The management of preterm labour involves the acute suppression of uterine contractions. By inhibiting the end-organ response it is presumed the initial stimulus will not remain operative or the incident producing it has passed. It is a conveniently uninvestigated aspect of preterm labour research – so are randomized trials using placebo controls which are scarce and nifedipine has never been subjected to this gold-standard form of investigation (Caritis AJOG 2011;204:95-6).
Most trials of uterine activity suppression test one drug against another and look at relative efficacy and side-effects rather than neonatal outcomes. However in the present ethical climate it may be that comparative efficiency is the best that can be hoped for and the best evidence comes from a meta-analysis by Conde-Anudelo et al (AJOG 2011;204:134 e 1-20).
Their work shows nifedipine to be superior to beta-adrenergics and magnesium sulphate for tocolysis of women in preterm labour, so if a decision is made on clinical grounds to suppress the myometrium then there is guidance in favour of nifedipine for the person in charge of the case.
04 April, 2011
Hot flush treatment
There are limited non-hormonal treatments for women seeking relief from hot flushes. Peri- and postmenopausal women may not wish to take estrogens and selective serotonin reuptake inhibitors (SSRIs) offer a reasonably good option for decreasing the frequency, severity or bothersome effects of hot flushes.
A report by Freeman et al (JAMA 2011;305:267-74) indicates that the SSRI escitalopram is effective in controlling flushes in healthy menopausal women.
As usual in controlled trials for flushes about one third of volunteers had a 50% reduction in symptoms on the placebo but more than half had a similar beneficial effect from 10 – 20 mg per day of escitalopram over 8 weeks. The active substance had few side effects and it was convincing that 3 weeks after the trial ended those who took the escitalopram had the return of more hot flushes than those “coming off” the placebo.
For the record the participants had at least 4 flushes or night sweats a day before treatment and there were no racial differences between African-American and white women who were equally represented in the sample population. Estrogens are the treatment of choice for menopausal symptoms but escitalopram appears to be an option in reducing the frequency, severity and bother of menopausal vasomotor symptoms.
A report by Freeman et al (JAMA 2011;305:267-74) indicates that the SSRI escitalopram is effective in controlling flushes in healthy menopausal women.
As usual in controlled trials for flushes about one third of volunteers had a 50% reduction in symptoms on the placebo but more than half had a similar beneficial effect from 10 – 20 mg per day of escitalopram over 8 weeks. The active substance had few side effects and it was convincing that 3 weeks after the trial ended those who took the escitalopram had the return of more hot flushes than those “coming off” the placebo.
For the record the participants had at least 4 flushes or night sweats a day before treatment and there were no racial differences between African-American and white women who were equally represented in the sample population. Estrogens are the treatment of choice for menopausal symptoms but escitalopram appears to be an option in reducing the frequency, severity and bother of menopausal vasomotor symptoms.
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