label pilot study of 20 overweight midlife women, aged 45-60 years, who were experiencing severe VMS. Participants received lorcaserin at the standard dose of 10 mg twice daily for 12 weeks, followed by 12 weeks of observation off the drug. The primary outcomes were changes in weight and subjectively reported VMS. RESULTS At the end of 12 weeks, mean change in weight was -2.4 kg (90% CI, -3.2 to -1.7, P < 0.001). However, the participants returned to the baseline weight at 24 weeks. Participants also reported significant subjective improvement in VMS, with a mean ± SD change in self-reported hot flash frequency from baseline to week 12 of -5.4 ± 3.9 (decrease of 1.4 standard deviations). There was a rapid increase in the frequency of VMS within 2 weeks of discontinuation of lorcaserin with a tendency to approach the baseline frequency of VMS. CONCLUSIONS In addition to its weight loss-inducing effect, 5-HT2C receptor modulation may have an additional beneficial effect on VMS in midlife women. A treatment option that targets both weight and VMS in midlife women is attractive. : Video Summary:http://links.lww.com/MENO/A622.
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Affiliation(s)
- Ekta Kapoor
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Center for Women’s Health, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Stephanie Faubion
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Center for Women’s Health, Mayo Clinic, Rochester, MN, USA
| | - Ryan T. Hurt
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen Fischer
- Department of Health Sciences Research, Division of Biosatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Darrell Schroeder
- Department of Health Sciences Research, Division of Biosatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Shawn Fokken
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ivana T. Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Elnazer HY, Baldwin DS. Structured review of the use of the Arizona sexual experiences scale in clinical settings. Hum Psychopharmacol 2020; 35:e2730. [PMID: 32236977 DOI: 10.1002/hup.2730] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Approximately 40% of women and 30% of men describe sexual dysfunction, although recognition in medical settings is suboptimal, due to problems in reporting and eliciting concerns relating to sexual function and satisfaction. Screening questionnaires may help to support this aspect of clinical practice. The Arizona sexual experiences scale (ASEX) includes items that quantify sex drive, arousal, vaginal lubrication or penile erection, ability to reach orgasm, and satisfaction from orgasm. METHOD We investigated the validity and other psychometric properties of the ASEX, and the findings from the populations in which it has been employed, by searching MEDLINE, EMBASE, and Google Scholar using the terms, Arizona sexual experiences scale, Arizona Sexual Experience Questionnaire, and ASEX. We eliminated duplications, letters, and papers not available in English, and grouped the remaining papers into the categories of psychometric, epidemiological, and outcome-based studies. RESULTS After elimination of letters and duplicates, papers not in English, and preclinical and irrelevant studies, 104 papers were analyzed. The ASEX has excellent internal consistency, scale reliability and strong test-retest reliability. Analyses of variance reveal significant differences in total ASEX scores between patients and controls and between females and males. ASEX appears to be useful in a range of clinical situations including patients with primary sexual dysfunction, specific psychiatric disorders, specific physical illnesses, and treatment emergent sexual dysfunction. DISCUSSION The ASEX appears to be a reliable instrument for identifying and quantifying sexual dysfunction across a range of populations in various clinical settings. Little is known about its utility in patients with anxiety disorders or relationships between ASEX scores and biological parameters.
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Affiliation(s)
- Hesham Y Elnazer
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry). Academic Department, University of Southampton, Southampton, UK
| | - David S Baldwin
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry). Academic Department, University of Southampton, Southampton, UK
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Aronow WS, Shamliyan TA. Effects of antidepressants on QT interval in people with mental disorders. Arch Med Sci 2020; 16:727-741. [PMID: 32542073 PMCID: PMC7286318 DOI: 10.5114/aoms.2019.86928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Drug-induced QT prolongation is associated with higher cardiovascular mortality. MATERIAL AND METHODS We conducted a protocol-based comprehensive review of antidepressant-induced QT prolongation in people with mental disorders. RESULTS Based on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used only with licensed doses, and that all patients receiving antidepressants require monitoring of QT prolongation and clinical symptoms of cardiac arrhythmias. Large observational studies suggest increased mortality associated with all antidepressants (RR = 1.62, 95% CI: 1.60-1.63, number of adults: 1,716,552), high doses of tricyclic antidepressants (OR = 2.11, 85% CI 1.10-4.22), selective serotonin reuptake inhibitors (OR = 2.78, 95% CI: 1.24-6.24), venlafaxine (OR = 3.73, 95% CI: 1.33-10.45, number of adults: 4,040), and nortriptyline (OR = 4.60, 95% CI: 1.20-18.40, number of adults: 5,298). CONCLUSIONS Evidence regarding the risk of QT prolongation in children is sparse.
