2009, Number 10
<< Back Next >>
Ginecol Obstet Mex 2009; 77 (10)
Non-hormonal treatment for vasomotor symptoms during menopause: role of desvenlafaxine
Lilue M, Palacios S
Language: Spanish
References: 32
Page: 475-481
PDF size: 259.30 Kb.
ABSTRACT
Objective: To review the published data that include Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), especially desvenlafaxine, on vasomotor symptoms (VMS).
Methods: This review is based on published data in Medline (1990-2009) for studies on SSRI and SNRIs, especially desvenlafaxine, and VMS.
Results: There is increasing evidence that both norepinephrine and serotonin are associated with the communication and modulation of the temperature homeostasis maintained by the hypothalamus. Different studies demonstrated the modest efficacy of SSRIs and SNRIs on VMS. Recently, a program of clinical trials with desvenlafaxine (a salt from the major metabolite of venlafaxine) has been developed for VMS. Currently, there are three randomized, double-blind clinical trials published, showing a significantly higher efficacy of desvenlafaxine versus placebo on VMS. There were also increased minor side effects with desvenlafaxine, especially nausea, at the beginning of the treatment.
Conclusions: A non-hormonal alternative –desvenlafaxine- has proven efficacy for VMS. There was also an increase in minor side effects, especially nausea, at the beginning of the treatment. There are clear subgroups of patients with VMS eligible, such as women with hormonedependent cancers, women who do not want to be treated with hormone therapy or just want to get relief of their vasomotor symptoms.
REFERENCES
Gold EB, Sternfeld B, Kelsey JL, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol 2000;152(5):463-73.
Oldenhave A, Jaszmann LJ, Haspels AA, Everaerd WT. Impact of climacteric on well-being. A survey based on 5213 women 39 to 60 years old. Am J Obstet Gynecol 1993;168(3 Pt 1):772-80.
Mortimer JE, Flatt SW, Parker BA, et al. Tamoxifen, hot flashes and recurrence in breast cancer. Breast Cancer Res Treat 2008;108(3):421-6.
Luoto R. Hot flushes and quality of life during menopause. BMC Womens Health 2009;18(9):13.
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288(3):321-33.
Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007;297(13):1465-77.
Utian WH, Shoupe D, Bachmann G, Pinkerton JV, Pickar JH. Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate. Fertil Steril 2001;75(6):1065-79.
Palacios S. Advances in hormone replacement therapy: making the menopause manageable. BMC Womens Health 2008;8:22.
The North American Menopause Society. Treatment of menopause- associated vasomotor symptoms: position statement of the North America Menopause Society. Menopause 2004;11(1): 11-33.
Freedman R. Hot flashes: behavioural treatments, mechanisms and relation to sleep. Am J Med 2005; 118 (12B):124s-130s
Deecher D. Fisiología de la disfunción termorreguladora y enfoques actuales del tratamiento de los síntomas vasomotores. Expert Opin 2005. Invest Drug 2005;14(4):435-48.
Peng N, Clark JT, Wei CC, Wyss JM. Estrogen depletion increases blood pressure and hypothalamic norepinephrine in middle-aged spontaneously hypertensive rats. Hypertension 2003;41(5):1164-7.
Gonzales GF, Carrillo C. Blood serotonin levels in postmenopausal women: effects of age and serum oestradiol levels. Maturitas 1993;17(1):23-9.
Smith LJ, Henderson JA, Abell CW, Bethea CL. Effects of ovarian steroids and raloxifene on proteins that synthesize, transport, and degrade serotonin in the raphe region of macaques. Neuropsychopharmacology 2004;29(11):2035-45.
Loprinzi CL, Kugler JW, Sloan JA, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 2000;356(9247):2059-63.
Evans ML, Pritts E, Vittinghoff E, et al. Management of postmenopausal hot flushes with venlafaxine hydrochloride: a randomized, controlled trial. Obstet Gynecol 2005;105(1):161-6.
Loprinzi CL, Sloan JA, Perez EA, et al. Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol 2002;20(6):1578-83.
Stearns V, Beebe KL, Iyengar M, Dube E. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA 2003;289(21):2827-34.
Stearns V, Slack R, Greep N, et al. Paroxetine is an effective treatment for hot flashes: results from a prospective randomized clinical trial. J Clin Oncol 2005;23(28):6919-30.
Stearns V, Johnson MD, Rae JM, et al. Active tamoxifen metabolite plasma concentrations after coadministration of tamoxifen and the selective serotonin reuptake inhibitor paroxetine. J Natl Cancer Inst 2003;95(23):1758-64.
Jin Y, Desta Z, Stearns V, et al. CYP2D6 genotype, antidepressant use, and tamoxifen metabolism during adjuvant breast cancer treatment. J Natl Cancer Inst 2005;97(1):30-9.
Alfinito P, Huselton C, Chen X, Deecher D. Pharmacokinetic and pharmacodynamic profiles of the novel serotonin and norepinephrine reuptake inhibitor desvenlafaxine succinate in ovariectomized Sprague-Dawley rats. Brain Research 2006;1098: 71-78.
Deecher D, Alfinito P, Leventhal L, et al. Alleviation of thermoregulatory dysfunction with the new Serotonin and Norepinephrine Reuptake Inhibitor Desvenlafaxine Succinate in Ovariectomized Rodent Models. Endocrinology 2007;148(3): 1376-83.
Pae CU, Park MH, Marks DM, et al. Desvenlafaxine, a serotonin- norepinefrine uptake inhibitor for major depressive disorder, neuropatic pain and the vasomotor symptoms associated with menopause. Curr Opin Investig Drugs 2009;10(1): 75-90.
DeMartinis NA, Yeung PP, Entsuah R, Manley AL. A doubleblind, placebo-controlled study of the efficacy and safety of desvenlafaxine succinate in the treatment of major depressive disorder. J Clin Psychiatry 2007;68(5):677-88.
Septien-Velez L, Pitrosky B, Padmanabhan SK, Germain JM, Tourian KA. A randomized, double-blind, placebo-controlled trial of desvenlafaxine succinate in the treatment of major depressive disorder. Int Clin Psychopharmacol 2007;22(6):338-47.
Liebowitz MR, Yeung PP, Entsuah R. A randomized, doubleblind, placebo-controlled trial of desvenlafaxine succinate in adult outpatients with major depressive disorder. J Clin Psychiatry 2007;68(11):1663-72.
Feiger AD, Tourian KA, Rosas GR, Padmanabhan SK. A placebo-controlled study evaluating the efficacy and safety of flexible-dose desvenlafaxine treatment in outpatients with major depressive disorder. CNS Spectr 2009;14(1):41-50.
Lieberman DZ, Montgomery SA, Tourian KA, et al. A pooled analysis of two placebo-controlled trials of desvenlafaxine in major depressive disorder. Int Clin Psychopharmacol 2008;23(4):188-97.
Speroff L, Margery G, Ginger C, Olivier S. Efficacy and Tolerability of Desvenlafaxine Succinate Treatment for Menopausal Vasomotor Symptoms. Obstet Gynecol 2008;111(1):77-86.
Archer D, Dupont C, Ginger C, Pickar J, Olvier S. Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double blind, randomized, placebocontrolled trial of efficacy and safety. Am J Obst and Gynecol 2009;238:e1- 238e10.
Archer D, Seidman L, Constantine G, Pickar J, Olivier S. A double blind, randomly assigned, placebo-controlled study of desvenlafaxine efficacy and safety for the treatment of vasomotor symptoms associated with menopause. Am J Obstet Gynecol 2009;172: e1-172 e 10