December 2011

Chronic Sinus Congestion?

If unresponsive to treatment with decongestants and antibiotics, the cause of your chronic sinus congestion may be Allergic Fungal Sinusitis (AFS). Symptoms include blocked nasal passages, sinus pain, runny nose, and frequently pressure around the eyes. Systemic antifungal drugs have not been effective for treatment of AFS, primarily because the drugs are not secreted into the nasal secretion. Conventional treatment consists of sinus surgery, but AFS has a high rate of recurrence. At New York Presbyterian Hospital, a study showed that a compounded antifungal (fluconazole) nasal spray improved the disease and decreased swelling of the nasal passages, without significant side effects. A second study showd that treatment with topical fluconazole as either a nasal spray or an irrigation solution can significantly reduce the rate of recurrence of AFS after surgery. Ask our compounding pharmacist for more information.

Ear Nose Throat J. 2011 Aug;90(8):E1-7. http://www.ncbi.nlm.nih.gov/pubmed/21853425
Ear Nose Throat J. 2004 Oct;83(10):692, 694-5. http://www.ncbi.nlm.nih.gov/pubmed/15586870

November 2011

Customized Medication for Warts, Plantar Warts, and Molluscum

Cantharidin is a medication that has been used by dermatologists as a treatment for molluscum contagiosum and warts since the 1950s. Following topical application, cantharidin is absorbed by the fat layers of the skin. Topical cantharidin treatment causes formation of blisters within 24 to 48 hours. Healing is complete in 4 to 7 days without scarring.

In a retrospective study at the Department of Dermatology, Henry Ford Hospital, Detroit, of 300 children with molluscum contagiosum treated with cantharidin, 90% of the patients experienced resolution of symptoms and an additional 8% noted some improvement.

Warts are treated more intensively. “Warts are pared, followed by cantharidin application to the wart and a 1-mm rim of normal skin, and occluded with nonporous tape. Cantharidin is washed off in 4 hours. If necessary, paring and retreatment are done in 1 to 2 weeks, with contact time increased if needed.”

A high cure rate has been achieved following treatment of plantar warts with a topical formulation consisting of 1% cantharidin, 5% podophyllotoxin and 30% salicylic acid (CPS). A study compared the efficacy of topical CPS and cryotherapy (freezing) and concluded that topical CPS is more effective than cryotherapy in the treatment of plantar warts.

Because of cantharidin's potential for toxicity, the FDA has proposed that cantharidin should be limited to "topical use in the professional office setting only." Severe blistering can result from improper use, and ingestion, especially by children, can be fatal. Treatment of mucous membranes is contraindicated and placement of cantharidin near the eyes and eyelids should be avoided to prevent scleral erosion.

When cantharidin is used appropriately, complications are exceedingly rare. Mild to moderate pain, temporary erythema, a transient burning sensation, and pruritis may occur. There is no scarring with proper use.

Cantharidin lost FDA approval in 1962 because its manufacturers failed to submit data attesting to cantharidin's efficacy. Although not commercially available, cantharidin is approved for compounding on a customized basis for individual patients.

Arch Dermatol. 2001;137:1357-1360 J Eur Acad Dermatol Venereol. 2011 Jul 26.
J Am Acad Dermatol. 2000;43:503-507 J Am Podiatr Med Assoc. 2008 Nov-Dec;98(6):445- 50.
http://www.mayoclinic.com/health/plantar-warts/DS00509/DSECTION=treatments-and-drugs

October 2011

ESTROGEN DOMINANCE - It's Not Just a Woman's Problem

Do you have any of these problems?

Fibrocystic and tender breasts
Heavy menstrual bleeding
Irregular menstrual cycles
Uterine fibroids
Decreased libido
Mood swings
Vasomotor symptoms
Weight gain (hips, waist, thighs)
Foggy thinking, forgetfulness
Increased levels of triglycerides

The problem could be due to "estrogen dominance", a common condition that occurs if you have a relative deficiency of progesterone in relation to estrogen. Without progesterone supplementation, most women will experience estrogen dominance at some point in their lifetime, the extent of which will vary based on genetics, nutrition, emotional stressors and exposure to environmental toxins.