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Affiliation(s)
- Wilbert S. Aronow
- Department of Medicine and Cardiology Research, Westchester Medical Center and New York Medical College, New York, USA
| | - Tatyana A. Shamliyan
- Elsevier, Clinical Solutions, Philadelphia, USA
- Corresponding author: Tatyana A. Shamliyan MD, MS, Elsevier Clinical Solutions, 1600 Kennedy Blvd, 19103 Philadelphia, USA, Phone: 2675004863, E-mail:
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Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials. ACTA ACUST UNITED AC 2019; 55:medicina55090554. [PMID: 31480427 PMCID: PMC6780738 DOI: 10.3390/medicina55090554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) −7.97 [−10.51, −5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, −0.40 awakenings/night [−1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes.
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Shea AK, Meschino D, Wolfman W. The effect of serotonin reuptake inhibitors on the vaginal epithelium in postmenopausal women. Climacteric 2019; 22:507-510. [DOI: 10.1080/13697137.2019.1604655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- A. K. Shea
- Department of Obstetrics and Gynecology, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - D. Meschino
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - W. Wolfman
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Ademosun AO, Adebayo AA, Oboh G. Anogeissus leiocarpus attenuates paroxetine-induced erectile dysfunction in male rats via enhanced sexual behavior, nitric oxide level and antioxidant status. Biomed Pharmacother 2019; 111:1029-1035. [DOI: 10.1016/j.biopha.2019.01.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 01/29/2023] Open
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Ielmini M, Poloni N, Caselli I, Bianchi L, Diurni M, Vender S, Callegari C. Efficacy and Tolerability of Two Different Kinds of Titration of Paroxetine Hydrocloride Solution: an Observational Study. PSYCHOPHARMACOLOGY BULLETIN 2018; 48:33-41. [PMID: 29713104 PMCID: PMC5875366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Depressive disorders are expected to be the second highest cause of morbidity in the world until few years. Moreover, patients with depression frequently show many side effects and low compliance to therapy. To find a more tolerated and more efficacy therapy is a growing need. OBJECTIVE This observational study investigates the efficacy, safety and tolerability of paroxetine hydrochloride comparing slow versus standard titration in a population affected by Depressive Disoders (according to DSM 5). METHODS 186 outpatients were assessed throught the following scales: Hamilton Depression Rating Scale (HDRS) for depression and World Health Organization Quality of Life Scale Bref for the perceived quality of life (WHOQOL BREF). Treatment-emerged Adverse Events (TEAEs) were recorded throught self-reports. Statystical analysys was performed by GraphPad Prism Version 5.1. RESULTS The efficacy of paroxetine was confirmed in both titrations by the number of clinical remitters (HDRS ≤ 7 at 12 weeks for 53% of the standard titration group and 58% of the slow titration group), without differences. About safety and tolerability there were more frequent TEAEs among the standard titration group (p < 0.01). Comparing WHOQOL BREF between the two groups at the recruitment and at the twelth week emerged a statistically significant difference (p = 0.003), with highest scores reached in slow titration group. CONCLUSIONS Although the short observation period is an evident limit, this study is consistent to the literature about the efficacy of both titrations of paroxetine to improve depression and shows promising results about the increased tolerability of paroxetine slow titration.
