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3.
Presse Med ; 48(11 Pt 1): 1222-1228, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31303372

RESUMO

Erectile dysfunction (ED) is not routinely discussed with patients in cardiology practices whereas it may impact the ability of patients to stay on therapy. Most of the studies about ED and antihypertensive therapies have several methodological limitations. Diuretics and beta-blockers have been shown to have a deleterious effect on ED. ISRA inhibitors, calcium antagonists, vasodilator beta-blockers and alpha-blockers have been shown to have a neutral impact on ED. Angiotensin 2 inhibitors, nebivolol and alpha-blockers use has sometimes beneficial effect on ED. In case of ED due to antihypertensive treatment, drugs can be switched each other but careful attention in patients with a high cardiovascular risk is required.


Assuntos
Anti-Hipertensivos/efeitos adversos , Hipertensão/tratamento farmacológico , Disfunções Sexuais Fisiológicas/induzido quimicamente , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores do Receptor Tipo 2 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Substituição de Medicamentos , Humanos , Masculino , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Fatores de Risco , Disfunções Sexuais Fisiológicas/prevenção & controle
4.
Psychiatry Res ; 276: 142-150, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31082749

RESUMO

BACKGROUND: While methadone maintenance therapy (MMT) in patients with opioid use disorder (OUD) decreases the risk of substance use relapses and criminal and risky sexual behavior, a major disadvantage is its negative impact on sexual function. In the present study we tested whether, compared to placebo, ginseng extract ameliorates methadone-related sexual dysfunction among female and male patients with OUD and receiving MMT. METHOD: A total of 74 patients (26 females: mean age: M = 39.0 years; 48 males; mean age: 40.64 years) took part in a double-blind, randomized and placebo-controlled study. Female and male patients were separately randomly assigned either to the ginseng or to a placebo condition. At the beginning of the study and four weeks later, patients completed questionnaires on sexual function. RESULTS: Irrespective of gender, sexual function improved over time, but more so in the ginseng condition than in the placebo condition. CONCLUSIONS: Ginseng appears to counteract the sexual dysfunction resulting from methadone use in both female and male patients with OUD and undergoing MMT.


Assuntos
Tratamento de Substituição de Opiáceos/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Panax , Extratos Vegetais/uso terapêutico , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Comportamento Sexual/efeitos dos fármacos , Disfunções Sexuais Fisiológicas/induzido quimicamente
6.
J Am Acad Dermatol ; 81(1): 163-172, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30905792

RESUMO

BACKGROUND: Prescription medications are among the most common causes of sexual dysfunction, and patients are often hesitant to seek help when experiencing these symptoms. OBJECTIVE: In this review, we identify the available evidence of sexual adverse effects in men using systemic dermatologic medications and suggest screening protocols and actions that may improve a patient's symptoms where possible. METHODS: A systematic review was conducted of all articles in the PubMed database published from the time of inception to May 2018 to identify studies evaluating the use of systemic dermatologic medications in men with evidence of sexual adverse effects. Subsequently, a secondary in-depth literature review was performed for each individual medication. RESULTS: There were 5497 articles reviewed in the primary systematic review, and 59 articles covering 11 systemic dermatologic medications met inclusion criteria. We identified level 1 evidence for sexual adverse effects as a primary outcome in patients taking finasteride. LIMITATIONS: Many included studies were limited by sample size and methodology. CONCLUSION: The information in this review may serve as a reference of adverse effects when deciding on a therapeutic agent and a guide to help identify patients to screen for sexual dysfunction.


Assuntos
Corticosteroides/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Fármacos Dermatológicos/uso terapêutico , Finasterida/efeitos adversos , Itraconazol/efeitos adversos , Disfunções Sexuais Fisiológicas/induzido quimicamente , Corticosteroides/uso terapêutico , Adulto , Fatores Etários , Ciclosporina/efeitos adversos , Ciclosporina/uso terapêutico , Finasterida/uso terapêutico , Humanos , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Medição de Risco , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/fisiopatologia
7.
J Eur Acad Dermatol Venereol ; 33(7): 1393-1397, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30835851