You are probably thinking "What does this have to do with a man? Estrogen and progesterone are female hormones." Actually, the male body also makes estrogen and progesterone, and these hormones need to be balanced in men, also.

In men, bioavailable testosterone (the type that can be used by the body) declines with age. However, an age-related increase in body weight and fat cells can result in increased conversion of testosterone to estrogen (which is measured as estradiol). Therefore, relative levels of free circulating estrogens increase with age and it has been proposed that increased estrogenic stimulation of the prostate in the aging male may lead to reactivation of prostate growth and cancer. In his book "Hormone Balance for Men: What Your Doctor May Not Tell You About Prostate Health and Natural Hormone Supplementation", the late John Lee, MD, stated "Optimal protection against estradiol-induced cancer occurs when the saliva progesterone level is 200-300 times that of saliva estradiol level." Progesterone has many benefits in the male body beyond prostate protection, including defense against cardiovascular disease and many neurodegenerative diseases such Alzheimer's.

Also, relatively low progesterone to estrogen (estradiol) ratios can create functional hypothyroidism with reported symptoms of fatigue, weight gain, constipation and thinning hair. When we are stressed, we produce higher amounts of the hormone cortisol which further reduces progesterone levels.

September 2011

Hormone Therapy for Wellness and Disease Prevention

Hormones are needed for all types of bodily functions. Our hormone levels change in response to our environment, thought processes, stress levels, food intake, and medications. We know that when hormone levels decline as part of the normal aging process, problems with health arise. Hormone therapy can relieve symptoms of menopause, improve quality of life, prevent chronic illnesses, and maintain wellness. Because each woman has unique biological needs which change as she ages, we compound hormone therapy in the most appropriate dose and dosage form to meet individual needs. We work together with each woman and her healthcare provider (physician, physician's assistant, or nurse practitioner) to customize hormone therapy based on the results of laboratory testing. And we monitor each woman's symptoms as well as follow-up lab results, to recommend changes when needed. The type of hormone therapy that is selected "is what makes the difference and must be carefully considered," according to Erika T. Schwartz, MD, and Kent Holtorf, MD, leading experts in hormone therapy. We recommend bioidentical hormones, which are molecularly identical to hormones found in the human body.

The terminology used by both the scientific and lay communities has lead to confusion and controversy about the benefits and side effects of bioidentical hormones including estrogen, progesterone, testosterone and thyroid hormones. For example, the three components of human estrogen (estriol, estradiol, and estrone) are frequently referred to as simply "estrogen"; however, each one acts differently in the body. For these reasons, hormone therapy is frequently prescribed as a combination of estradiol and estriol, but estrone is typically not included.

The term progesterone is often used to describe the human hormone as well as synthetic derivatives (such as medroxyprogesterone acetate) which should more appropriately be called "progestins". Progesterone is a precursor to most sex hormones, including estrogen, testosterone and other androgens, and adrenal hormones. Therefore, an adequate level of progesterone is needed by all women, not just to prevent endometrial hyperplasia (which can lead to uterine cancer) in women who are receiving estrogen. Progesterone also counteracts estrogen's stimulation of cell growth in breast tissue (which can lead to breast cancer).

Testosterone is produced by the ovaries and adrenals in young women in low amounts, and has been nicknamed "The Hormone of Desire" after a book by Susan Rako, MD. But, testosterone and dehydroepiandrosterone (DHEA), which are classified as androgens, offer many benefits in addition to enhancing libido in aging women. "The addition of testosterone to conjugated estrogen results in an increase in fat-free body mass and mitigates central fat deposition associated with estrogen use. Further evaluation and research must be conducted as we address the possibility of usage of testosterone in the aging female to help improve muscle mass and decrease central [body fat]… A growing number of physicians involved with menopausal women's wellness are using testosterone supplementation to provide improvement in libido and mood simply based on clinical findings and blood levels." Commercially available testosterone preparations which are FDA-approved for use in men should not be used in women as the dose is too high. Testosterone can be compounded in topical and sublingual dosage forms in doses that are appropriate for women.