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Affiliation(s)
- Marta Ielmini
- Ielmini, Caselli and Bianchi, Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Poloni, Universitary Researcher at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Diurni, PhD and Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Vender, Honorary Professor at the University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Callegari, Associate Professor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy
| | - Nicola Poloni
- Ielmini, Caselli and Bianchi, Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Poloni, Universitary Researcher at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Diurni, PhD and Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Vender, Honorary Professor at the University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Callegari, Associate Professor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy
| | - Ivano Caselli
- Ielmini, Caselli and Bianchi, Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Poloni, Universitary Researcher at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Diurni, PhD and Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Vender, Honorary Professor at the University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Callegari, Associate Professor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy
| | - Lucia Bianchi
- Ielmini, Caselli and Bianchi, Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Poloni, Universitary Researcher at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Diurni, PhD and Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Vender, Honorary Professor at the University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Callegari, Associate Professor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy
| | - Marcello Diurni
- Ielmini, Caselli and Bianchi, Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Poloni, Universitary Researcher at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Diurni, PhD and Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Vender, Honorary Professor at the University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Callegari, Associate Professor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy
| | - Simone Vender
- Ielmini, Caselli and Bianchi, Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Poloni, Universitary Researcher at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Diurni, PhD and Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Vender, Honorary Professor at the University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Callegari, Associate Professor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy
| | - Camilla Callegari
- Ielmini, Caselli and Bianchi, Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Poloni, Universitary Researcher at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Diurni, PhD and Medical Doctor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Vender, Honorary Professor at the University of Insubria, Via Guicciardini 2, 21100 Varese, Italy. Callegari, Associate Professor at the Department of Medicine and Surgery, Psychiatry, University of Insubria, Via Guicciardini 2, 21100 Varese, Italy
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Kagan R, Goldstein SR, Pickar JH, Komm BS. Patient considerations in the management of menopausal symptoms: role of conjugated estrogens with bazedoxifene. Ther Clin Risk Manag 2016; 12:549-62. [PMID: 27103814 PMCID: PMC4827910 DOI: 10.2147/tcrm.s63833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Menopausal symptoms (eg, hot flushes and vaginal symptoms) are common, often bothersome, and can adversely impact women's sexual functioning, relationships, and quality of life. Estrogen-progestin therapy was previously considered the standard care for hormone therapy (HT) for managing these symptoms in nonhysterectomized women, but has a number of safety and tolerability concerns (eg, breast cancer, stroke, pulmonary embolism, breast pain/tenderness, and vaginal bleeding) and its use has declined dramatically in the past decade since the release of the Women's Health Initiative trial results. Conjugated estrogens paired with bazedoxifene (CE/BZA) represent a newer progestin-free alternative to traditional HT for nonhysterectomized women. CE/BZA has demonstrated efficacy in reducing the frequency and severity of vasomotor symptoms and preventing loss of bone mineral density in postmenopausal women. CE/BZA provides an acceptable level of protection against endometrial hyperplasia and does not increase mammographic breast density. Compared with traditional estrogen-progestin therapy, it is associated with lower rates of breast pain/tenderness and vaginal bleeding. Patient-reported outcomes indicate that CE/BZA improves menopause-specific quality of life, sleep, some measures of sexual function (especially ease of lubrication), and treatment satisfaction. This review looks at the rationale for selection and combination of CE with BZA at the dose ratio in the approved product and provides a detailed look at the efficacy, safety, tolerability, and patient-reported outcomes from the five Phase III trials. Patient considerations in the choice between CE/BZA and traditional HT (eg, tolerability, individual symptoms, and preferences for route of administration) are also considered.