RESUMO

BACKGROUND: The occurrence of sexual dysfunction side-effects associated with finasteride use in men with androgenetic alopecia (AGA) is thought to be less prevalent than is publicized. There is a need to investigate sexual dysfunction among finasteride users with population-based controls. OBJECTIVE: To evaluate the presence of sexual dysfunction in men using finasteride or not using finasteride. METHOD: Adult men visiting a dermatologist's office for any reason were asked to complete a survey including a modified version of the Arizona Sexual Experience Scale (ASEX) to assess the presence of sexual dysfunction with and without finasteride use. RESULTS: Data from 762 men aged 18-82 were collected: 663 finasteride users and 99 non-finasteride users. There were no significant differences between finasteride users and non-user controls in reporting sexual dysfunction using the ASEX. Regression analysis indicated that self-reporting libido loss and reduced sexual performance, not finasteride use, predict a higher ASEX score. CONCLUSION: The use of finasteride does not result in sexual dysfunction in men with AGA. These data are consistent with other large survey-based controlled studies.


Assuntos
Alopecia/tratamento farmacológico , Fármacos Dermatológicos/efeitos adversos , Finasterida/efeitos adversos , Disfunções Sexuais Fisiológicas/induzido quimicamente , Adolescente , Adulto , Estudos de Casos e Controles , Humanos , Libido , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
8.
Physiol Int ; 106(1): 59-69, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30888217

RESUMO

INTRODUCTION: Major depressive disorder is a serious mental disorder in which treatment with antidepressant medication is associated with incidence of adverse events, such as constipation, diarrhea, dry mouth, headache, insomnia, and sexual dysfunction (SDys). Escitalopram (ESC), an effective and safe selective serotonin reuptake inhibitor with good tolerability, was used in this study. In this study, we investigated the prospective effect of Pycnogenol (PYC), an antioxidant, anti-inflammatory, and vasodilator agent, on ESC-induced SDys. METHODS: This was a randomized, parallel, open-label study. Seventy-two outpatients of both genders with depression were randomized into two groups as follows: 37 patients from the ESC + PYC group took 50 mg of PYC per day for 4 months in ESC co-treatment, and 35 subjects from the ESC group took ESC only. Five patients dropped out and were excluded from the analysis. The participants were examined every month (visits 1-4). RESULTS: ESC use led to improvement of depressive symptoms and severity scored by standardized psychiatric tests. PYC co-treatment resulted in attenuation of SDys beginning at 1 month of treatment and continuing for two consecutive months. Furthermore, an increase in heart rate in the PYC group was registered. CONCLUSIONS: We propose that PYC-mediated SDys attenuation is based on its ability to improve endothelial functions by its antioxidant, anti-inflammatory, vasodilatory, and anticoagulant action. We assume that the action of PYC on heart rate is in accordance with the aforementioned vasodilatory action of PYC and consequent baroreflex-mediated heart rate response. PYC co-treatment reduced ESC-induced SDys and elevated heart rate.


Assuntos
Antidepressivos/efeitos adversos , Antioxidantes/uso terapêutico , Citalopram/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Flavonoides/uso terapêutico , Extratos Vegetais/uso terapêutico , Disfunções Sexuais Fisiológicas/induzido quimicamente , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Adulto , Antidepressivos/uso terapêutico , Antioxidantes/farmacologia , Citalopram/uso terapêutico , Feminino , Flavonoides/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/farmacologia , Estudos Prospectivos , Resultado do Tratamento
9.
Psychiatry Res ; 274: 58-65, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30780063

RESUMO

Sexual side-effects along with antipsychotic treatment may be linked to hyperprolactinemia and dopamine D2 receptor blockade. High prevalence of sexual dysfunction in un-medicated patients challenges the notion of sexual dysfunction as merely a side-effect of antipsychotic medication. Sexual dysfunction was assessed in fifty-six initially antipsychotic-naïve patients with schizophrenia using the UKU (Udvalget for Kliniske Undersøgelser) questionnaire. Serum-prolactin was obtained before and after six weeks of D2/3 receptor blockade with amisulpride. At baseline 68% of patients reported one or more items of sexual dysfunction (males > females,), but the cumulative load of sexual dysfunction was similar in males and females. After 6 weeks treatment with amisulpride (mean dose 279 mg/day), 65% of patients reported one or more items of sexual dysfunctions (females > males). There was a significant sex*time interaction on mean sexual dysfunction load. All patients developed hyperprolactinaemia, and a significant effect of time and sex was found on s-prolactin (females > males). The results support that patients with schizophrenia report high levels of sexual dysfunction before antipsychotic exposure. After treatment, sexual side-effects were more frequent in females, coinciding with pronounced serum-prolactin increases. These findings suggest sex differences in sexual dysfunction before and after antipsychotic treatment.