For an excellent review of the medical literature and more information, we highly recommend the following article (from which we have used several quotations above):

Hormones in Wellness and Disease Prevention: Common Practices, Current State of the Evidence, and Questions for the Future by Erika T. Schwartz, MD, and Kent Holtorf, MD.
This article was published in the journal Primary Care. [2008 Dec;35(4):669-705]
As of this writing (Aug. 24, 2011), the article can be found in its entirely at
www.drerika.com/Files/ServicePageFiles/ 9ad83a4d-247f-47b4-8d99-96bf19f19b10.pdf

We compound customized preparations of bioidentical hormones for women and men in the most appropriate strength and dosage form to meet individual patient needs, based on a prescription from a licensed practitioner.

August 2011

PALLIATIVE CARE - Providing Comfort for People with Serious or Life-Threatening Illnesses

Palliative care is focused on providing comfort and relieving symptoms and stress of chronic illness, rather than curing the disease. Although palliative care is often associated with cancer or Hospice, patients with chronic, progressive pulmonary disorders, renal disease, chronic heart failure, and progressive neurological conditions, as well as children with serious illness, can also benefit.

We work together with patients, their caregivers and the healthcare team to improve each patient's quality of life by providing solutions for the following problems:

Nausea & Vomiting may be caused by the disease or by the treatment, such as chemotherapy. When a patient is unable to swallow or "keep down" medication, we can compound the needed drugs into transdermal dosage forms such as topical gels and creams or rectal suppositories.

Mucositis - one of the most agonizing side effects of certain types of chemotherapy is mucositis, which is a painful inflammation or ulceration of the lining of the GI tract, anywhere from the mouth to the anus. Patients with mucositis are often unable to eat. Reduction of caloric intake can lead to weight loss, loss in muscle mass strength and other complications, including a decrease in immunity. Our compounding pharmacist can prepare oral gels and rinses - and even lollipops - to decrease the pain and speed the healing of mucosal lesions. Also, for patients who are receiving bone marrow transplants, we can compound preparations containing glutamine, which has been shown to decrease the risk of developing mucositis.

Oral Thrush is a fungal infection that commonly occurs in the mouth of patients who are immunosuppressed. We can prepare pain relievers and antifungals in the form of lozenges, suspensions, and lollipops to increase the contact time between the medication and the mouth, and help with the healing process.

Xerostomia (dry mouth) may occur as a result of radiation therapy to the head or neck, or as the result of conditions such as Sjögren's disease. We can compound medications to help stimulate saliva flow.

- Chronic pain may be intermittent or continuous, and it prevents many people from working, eating properly, participating in physical activity or enjoying life. Cancer is a major cause of both acute and chronic pain. Most people with cancer will experience pain at some point during their course of treatment, and some will continue to have pain after the treatment ends.

The key to successful pain management is managing the pain to improve the function and quality of the life of the person living with pain. Our compounding pharmacist works together with patients and their healthcare provider to customize medications that meet the specific needs of each individual. Often, the need for or dose of opioids can be reduced when used in combination with other medications with different mechanisms of action.

Decubitus Ulcers/Wound Care - We can customize topical medications containing a variety of drugs to promote healing, fight infection, and improve blood flow to wound margins, as well as preparations that form a barrier to protect against bile salts and stomach acid and prevent irritation around stomas. Ask us about hypoallergenic bases.

Flavored Oral Medications - Taste changes can occur as a consequence of chronic disease. We can flavor oral medications according to each patient's preference.

When needed medications are not commercially available, our compounding professionals can help. We can prepare customized medications in the most appropriate dose and dosage form for each patient. By changing the route of administration, for example from intravenous to transdermal, we can eliminate the need for injections. Please contact our pharmacist for more information.

July 2011

Effective Treatment for Chronic and Cancer Pain - Dispelling the Myths

Pain is among the most common reasons Americans use the health care system and the leading cause of disability. Chronic pain (pain that lasts more than six months) can be caused by a variety of injuries and diseases, including nerve damage and cancer, and most commonly affects the lower back and legs. Chronic pain may be intermittent or continuous, and it prevents many people from working, eating properly, participating in physical activity or enjoying life. Left untreated or under treated, chronic pain may cause significant physical and emotional disability.