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Affiliation(s)
- Risa Kagan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Berkeley, CA, USA
- East Bay Physicians Medical Group, Berkeley, CA, USA
| | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - James H Pickar
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Barry S Komm
- Global Medical Affairs, Pfizer Inc., Collegeville, PA, USA
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11
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The effect of conjugated estrogens/bazedoxifene therapy on body weight of postmenopausal women. Menopause 2016; 23:376-82. [DOI: 10.1097/gme.0000000000000541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Objective Sleep disturbances are common among women in midlife; prevalence increases among perimenopausal/postmenopausal women with vasomotor symptoms. Paroxetine 7.5 mg is the only nonhormonal treatment that has been approved in the United States for moderate to severe vasomotor symptoms associated with menopause. In two pivotal phase 3 studies evaluating its efficacy and safety, improvements in sleep disturbances were also prospectively evaluated. Methods Postmenopausal women with moderate to severe vasomotor symptoms were randomly assigned to paroxetine 7.5 mg (n = 591) or placebo (n = 593) once daily for 12 weeks (both studies) or 24 weeks (24-wk study). Predefined assessments on weeks 4, 12, and 24 included number of nighttime awakenings attributed to vasomotor symptoms, sleep-onset latency, sleep duration, and sleep-related adverse events. The two studies’ data for weeks 1 to 12 were pooled. Results At baseline, participants reported a mean of 3.6 awakenings/night attributed to vasomotor symptoms. Nighttime awakenings attributed to vasomotor symptoms were significantly reduced within 4 weeks of initiating paroxetine 7.5 mg treatment (39% reduction vs 28% for placebo; P = 0.0049), and reductions were sustained through 12 or 24 weeks of treatment. Paroxetine 7.5 mg treatment also significantly increased nighttime sleep duration (week 4, +31 vs +16 min for placebo; P = 0.0075), but no significant between-group differences in sleep-onset latency or sleep-related adverse events such as sedation were observed. Conclusions In postmenopausal women treated for menopausal vasomotor symptoms, paroxetine 7.5 mg significantly reduces the number of nighttime awakenings attributed to vasomotor symptoms and increases sleep duration without differentially affecting sleep-onset latency or sedation.
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Carroll DG, Lisenby KM, Carter TL. Critical appraisal of paroxetine for the treatment of vasomotor symptoms. Int J Womens Health 2015; 7:615-24. [PMID: 26124682 PMCID: PMC4476484 DOI: 10.2147/ijwh.s50804] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Vasomotor symptoms (VMS), characterized by hot flashes and night sweats, are the most commonly reported symptoms associated with estrogen deficiency during menopause and occur in up to 70% of women. The goal of treatment is to reduce the frequency and severity of symptoms. Although hormone therapy (HT) is generally recommended as first-line treatment, it is not appropriate for all patients. Antidepressants, specifically selective serotonin reuptake inhibitors, have been evaluated and utilized internationally for alternative treatment for VMS. In 2013, paroxetine mesylate (Brisdelle®) received a US Food and Drug Administration-labeled indication for moderate-to-severe hot flashes, making it the first nonhormonal treatment for VMS associated with menopause. The objective of this review is to critically evaluate available clinical data regarding the efficacy and safety of paroxetine for the treatment of VMS in menopausal women. Methods MEDLINE, PubMed, and Google Scholar were searched using the keywords paroxetine, vasomotor symptoms, hot flashes, and menopause. Searches were limited to humans, English language, and clinical trial design with a primary outcome of hot flash/vasomotor changes. Results Paroxetine (hydrochloride and mesylate) has been associated with a 33%–67% reduction in hot flash frequency with 6–12 weeks of treatment compared to 13.7%–37.8% reductions with placebo in patients both with and without a history of breast cancer. It was also associated with significant reductions in hot flash severity. Benefits of treatment persisted through 24 weeks in the study of the longest duration. Most adverse effects reported were of mild-to-moderate severity, with improved tolerability associated with lower doses (7.5–12.5 mg/day). Conclusion Paroxetine is a safe and effective therapy for the treatment of VMS during menopause. Paroxetine (7.5–12.5 mg/day) should be considered a first-line therapy option for VMS in patients when HT is either inappropriate or intolerable.
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Affiliation(s)
- Dana G Carroll
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA ; Department of Family Medicine, College of Community Health Sciences, University of Alabama, University Medical Center, Tuscaloosa, AL, USA
| | - Katelin M Lisenby
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA ; Department of Family Medicine, College of Community Health Sciences, University of Alabama, University Medical Center, Tuscaloosa, AL, USA
| | - Tracy L Carter
- Department of Pharmacy, DCH Regional Medical Center, Tuscaloosa, AL, USA
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Genazzani AR, Komm BS, Pickar JH. Emerging hormonal treatments for menopausal symptoms. Expert Opin Emerg Drugs 2015; 20:31-46. [DOI: 10.1517/14728214.2015.986093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Another option for menopausal vasomotor symptoms without negative impact on weight and sexual function. Menopause 2014; 21:1036-7. [PMID: 25072955 DOI: 10.1097/gme.0000000000000309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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