Assuntos
Amissulprida/uso terapêutico , Antagonistas de Dopamina/uso terapêutico , Hiperprolactinemia/epidemiologia , Receptores de Dopamina D2 , Receptores de Dopamina D3 , Esquizofrenia/epidemiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Adulto , Amissulprida/farmacologia , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Antagonistas de Dopamina/efeitos adversos , Antagonistas dos Receptores de Dopamina D2/efeitos adversos , Antagonistas dos Receptores de Dopamina D2/uso terapêutico , Feminino , Humanos , Hiperprolactinemia/diagnóstico , Hiperprolactinemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , Prolactina , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Caracteres Sexuais , Disfunções Sexuais Fisiológicas/induzido quimicamente , Disfunções Sexuais Fisiológicas/diagnóstico
10.
Psychiatry Res ; 272: 450-453, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30611963

RESUMO

Opioid use disorder is a growing social problem. Different agents are used in the treatment of this disorder. One of these agents is buprenorphine / naloxone combination that includes buprenorphine and naloxone in a ratio of 4:1. Although used successfully in opiate maintenance treatment, buprenorphine / naloxone could have some side effects that might affect the treatment. The present study aimed to examine the effects of buprenorphine /naloxone opiate maintenance treatment on sexual dysfunction, sleep and bodyweight in patients diagnosed with opioid use disorder and to draw the attention of clinicians to the adverse effects of the treatment. The study group included 107 inpatients who were diagnosed based on The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and received treatment for opioid use disorder. On admission to the hospital and at the end of the 4th month, a Sociodemographic and Clinical Data Form, the Pittsburgh Sleep Quality Index (PSQI) and the Arizona Sexual Life Scale (ASEX) were applied to all patients. Patients were weighed, and their weight was recorded on the day of admission to the hospital and at the end of the 4th month. The data recorded at the beginning and during the treatment of the same group were compared. The mean age of 107 patients was 24.55 ±â€¯4.27. Overall ASEX scores were 12.98 ±â€¯4.33 before treatment and 15.03 ±â€¯6.61 at 4 months (p < 0.001). The mean patient bodyweight was 63.86 ±â€¯8.78 kg before the treatment and 68.49 ±â€¯8.65 kg at the 4th month of the treatment (p < 0.001). Total PSQI scores were 8.87 ±â€¯3.53 before the treatment and 6.85 ±â€¯3.29 at the 4th month of the treatment (p < 0.001). The study findings demonstrated that after 4 months of buprenorphine /naloxone treatment, total ASEX scores and bodyweight of the patients increased and total PSQI scores decreased. These results demonstrated that sexual problems and bodyweight of the patients increased after the buprenorphine /naloxone treatment and sleep-related problems decreased, albeit still prevalent. These potential side effects should be included with other information about buprenorphine that is given to patients as they may influence interest in starting or continuing treatment.


Assuntos
Peso Corporal/efeitos dos fármacos , Combinação Buprenorfina e Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Disfunções Sexuais Fisiológicas/induzido quimicamente , Transtornos do Sono-Vigília/tratamento farmacológico , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Peso Corporal/fisiologia , Combinação Buprenorfina e Naloxona/efeitos adversos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Masculino , Antagonistas de Entorpecentes/efeitos adversos , Tratamento de Substituição de Opiáceos/efeitos adversos , Tratamento de Substituição de Opiáceos/tendências , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/psicologia , Sono/efeitos dos fármacos , Sono/fisiologia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia , Ganho de Peso/efeitos dos fármacos , Ganho de Peso/fisiologia , Adulto Jovem
11.
Drug Discov Today ; 24(3): 890-897, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30690197

RESUMO

Adverse drug reactions (ADRs) that diminish sexual functioning can seriously affect a person's quality of life and can also affect drug adherence. However, no comprehensive overview on the subject is available and a lack of knowledge among healthcare professionals might be present. This systematic review of Summary of Products Characteristics identified 346 drugs registered with at least one sexual ADR. The drug class 'nervous system' (N) was represented most frequently with 105 drugs, followed by 'cardiovascular system' (C) with 89 drugs. For 16 drugs an incidence rate for sexual ADR of >10% was reported and for 98 drugs there was an incidence rate >1%. Because sexual ADRs occur in frequently used drugs, they should be considered in clinical practice to optimize drug treatment.