Cancer is a major cause of both acute and chronic pain. Most people with cancer will experience pain at some point during their course of treatment, and some will continue thave pain after the treatment ends. The vast majority of people with cancer are treated for pain by practitioners whare not pain specialists. As a result, they are at high risk of under-treatment for pain.

The World Health Organization (WHO) has developed guidelines for the treatment of cancer pain with opioid medications (previously referred to as "narcotics"), which are considered the mainstay approach for all people with cancer who have moderate to severe pain. However, non-opioid medications, psychosocial interventions, rehabilitative techniques and other pain treatment options should be part of the treatment plan. Application of the WHO approach suggests that satisfactory control of pain is possible in 75 percent to 90 percent of cases.

Satisfactory pain control is possible but barriers exist…
with health care professionals:

Inadequate knowledge of pain management
Poor assessment of pain
Concern about regulation of controlled substances
Fear of patient addiction
Concern about side effects of analgesics
Concern about patients becoming tolerant to analgesics

with patients:

Reluctance to report pain
Concern about distracting physicians from treatment of underlying disease
Fear that pain means disease is worse
Concern about not being a "good" patient
Reluctance to take pain medication
Fear of addiction or perception of being an addict
Worries about unmanageable side effects (e.g., constipation, nausea, clouded thought)
Concern about becoming tolerant to pain medications

with the health care system:

Low priority given to treatment of cancer pain
Most appropriate treatment not reimbursed or to costly for patients and families
Restrictive regulation of controlled substances
Problems of availability of treatment or access tit

Fears and misunderstandings about addiction, tolerance and physical dependence greatly hinder use of opioid therapy. On their website, www.painfoundation.org, the American Pain Foundation seeks to clarify these issues:

Addiction may occur when people use legal or illegal substances repeatedly in a way that causes them to feel high or euphoric, or, sometimes, to escape psychological pain. This use may to trigger a brain change that may cause the person to crave the substance, lose control over its use and continue tuse the drug despite physical or psychological harm.

Physical dependence does NOT mean that the person has developed an addiction. It does mean that the person's body will go through withdrawal if the drug is stopped abruptly. Physical dependence on an opioid is an expected response to daily use for more than a few days. If the opioid is no longer necessary, withdrawal symptoms can be avoided if the dosage is lowered gradually over several days.

Tolerance tan opioid is a physical response that may occur as the body adapts tthe medication over time, making the original dose less effective. An increase in pain may be caused by a new or increasing physical problem or by tolerance. To manage this pain, the doctor may increase the dose or may change the prescription ta different medication. People may also develop a tolerance to some of the side effects of opioids, such as drowsiness.

The behavior of an "addict" is the opposite of someone whose pain is effectively managed.

"The key to successful pain management is to manage the pain to improve the function and quality of the life of the person living with pain." Our compounding pharmacist works together with patients and their physicians (or PA or RN) to customize medications that meet the specific needs of each individual. Often, the need for or dose of opioids can be reduced when used in combination with other medications with different mechanisms of action. Ask our pharmacist for more information on how we can help to solve your medication problems.

June 2011

Men's Health: Restoring Vitality

Beginning at approximately 40 years of age, a man's testosterone levels slowly decline. Approximately 30% of men aged 60-70 years and 70% of men aged 70-80 have low levels of testosterone, a condition often called "andropause" because testosterone is in a class of hormones known as androgens. Androgen deficiency is strongly associated with common medical conditions including metabolic syndrome, obesity, diabetes, hypertension and atherosclerosis; as well as elevations in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C). Androgens may provide a protective effect against the development and/or progression of atherosclerosis in men, and emerging evidence indicates that appropriate therapy can relieve or partially reverse the progression of these problems in testosterone-deficient men.

Hypogonadism is the clinical term for low levels of serum testosterone in association with specific signs and symptoms, including:

diminished sex drive and sense of vitality
erectile dysfunction
depression
anemia
heart disease or worsening lipid profile
reduced muscle mass and bone density
increased fat mass
frailty
osteoporosis

Testosterone levels can be measured by saliva or blood tests. Hormone therapy is recommended for men with symptoms of hypogonadism and low total testosterone levels or high estrogen levels.

