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Undeberg MR, Barash A, McKeirnan KC. Role of the pharmacist in the management of postmenopausal breast cancer treatment with vasomotor symptoms: A case report. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100324. [PMID: 37694166 PMCID: PMC10485165 DOI: 10.1016/j.rcsop.2023.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
This case report describes the pharmacist intervention with a 62-year-old woman who had postmenopausal breast cancer. The patient was experiencing severe vasomotor symptoms from her cancer therapy and wanted to discontinue her treatment despite her risk of cancer returning. Using guidelines for treatment of postmenopausal breast cancer and medication options to mitigate vasomotor symptoms, the pharmacist developed a treatment plan that was acceptable to the patient and approved by the oncologist. Following implementation, the patient was satisfied to experience minimal hot flashes and relayed full compliance with her breast cancer treatment regimen. Pharmacists can play an important role in the management of postmenopausal breast cancer and vasomotor symptoms by providing patient education and recommending medications based on treatment guidelines with consideration to side effects and drug interactions.
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Affiliation(s)
- Megan R. Undeberg
- Washington State University College of Pharmacy and Pharmaceutical Sciences, 412 E. Spokane Falls Blvd, Spokane, WA 99202-2131, USA
| | - Alanda Barash
- Washington State University College of Pharmacy and Pharmaceutical Sciences, 412 E. Spokane Falls Blvd, Spokane, WA 99202-2131, USA
| | - Kimberly C. McKeirnan
- Washington State University College of Pharmacy and Pharmaceutical Sciences, 412 E. Spokane Falls Blvd, Spokane, WA 99202-2131, USA
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Azizi M, Khani S, Kamali M, Elyasi F. The Efficacy and Safety of Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors in the Treatment of Menopausal Hot Flashes: A Systematic Review of Clinical Trials. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:173-193. [PMID: 35634530 PMCID: PMC9126898 DOI: 10.30476/ijms.2020.87687.1817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hot flashes (HF) are a common symptom during the menopausal transition. It is therefore important to identify effective drugs that can alleviate HF. This study aimed to systematically review published clinical trials on the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the treatment of HF in healthy menopausal women. METHODS In this systematic review, articles published during 2003-2019 in PubMed, MEDLINE, Web of Science, Scopus, Science Direct, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Google Scholar as well as Iranian databases such as SID, and Magiran were searched. The quality of the selected articles was assessed using the Jadad score calculation. RESULTS Thirty-six articles on randomized controlled trials were included in this study, out of which 27 articles had acceptable, and nine had weak methodological quality. Findings on SSRIs class of drugs indicated that escitalopram, paroxetine, and fluoxetine have higher efficacy and safety in the treatment of menopausal HF than other drugs. Studies on the effectiveness of sertraline, citalopram, and fluvoxamine are limited in number or show inconsistent results. Therefore, further high-quality studies are required to confirm their effectiveness in alleviating HF. Within the SNRIs class, venlafaxine and desvenlafaxine showed significant efficacy in the treatment of menopausal HF. However, studies on the effectiveness of duloxetine are also limited, which requires further research. CONCLUSION Most studies have indicated the efficacy and safety of some antidepressants, such as SSRIs and SNRIs, in decreasing the frequency and severity of HF. These drugs are therefore recommended for the treatment of menopausal HF.
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Affiliation(s)
- Marzieh Azizi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran,
Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghra Khani
- Sexual and Reproductive Health Research Center, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahsa Kamali
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Edinoff AN, Akuly HA, Hanna TA, Ochoa CO, Patti SJ, Ghaffar YA, Kaye AD, Viswanath O, Urits I, Boyer AG, Cornett EM, Kaye AM. Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review. Neurol Int 2021; 13:387-401. [PMID: 34449705 PMCID: PMC8395812 DOI: 10.3390/neurolint13030038] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 12/27/2022] Open
Abstract
Depression is the most prevalent psychiatric disorder in the world, affecting 4.4% of the global population. Despite an array of treatment modalities, depressive disorders remain difficult to manage due to many factors. Beginning with the introduction of fluoxetine to the United States in 1988, selective serotonin reuptake inhibitors (SSRIs) quickly became a mainstay of treatment for a variety of psychiatric disorders. The primary mechanism of action of SSRIs is to inhibit presynaptic reuptake of serotonin at the serotonin transporter, subsequently increasing serotonin at the postsynaptic membrane in the serotonergic synapse. The six major SSRIs that are marketed in the USA today, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine, are a group of structurally unrelated molecules that share a similar mechanism of action. While their primary mechanism of action is similar, each SSRI has unique pharmacokinetics, pharmacodynamics, and side effect profile. One of the more controversial adverse effects of SSRIs is the black box warning for increased risk of suicidality in children and young adults aged 18–24. There is a lack of understanding of the complexities and interactions between SSRIs in the developing brain of a young person with depression. Adults, who do not have certain risk factors, which could be confounding factors, do not seem to carry this increased risk of suicidality. Ultimately, when prescribing SSRIs to any patient, a risk–benefit analysis must factor in the potential treatment effects, adverse effects, and dangers of the illness to be treated. The aim of this review is to educate clinicians on potential adverse effects of SSRIs.
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Affiliation(s)
- Amber N. Edinoff
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA; (H.A.A.); (T.A.H.)
- Correspondence: ; Tel.: +1-(318)-675-8969
| | - Haseeb A. Akuly
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA; (H.A.A.); (T.A.H.)
| | - Tony A. Hanna
- Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA; (H.A.A.); (T.A.H.)
| | - Carolina O. Ochoa
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.O.O.); (S.J.P.); (Y.A.G.)
| | - Shelby J. Patti
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.O.O.); (S.J.P.); (Y.A.G.)
| | - Yahya A. Ghaffar
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (C.O.O.); (S.J.P.); (Y.A.G.)