Assuntos
Disfunções Sexuais Fisiológicas/induzido quimicamente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos
12.
J Pharm Pract ; 32(2): 231-235, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29183252

RESUMO

Sexual dysfunction is a bothersome side effect of several medications, though it has not yet been reported with the use of ledipasvir/sofosbuvir for the treatment of hepatitis C. However, sexual dysfunction is a potentially unrecognized side effect of ledipasvir/sofosbuvir that could result in nonadherence and treatment failure. We report a case of a 42-year-old man with a sudden onset of sexual dysfunction with the initiation of ledipasvir/sofosbuvir for the treatment of hepatitis C. The patient had no prior history or risk factors for the development of sexual dysfunction. His symptoms resolved upon discontinuation of ledipasvir/sofosbuvir after a successful 12-week course. Clinicians should be aware that sexual dysfunction is a possible side effect of ledipasvir/sofosbuvir and educate patients appropriately. Adherence should be emphasized as the risks of untreated hepatitis C virus far outweigh transient sexual dysfunction.


Assuntos
Antivirais/efeitos adversos , Benzimidazóis/efeitos adversos , Fluorenos/efeitos adversos , Hepatite C/tratamento farmacológico , Disfunções Sexuais Fisiológicas/induzido quimicamente , Uridina Monofosfato/análogos & derivados , Adulto , Antivirais/uso terapêutico , Benzimidazóis/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Fluorenos/uso terapêutico , Humanos , Masculino , Uridina Monofosfato/efeitos adversos , Uridina Monofosfato/uso terapêutico
13.
Acta Derm Venereol ; 99(1): 12-17, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30206635

RESUMO

Treatment of male androgenetic alopecia with 5α-reductase inhibitors is efficacious. However, the risk of adverse sexual effects remains controversial. This systematic review and meta-analysis investigated the risk of adverse sexual effects due to treatment of androgenetic alopecia in male patients with finasteride, 1 mg/day, or dutasteride, 0.5 mg/day. Fifteen randomized double-blinded placebo-controlled trials (4,495 subjects) were meta-analysed. Use of 5α-reductase inhibitors carried a 1.57-fold risk of sexual dysfunction (95% confidence interval (95% CI) 1.19-2.08). The relative risk was 1.66 (95% CI 1.20-2.30) for finasteride and 1.37 (95% CI 0.81-2.32) for dutasteride. Both drugs were associated with an increased risk, although the increase was not statistically significant for dutasteride. As studies into dutasteride were limited, further trials are required. It is important that physicians are aware of, and assess, the possibility of sexual dysfunction in patients treated with 5α-reductase inhibitors.


Assuntos
Inibidores de 5-alfa Redutase/efeitos adversos , Alopecia/tratamento farmacológico , Dutasterida/efeitos adversos , Finasterida/efeitos adversos , Disfunções Sexuais Fisiológicas/induzido quimicamente , Inibidores de 5-alfa Redutase/administração & dosagem , Administração Oral , Dutasterida/administração & dosagem , Ejaculação/efeitos dos fármacos , Disfunção Erétil/induzido quimicamente , Disfunção Erétil/fisiopatologia , Finasterida/administração & dosagem , Humanos , Libido/efeitos dos fármacos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Comportamento Sexual/efeitos dos fármacos , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia
14.
Chem Biol Interact ; 297: 119-129, 2019 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-30365938