Depressed men have been found to have significantly lower bioavailable (free; able to be used by the body) testosterone levels, perhaps because an associated decrease in sexual function results in depression, irritability, and mood swings. Testosterone therapy may improve depressed mood in older men who have low levels of bioavailable testosterone.

Osteoporosis-related fractures occur in 12% of all men over 50 years of age. Twenty- five percent of all hip fractures occur in men, and 33% of these patients die within one year of fracture. Gradual loss of testosterone is one of the major causes of osteoporosis in elderly men. Studies have reported beneficial effects of testosterone therapy in older men, showing an increase in bone mineral density (BMD) and slowing of bone degeneration.

Testosterone replacement therapy (TRT) has relieved symptoms and improved the quality of life for many men. TRT is well tolerated. Laboratory values and clinical response should be monitored frequently so that any necessary adjustments can be made. A recent study found that TRT was associated with beneficial effects on insulin resistance, cardiovascular risk factors (total and LDL-cholesterol, Lipoprotein-a), and symptoms in hypogonadal men with type 2 diabetes and/or metabolic syndrome.

By administering testosterone transdermally (through the skin) in a cream or gel, adequate amounts of testosterone can be absorbed to mimic the normal daily production. Testosterone can also be administered as a sublingual drop or a lozenge that dissolves in the mouth. Compounded preparations can be very advantageous because customized therapies increase compliance.

the specific dose of hormone(s) needed by each man can be compounded as a dosage form that is most appropriate for the individual.
there is no need to shave the scrotum to apply a patch and there is no skin irritation from patch adhesive.

A healthy lifestyle is associated with higher hormone levels, and higher hormone levels seem to induce a more active, healthier lifestyle. For optimal results, it is vital that hormone replacement therapy be combined with adequate exercise, proper nutrition, and appropriate use of supplements.

The presence of prostate or breast cancer is an absolute contraindication for androgen replacement therapy. Guidelines recommend that TRT should not be started in older men with PSA serum levels above the normal range. Testosterone should be used with caution in men with severe heart, kidney or liver disease, increased red blood cell counts, and sleep apnea.

Ask our compounding pharmacist for more information.

May 2011

Oxytocin for Fibromyalgia, Autism, Lactation and to Enhance Bonding

Oxytocin is a hormone naturally found in mammals that is involved in a wide variety of physiological and pathological functions such as sexual activity, penile erection, ejaculation, pregnancy, uterus contraction, milk ejection, maternal behavior, osteoporosis, diabetes, cancer, social bonding, and stress.1

Oxytocin Nasal Spray for Lactation -Lactation failure may result from insufficient oxytocin. A rise in the concentration of oxytocin causes contraction of cells around the alveoli and milk ducts, in preparation for suckling. Oxytocin nasal solution was formerly commercially available (Syntocinon®), and indicated for use in stimulating lactation during the first week postpartum (not for continued use). Oxytocin should not be used during pregnancy since it may cause contractions and abortion. The medication is still frequently requested and can be compounded per a prescription order.

Oxytocin promotes social behavior in high-functioning autism spectrum disorders - Social adaptation requires specific cognitive and emotional competence. Individuals with high- functioning autism or with Asperger syndrome cannot understand or engage in social situations even if they have the intellectual abilities. Recently, it has been suggested that oxytocin, a hormone known to promote mother-infant bonds, may be implicated in the social deficit of autism. The behavioral effects of oxytocin were investigated in 13 children with autism. In a simulated ball game where participants interacted with fictitious partners, after oxytocin inhalation, the children exhibited stronger interactions with the most socially cooperative partner and reported enhanced feelings of trust and preference. Also, during free viewing of pictures of faces, oxytocin selectively increased patients' gazing time on the socially informative region of the face, namely the eyes. Following oxytocin use, patients responded more strongly to others and exhibited more appropriate social behavior and mood.2

Oxytocin Levels Low in Patients with Fibromyalgia - Oxytocin is known to have antinociceptive and analgesic, as well as anxiolytic and antidepressant effects. Researchers assessed oxytocin concentrations in female in depressed and non-depressed FMS patients and relate low oxytocin concentrations to adverse symptoms as pain, stress, depression and anxiety.3

1 CNS Neurosci Ther. 2010 Oct;16(5):e138-56.
2 Proc Natl Acad Sci U S A. 2010 Mar 2;107(9):4389-94.
3 Z Rheumatol. 2000 Dec;59(6):373-9.