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (I.U.); (E.M.C.)
| | - Omar Viswanath
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA;
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE 68124, USA
- Valley Anesthesiology and Pain Consultants—Envision Physician Services, Phoenix, AZ 85004, USA
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (I.U.); (E.M.C.)
- Southcoast Physicians Group Pain Medicine, Southcoast Health, Wareham, MA 02571, USA
| | - Andrea G. Boyer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29464, USA;
| | - Elyse M. Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; (A.D.K.); (I.U.); (E.M.C.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA 95211, USA;
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Yalçın M, Oğuz A, Beştepe EE, Sağlam NGU, Ergelen M. Black cohosh associated mania in a patient with unipolar depression. Int J Psychiatry Med 2021; 56:67-72. [PMID: 32955954 DOI: 10.1177/0091217420961185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Black cohosh (actaea racemosa, cimicifuga racemosa) a popular complementary medicine, is commonly prescribed as an alternative drug to hormone replacement therapy for the treatment of menopause symptoms and menstrual pain. Studies on the black cohosh's psychological effects are generally focused on the perimenopausal depression and anxiety; and, its effects have been considered to be affiliated with its serotonergic and dopaminergic activities. We report a patient presenting with acute onset mania associated with black cohosh use, probably due to its psychopharmacological activities on serotonergic and dopaminergic receptors. We suggest that black cohosh must be used cautiously in the patients with history of unipolar depression or bipolar disorder.
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Affiliation(s)
- Murat Yalçın
- Psychiatry Department, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Ayşenur Oğuz
- Psychiatry Department, Istanbul Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Engin Emrem Beştepe
- Psychiatry Department, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Nazife Gamze Usta Sağlam
- Psychiatry Department, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Mine Ergelen
- Psychiatry Department, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
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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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Role of paroxetine in the management of hot flashes in gynecological cancer survivors: Results of the first randomized single-center controlled trial. Gynecol Oncol 2016; 143:584-588. [PMID: 27751589 DOI: 10.1016/j.ygyno.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the effects of paroxetine supplementation on hot flashes and sleep in gynecological cancer survivors. METHODS In a randomized, double-blind, placebo-controlled study, postmenopausal women with a prior history of stage 0-III gynecological cancer who had completed active cancer treatment (including hormonal therapy) were randomly assigned 1:1 to either 7.5mg oral paroxetine or placebo daily for 16weeks. Sleep and hot flashes were assessed at baseline, week 4 and week 16. RESULTS Eighty women (91%) completed the study. We found out a statistically significant difference in weekly reductions in VMS frequency and severity for paroxetine 7.5mg than for placebo on week 4 and 16. Regarding sleep characteristics, the analysis of data through week 16 reported a statistically significant reduction in the number of nighttime awakenings attributed to VMS among participants receiving paroxetine than among participants receiving placebo on baseline and weeks. The duration of sleep per night increased significantly more among participants receiving paroxetine than among those receiving placebo at all post baseline time points. No significant differences in sleep-onset latency were noted between the two treatment arms during the course of the study. Paroxetine was well-tolerated with a high level of compliance. In our cohort of patients, no serious adverse events have been reported. CONCLUSIONS This is the first randomized placebo-controlled study in gynecological cancer survivors that demonstrates that paroxetine significantly reduces hot flashes in weekly frequency and severity and the number of nighttime awakenings attributed to vasomotor symptoms, increasing sleep duration.
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Wei D, Chen Y, Wu C, Wu Q, Yao L, Wang Q, Wang XQ, Yang KH. Effect and safety of paroxetine for vasomotor symptoms: systematic review and meta-analysis. BJOG 2016; 123:1735-43. [PMID: 27062457 DOI: 10.1111/1471-0528.13951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Paroxetine is the first non-hormone therapy for vasomotor symptoms (VMS) approved based on the results of two phase 3, randomised, placebo-controlled trials by the Food and Drug Administration (FDA) in 2013. OBJECTIVE To confirm the effect and safety of paroxetine for vasomotor symptoms (VMS). SEARCH STRATEGY MEDLINE, EMBASE, PsycINFO, CENTRAL, WHO International Clinical Trials Registry Platform (ICTRP) and four Chinese databases was searched from the date of their inception to 7 June 2014. SELECTION CRITERIA We included RCTs on the effect of paroxetine compared with placebo or no treatment for perimenopausal and postmenopausal women who experienced moderate-to-severe vasomotor symptoms. DATA COLLECTION AND ANALYSIS Two reviewers screened records and extracted the information independently. The included studies were appraised by two independent reviewers using the Cochrane risk of bias tool. We synthesised the data in random-effects models and rated the quality of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. MAIN RESULTS Five articles with six RCTs (1571 participants) were included. Paroxetine significantly reduced the frequency of hot flushes by 8.86 per week (95% confidence interval (CI) 5.69-12.04, P < 0.00001, I(2) = 83%) at week 4 and 7.36 per week (95% CI, 4.25-10.46, P < 0.00001, I(2) = 62%) at week 12. The quality of the evidence on the effect of paroxetine for VMS was moderate. CONCLUSIONS There was moderate quality of evidence supporting the effectiveness of paroxetine for vasomotor symptoms; however, it causes nausea and dizziness. TWEETABLE ABSTRACT Review finds paroxetine effective for menopausal symptoms with some side effects: evidence strength moderate.
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Affiliation(s)
- D Wei
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Y Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - C Wu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Q Wu
- Anesthesiology Department of Peking University First Hospital, Beijing, China
| | - L Yao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Q Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - X Q Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - K H Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. .,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
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