bellergal and Hot-Flashes

To critically evaluate and synthesize intervention research related to hot flashes in the context of cancer and to identify implications and future directions for policy, research, and practice.. Published, peer-reviewed articles and textbooks; editorials; and computerized databases.. Although a variety of pharmacologic and nonpharmacologic treatments are available, they may not be appropriate or effective for all individuals.. The large and diverse evidence base and current national attention on hot flash treatment highlight the importance of the symptom to healthcare professionals, including oncology nurses.. Using existing research to understand, assess, and manage hot flashes in the context of cancer can prevent patient discomfort and improve the delivery of evidence-based care.

Topics: Antidepressive Agents; Antineoplastic Agents; Belladonna Alkaloids; Cimicifuga; Combined Modality Therapy; Complementary Therapies; Drug Combinations; Drug Interactions; Ergotamines; Female; Glycine max; Hot Flashes; Humans; Hypericum; Male; Methysergide; Neoplasms; Neurotransmitter Agents; Phenobarbital; Progestins; Selective Serotonin Reuptake Inhibitors; Treatment Outcome; Vitamin E

For many years, women have sought alternative therapies for menopausal symptoms and for general health overall. The highly publicized findings from the Women's Health Initiative have led to an increased pressure on the medical community to find safe and alternative medications for female health. This article reviews the challenges and problems with the use of alternative medicines, and the clinical trials that prove their efficacy, and discusses the safety issues that may occur with these types of products.

Topics: Acetates; Acupuncture Therapy; Adrenergic alpha-Agonists; Amines; Antidepressive Agents, Second-Generation; Antioxidants; Behavior Therapy; Belladonna Alkaloids; Cimicifuga; Cyclohexanecarboxylic Acids; Dietary Supplements; Drug Combinations; Ergotamines; Estrogen Replacement Therapy; Female; Gabapentin; gamma-Aminobutyric Acid; Hot Flashes; Humans; Isoflavones; Menopause; Methysergide; Phenobarbital; Phytoestrogens; Plant Preparations; Selective Serotonin Reuptake Inhibitors; Sulpiride; United States; Vitamin E; Women's Health

Hot flashes can be a major problem for patients with a history of breast cancer. Although oestrogen can alleviate hot flashes to a large extent in most patients, there has been debate about the safety of oestrogen use in survivors of breast cancer. The decrease in hot flashes achieved with progestational agents is similar to that seen with oestrogen therapy but, again, there is some debate about the safety of progestational agents in patients with a history of breast cancer. Several alternative substances have therefore been investigated. These include a belladonna alkaloid preparation, clonidine, soy phyto-oestrogens, vitamin E, gabapentin, and several of the newer antidepressants, with venlafaxine being the best studied to date. Several studies in progress may provide better non-hormonal means of treating hot flashes in the future.

Topics: Antidepressive Agents; Belladonna Alkaloids; Breast Neoplasms; Clonidine; Drug Combinations; Ergotamines; Estrogens; Female; Hot Flashes; Humans; Methysergide; Phenobarbital; Progesterone Congeners; Survivors

Given the problems associated with hormonal therapy, and the prominent problem of hot flashes in menopausal women, there is a need for nonhormonal agents to alleviate hot flashes. Several compounds that appear to act on the central nervous system have been investigated. Potential mechanisms for their effects on hot flashes have been described. Bellergal (no longer available on the US market, where it was known as Bellergal-S), a combination preparation sedative that consists of low-dose phenobarbital, ergotamine tartrate, and levorotatory alkaloids of belladonna, is an old agent that was popular approximately 20 years ago; however, there is limited suggestion of efficacy for this agent. Clonidine, an older antihypertensive drug, is another centrally active agent that has been studied. Randomized trials have demonstrated that it clearly works for reducing hot flashes, but the magnitude of efficacy is somewhat limited. Toxicity from this agent limits its utility in the clinic. Methyldopa is another centrally active agent that has been studied but to a more limited degree. It appears to have minimal efficacy and too much toxicity to make it clinically useful. Anecdotal observations from a number of sources suggested that newer antidepressants can alleviate hot flashes. This led to pilot trials of venlafaxine and paroxetine, with results suggesting benefit from both drugs. Subsequently, randomized, placebo-controlled, double-blind clinical trials of venlafaxine, paroxetine, and fluoxetine were conducted. All 3 of these clinical trials demonstrated statistically significant reductions in hot flashes with these newer antidepressants compared with placebo. Pilot trials of citalopram and mirtazapine, 2 other newer antidepressants, have also suggested efficacy. Toxicity evaluations have suggested that these agents are, again, well tolerated by the majority of patients. A recent trial, however, was unable to demonstrate any benefit for fluoxetine or citalopram over a placebo. Anecdotal observations also suggested that gabapentin was helpful for alleviating hot flashes. This led to pilot trials that again suggested efficacy. Subsequently, 2 large placebo-controlled, randomized, double-blind clinical trials were conducted. Both of these demonstrated statistically significant efficacy for gabapentin compared with a placebo. This drug is relatively well tolerated by most patients. Thus, centrally active nonhormonal agents clearly do decrease hot flashes in women. The m

Topics: Amines; Antidepressive Agents; Antihypertensive Agents; Belladonna Alkaloids; Clonidine; Cyclohexanecarboxylic Acids; Drug Combinations; Ergotamines; Female; Gabapentin; gamma-Aminobutyric Acid; Hot Flashes; Humans; Menopause; Methyldopa; Methysergide; Phenobarbital

Topics: Administration, Oral; Antineoplastic Agents, Hormonal; Belladonna Alkaloids; Diethylstilbestrol; Dose-Response Relationship, Drug; Drug Combinations; Ergotamines; Gonadotropin-Releasing Hormone; Hot Flashes; Humans; Injections, Intramuscular; Male; Medroxyprogesterone Acetate; Megestrol Acetate; Methysergide; Middle Aged; Phenobarbital; Prostatic Neoplasms