Drug of choice for treatment of hot flushes in postmenopausal women with estrogen sensitive cancer is (LQ)
a. Yohimbine has been used as both an over-the-counter dietary supplement in herbal extract form and prescription medicine in pure form for the treatment of sexual dysfunction.
b. Yohimbine was explored as a remedy for type 2 diabetes in animal and human models carrying polymorphisms of the α2A-adrenergic receptor gene.The risk of hot flushes is more with this drug
c. Tamoxifen is an antagonist of the estrogen receptor in breast tissue via its active metabolite, hydroxytamoxifen.
d. In other tissues such as the endometrium, it behaves as an agonist, and thus may be characterized as a mixed agonist/antagonist.
e. Tamoxifen is the usual endocrine (anti-estrogen) therapy for hormone receptor-positive breast cancer in pre-menopausal women, and is also a standard in post-menopausal women although aromatase inhibitors are also frequently used in that setting.Hot flushes is the most common and distressing side effect of tamoxifen.
f. Clonidine is a blood pressure medicine that relaxes the smooth muscle of blood vessels, causing them to widen, or dilate.
g. This reduces the pressure of blood flow through the artery. Clonidine's effect on hot flashes is not well understood. Clonidine can be used to treat hot flushes.
h. Because it is a nonhormonal treatment, women with a history of breast cancer can use it without increasing the risk of further cancer cell growth (as in the case of estrogen treatment).
i. Clonidine may relieve hot flushes for some women. But studies have not shown that clonidine makes hot flushes less severe or less frequent. If patient has high blood pressure and hot flushes, clonidine may be an effective choice for both problems.
j. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant drugs.
k. They include: paroxetine, fluoxetine, escitalopram and citalopram.
l. Several years ago it was noticed as a side-effect that menopausal women who took these drugs for depression had fewer hot flushes.
m. Since then, research trials have confirmed that several SSRIs stop or reduce hot flushes in some (but not all) menopausal women.
n. That is, whether they were depressed or not. A similar antidepressant drug called venlafaxine has also been shown to have this effect. Strictly speaking, venlafaxine is classed as a selective noradrenaline reuptake inhibitors (SNRI). How SSRIs and SNRIs work to help hot flushes is not clear.
o. When it works, an SSRI or SNRI provides relief from hot flushes almost immediately.
p. A 1-2 week trial is usually enough to find out whether it is going to work or not. If symptoms improve, a longer course may then be prescribed.
q. The main drawback with these drugs is that they may cause side-effects in some women, such as nausea (feeling sick), reduced libido and reduced sexual response.