To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: NAMS: Venlafaxine Reduces Menopausal Symptoms in Breast Cancer Survivors Who Cannot Take Estrogen URL: http://www.pslgroup.com/dg/20824A.htm Doctor's Guide October 8, 2001
By Cameron Johnston Special to DG News
NEW ORLEANS, LA -- October 8, 2001 -- The antidepressant venlafaxine (Effexor) appears to be a safe and effective alternative for peri-menopausal women who have had breast cancer and are reluctant to treat their hot flushes and other menopausal symptoms with estrogen or other hormone replacement therapies.
In a presentation today at the annual meeting of the North American Menopause Society, Dr. Charles Loprinzi, chairman of the department of medical oncology at the Mayo Clinic in Rochester, Minnesota, said venlafaxine is one of several medications not indicated as a treatment for hot flushes, but it has generated enough interest anecdotally that further study is warranted.
A pilot study with venlafaxine, conducted at the Mayo Clinic, involved 19 men who had had prostate cancer (and also suffer hot flushes as a result of their anti-androgen therapy) and 25 women who had had breast cancer.
Patients were given 12.5 mg of venlafaxine twice daily for 28 days. This dose, Dr. Lopirinzi said, is half of the lowest currently available sized tablet, but is still a fraction of what the normal therapeutic dose to treat depression would be.
The effect was rapid, he said, and amounted to a 50 percent reduction in hot flushes.
In a Phase III trial (Lancet 2000;356:2059-2063), all the women started off at 37.5 mg/day and then one group was increased to 75 mg/day and another group was increased to 150 mg/day. The third group continued treatment at 37.5 mg/day for the duration of the study.
Those who received the lowest dose had a reduction in hot flushes of 40 percent while those who had their doses increased to 75 mg/day after the first week had 60 percent reduction in hot flushes. The difference between 150 mg/day and 75 mg/day was not statistically significant, and might even have been less effective, Dr. Loprinzi said.
All of the doses were statistically superior to placebo, with which the reduction in hot flushes was 27 percent.
Side effects from venlafaxine included dry mouth, nausea, sometimes serious, and constipation. On the upside, 40 percent of the women taking 75 mg of venlafaxine per day reported an improved libido, so their sex lives also improved while they were taking the drug.
Dr. Loprinzi noted that other antidepressants also seem to offer some benefit in reducing hot flushes for menopausal women. In one trial that was not placebo controlled, paroxetene (Paxil) was associated with a 70 percent reduction in hot flushes, while fluoxetine (Prozac) has been associated with a 40 percent reduction in some studies.
Other drugs that have been tested in menopausal women who have had breast cancer and are unable to take hormone replacement therapy include clonidine and gabapentin, which is commonly used at high doses to treat seizure disorders.
"I would start off the patient at the lowest dose of venlafaxine -- 37.5 mg/day -- and then, if there was no reduction in hot flushes, increase it again to 75 mg/day," Dr Loprinzi said in his presentation. "If there is no reduction after two weeks at the higher dose, I would discontinue it, because you're not likely to see any benefit." --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.