RESUMO

Diabetes-associated sexual dysfunction and fertility impairments are major secondary complications in diabetic patients and animal models. Natural herbs are important sources of therapeutic agents for diabetic complications. This study investigated the effect of vitexin on male sexual dysfunction and fertility impairments in streptozotocin (STZ)-induced diabetic mice. Diabetes was induced by intraperitoneal injection of 45 mg/kg STZ for 5 consecutive days in mice. Vitexin (10, 20 or 40 mg/kg) and Sildenafil citrate (SC, 5 mg/kg) were administered daily for 62 days after the induction of diabetes. The parameters of sexual behavior and fertility were analyzed. The reproductive organ weight, sperm motility, and viability of the treated mice were examined. Testicular histopathological alterations were detected by hematoxylin and eosin (H&E) staining. Enzyme-linked immunosorbent assay (ELISA) was used to evaluate serum hormonal levels. Results showed that 40 mg/kg vitexin significantly improved the sexual behavior and fertility levels compared with the diabetic group. Moreover, vitexin (20 or 40 mg/kg) significantly increased reproductive organ weight and improved testicular pathological structure damage. Meanwhile, sperm analysis demonstrated that vitexin significantly restored sperm quality in a dose-dependent manner. Furthermore, ELISA data showed that vitexin significantly increased the serum testosterone (T), follicular-stimulating hormone (FSH), and luteinizing hormone (LH) levels but decreased the gonadotropin-releasing hormone (GnRH) level to different degrees. These findings suggest that vitexin ameliorates sexual dysfunction and fertility impairments in male diabetic mice possibly by modulating the hypothalamus-pituitary-gonadal axis.


Assuntos
Apigenina/farmacologia , Diabetes Mellitus Experimental/tratamento farmacológico , Fertilidade/efeitos dos fármacos , Gônadas/efeitos dos fármacos , Hipotálamo/efeitos dos fármacos , Hipófise/efeitos dos fármacos , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Animais , Apigenina/administração & dosagem , Apigenina/química , Glicemia/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Diabetes Mellitus Experimental/induzido quimicamente , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Feminino , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Injeções Intraperitoneais , Masculino , Camundongos , Estrutura Molecular , Disfunções Sexuais Fisiológicas/induzido quimicamente , Motilidade Espermática/efeitos dos fármacos , Espermatozoides/efeitos dos fármacos , Estreptozocina/administração & dosagem , Relação Estrutura-Atividade
15.
Sex Med Rev ; 7(2): 277-282, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30301703

RESUMO

INTRODUCTION: 5-Alpha reductase inhibitors (5-ARIs) are widely used in the treatment of benign prostatic hyperplasia (BPH) and androgenic alopecia (AGA). AIM: To examine all available data on the effects of 5-ARIs on sexual functioning in AGA treatment and to assess whether 5-ARIs increase the risk of sexual dysfunction. METHODS: A literature review of publications at PubMed related to the subject was used. MAIN OUTCOME MEASURE: We assessed erectile dysfunction, ejaculation impairment, and decreased libido. RESULTS: 5-ARIs may cause side effects such as erectile dysfunction, ejaculation problems, and decreased libido in patients. Their long-term impact and precise mechanism have not been clarified. Data from studies on 5-ARIs are important for drug selection and patient counseling. More training and awareness is needed for clinicians and patients to recover many patients from sexual adverse effects. CONCLUSION: 5-ARIs used in the treatment of AGA have well-defined side effects, which can negatively affect sexual life. It is unknown and unpredictable which men using these drugs may be subject to these side effects and when these effects may appear. Studies have been insufficient to provide a clear answer to this question. Coskuner ER, Ozkan B, Culha MG. Sexual Problems of Men With Androgenic Alopecia Treated With 5-Alpha Reductase Inhibitors. Sex Med Rev 2019;7:277-282.


Assuntos
Inibidores de 5-alfa Redutase/efeitos adversos , Alopecia/tratamento farmacológico , Dutasterida/efeitos adversos , Finasterida/efeitos adversos , Disfunções Sexuais Fisiológicas/induzido quimicamente , Disfunções Sexuais Psicogênicas/induzido quimicamente , Alopecia/complicações , Dutasterida/uso terapêutico , Ejaculação/efeitos dos fármacos , Disfunção Erétil/induzido quimicamente , Finasterida/uso terapêutico , Humanos , Libido , Masculino , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Psicogênicas/complicações
16.
Bull Cancer ; 106(12S1): S37-S42, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-32008736

RESUMO

Despite proven survival benefits after breast cancer, long-trem compliance with adjuvant hormone therapy remains a major issue, partly due to the side effects of treatment. In young women treated for breast cancer, these treatments include tamoxifen, anti-aromatase and LH-RH analogues, with even more side effects when these treatments are combined, especially for younger patients with more aggressive disease. The management of the potential side effects requires first of all detailed and precise information at initiation of treatment, and preventive measures including patient education. Once the treatment has been initiated, clinicians should be able to propose to their patients appropriate measures to alleviate the potential of the side effects, which can be of various types: biological (dyslipidemia), physical (weight gain, hot flushes, vaginal dryness, sexual disorders with low libido, musculoskeletal symptoms…) or psychosocial (anxio-depressive disorders, poor body image, difficulties of professional reintegration). Management of these effects can combine various modalities: drugs (switching hormone therapy, anti-depressants, hormonal treatments of vaginal dryness in some cases, gabapentin), physical treatments (CO2 laser for vulvovaginal atrophy) or psycho-physical techniques (physical activity, mindfulness, acupuncture…). Eventually, the lenghth of these adjuvant hormonal treatments requires supportive measures to help young patients engage in new lifestyle measures, in particular in term of physical activity and diet. This will help them mitigate the symptoms related to these side-effects while reducing the long-term risks related to their disease and treatments.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Tamoxifeno/efeitos adversos , Adulto , Fatores Etários , Antineoplásicos Hormonais/uso terapêutico , Ansiedade/induzido quimicamente , Ansiedade/terapia , Inibidores da Aromatase/uso terapêutico , Imagem Corporal/psicologia , Neoplasias da Mama/psicologia , Quimioterapia Adjuvante/efeitos adversos , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/terapia , Desidratação/induzido quimicamente , Desidratação/terapia , Depressão/induzido quimicamente , Depressão/terapia , Fadiga/induzido quimicamente , Fadiga/terapia , Feminino , Humanos , Menopausa Precoce , Doenças Musculoesqueléticas/induzido quimicamente , Doenças Musculoesqueléticas/terapia , Osteoporose/induzido quimicamente , Osteoporose/terapia , Educação de Pacientes como Assunto , Disfunções Sexuais Fisiológicas/induzido quimicamente , Disfunções Sexuais Fisiológicas/terapia , Tamoxifeno/uso terapêutico , Doenças Vaginais/induzido quimicamente , Doenças Vaginais/terapia
17.
Eur J Endocrinol ; 179(6): 353-362, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30324794

RESUMO

Objective To evaluate pituitary function, sexual function and quality of life (QoL) in patients on oral or transdermal opioids. Design and methods Cross-sectional study comparing pituitary function, QoL and sexual function in people on long-term opioid therapy (n = 40) vs an age- and sex-matched control group (n = 25). Baseline pituitary function was assessed on blood samples collected prior to 0900 h. Further testing with corticotropin (250 µg IV) and metyrapone (30 mg/kg) stimulation tests was undertaken on participants with serum cortisol <250 nmol/L. Validated questionnaires completed to assess QoL, fatigue and sexual function. Results Secondary adrenal insufficiency (SAI) was identified on the basis of a failed stimulation test in 22.5% of opioid users vs no controls (P = 0.01). Opioid users with SAI had a higher median morphine-equivalent daily dose (MEDD), P = 0.037 - 50% with MEDD >200 mg and 0% with MEDD <60 mg had SAI. Among male participants, testosterone was inversely associated with BMI (P = 0.001) but not opioid use. A non-significant trend to low testosterone <8 nmol/L in male opioid users (11/24 opioid users vs 2/14 control, P = 0.08) suggests a small subgroup with opioid-induced androgen deficiency. Opioid users had greater fatigue, reduced quality of life in all subsections of the SF-36 and impaired sexual function in both males and females (all scores P < 0.001 compared to controls). Conclusion Long-term opioid therapy was associated with dose-related SAI in over 20% of chronic pain patients and is associated with poor quality of life, fatigue and sexual dysfunction. Obesity confounds the interpretation of opioid-induced male androgen deficiency.


Assuntos
Insuficiência Adrenal/induzido quimicamente , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Hipófise/efeitos dos fármacos , Administração Cutânea , Administração Oral , Insuficiência Adrenal/sangue , Insuficiência Adrenal/diagnóstico , Adulto , Idoso , Dor Crônica/sangue , Dor Crônica/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipófise/metabolismo , Hormônios Hipofisários/sangue , Qualidade de Vida , Disfunções Sexuais Fisiológicas/sangue , Disfunções Sexuais Fisiológicas/induzido quimicamente , Disfunções Sexuais Fisiológicas/diagnóstico , Adulto Jovem
19.
Zhonghua Nan Ke Xue ; 24(3): 247-253, 2018 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-30161312

RESUMO

Objective: To investigate the therapeutic effects of commonly used selective α-adrenergic receptor antagonists (α-ARA) on benign prostatic hyperplasia (BPH). METHODS: PubMed, Embase and CNKI databases were searched for the literature about selective α-ARAs for the treatment of BPH and the information was extracted on the common adverse reactions in the course of treatment. Multivariate meta-analysis was conducted to investigate the therapeutic effects of different α-ARAs. RESULTS: The total rates of adverse effects of silodosin and tamsulosin were the highest, 51.9% and 34.0% respectively, with the highest incidences of headache (38.3%), weakness (23.6%) and dizziness (17.5%). Besides, tamsulosin ranked the first in inducing sexual dysfunction of the male patients with BPH (70.4%). CONCLUSIONS: Doxazosin is preferable as the first-choice treatment of BPH for its therapeutic effect and improvement of the patient's quality of life. Silodosin and tamsulosin, however, can be selectively used according to the patient's specific tolerance to different adverse effects.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Antagonistas Adrenérgicos alfa/efeitos adversos , Doxazossina/efeitos adversos , Doxazossina/uso terapêutico , Humanos , Indóis/efeitos adversos , Indóis/uso terapêutico , Masculino , Meta-Análise em Rede , Qualidade de Vida , Disfunções Sexuais Fisiológicas/induzido quimicamente , Tansulosina/efeitos adversos , Tansulosina/uso terapêutico
20.
Am J Mens Health ; 12(5): 1705-1718, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29973132

RESUMO

Methadone is largely recognized as an effective treatment for opiate-dependent patients; however, it causes reduced brain dopaminergic action resulting in significant sexual dysfunction. Bupropion is a dopamine reuptake inhibitor which can potentially improve erectile function among male patients on methadone (MMT). This is a phase II, randomized, double-blind, parallel-group, placebo-controlled trial, involving 80 MMT male patients (73.4%) with mean age of 42.83 years ±9.68. These MMT male patients were randomly assigned into two groups to receive bupropion and placebo, respectively. The primary efficacy outcome measure was the difference between the two groups in end-point mean improvement scores using the measurement of Clinical Global Impression Scale adapted for Sexual Function (CGI-SF) at baseline (week 0) and at weeks 2, 4, and 6. Malay version of the sexual desire inventory-2 (SDI-2-BM) and Malay version of International Index of Erectile Function 15 (Mal-IIEF-15) domain scores were evaluated as secondary parameters. Improvement of the end-point mean from baseline were seen across the scores of SDI-2-BM (mean difference = 11.77 ± 2.90, 95% confidence interval (CI) [3.89, 19.54], p < .001) and Mal-IIEF-15 (mean difference = 8.37 ± 2.71, 95% CI [15.75, 0.99], p = .02), and the total plasma testosterone level (mean difference = 4.03, 95% CI [0.90, 7.15], p = .01). A categorical improvement of "much/very much improved" (CGI-SF score = 2) was reported by 58.3% ( n = 21/36) of bupropion SR-assigned versus 27.7% ( n = 10/36) placebo-assigned patient. Bupropion was well tolerated with no serious adverse events reported other than insomnia (17.7%). Six weeks of bupropion SR treatment reported significant improvement in key aspects of sexual function among male opiate-dependent patients on methadone maintenance treatment with emergent sexual dysfunction.


Assuntos
Bupropiona/uso terapêutico , Disfunção Erétil/tratamento farmacológico , Metadona/efeitos adversos , Disfunções Sexuais Fisiológicas/induzido quimicamente , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Adulto , Bupropiona/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Disfunção Erétil/induzido quimicamente , Humanos , Masculino , Metadona/administração & dosagem , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Resultado do Tratamento
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