April 2011

Spring Break? Planning your Summer Vacation?

We can help with customized medications and “vacation friendly” seasonal preparations.

Often, vacation planning raises concerns of how an antibiotic or other medication will be refrigerated when traveling. We can compound individual doses that are easy-to administer when traveling.Â When stability or refrigeration is a concern, we can prepare individual doses of drugs in an effervescent powder base that hides any bitter taste and is easy to mix when needed.

Keep in mind that high temperatures can lead to breakdown and loss of potency of many medications. Also, PLO gels become thicker at higher temperatures. Do not leave your medications locked in a hot car.

Prone to motion sickness? We can compound various medications that help to prevent motion sickness as transdermal gels, troches, lollipops, or flavored liquids. Ask us about preparations containing ginger. If dyes are a concern, we have color-free flavors.

Stings and Bites?Â We compound gels to help relieve pain and itching from bug bites, including those from chiggers and red bugs.Â Our creative compounders can also prepare a sting neutralizer solution which can be used for any type of sting which results in an acidic substance being injected into the skin.

Don’t forget your “best friend”. Fleas thrive outdoors in the summer. Use flea and tick protection on your dog, but if your dog does suffer from flea bites, we can work together with your veterinarian to provide a topical medication to reduce the itching.

Poison Ivy/Poison Oak - Ask us about preparations that relieve pain, itching and inflammation caused by exposure to poison ivy/sumac/oak.Â Also, a homeopathic solution known as Rhus-Tox has been shown to prevent reactions to plant irritants, but must be started very early in the spring.

Remember your sunscreen and LIP BALM WITH SUNSCREEN to protect yourself from overexposure.

When you get too much sun, remember us for customized preparations to relieve inflammation and sunburn pain. We can compound lotions containing aloe vera to help to heal the skin, and prepare lip balms containing a natural anti-viral that can be used at the first sign of a lip lesion to minimize the development of or speed the healing of lesions that occur after too much sun exposure.

Want to look your best in that bathing suit and sandals? Ask us about
Â· anti-cellulite cream. Help restore the smoothness of youth.
Â· preparations to help with weight loss and fat reduction.
Â· topical anti-fungals containing penetrant enhancers to get rid of ugly fungal infections of the toenail (most common on the big toe).

Sharing a hotel room and concerned about snoring?Â We can compound a spray that many have found useful.

Embarrassed by excessive perspiration? This can be very problematic during all seasons, and “hyperhidrosis” can affect not only the armpits but the palms of the hands and the face/forehead. We can compound a helpful solution.

Sensitive to aluminum? We can compound aluminum-free antiperspirant/deodorant sticks and sprays.

Plan ahead â€“ call our compounding professionals for your travel needs.
We work together with patients and other health care practitioners to
customize medications that meet specific patient needs.

February 2011

Have a Healthy Heart!

A recent poll showed that most women's number one health concern is cancer, but according to the Centers for Disease Control, heart disease is the leading cause of death for women over age 65 in the United States. Heart disease is the second leading cause of death for women age 45-64, and the third leading cause of death among females 25-44.

When we think of heart health, the first things that come to mind may be diet and exercise. Certainly, eating nutritious foods and a balanced diet and appropriate exercise are important to all facets of our health. However, what you might not know is how customized hormone therapy and use of quality supplements (such as the proper form of vitamin D) can improve and maintain your cardiovascular health.

Coronary artery disease occurs when the arteries that supply blood to the heart become occluded, a condition resulting from the buildup of plaque on the inner walls or lining of the arteries (atherosclerosis). Excess cholesterol can contribute to plaque buildup in the arteries. Restoring hormones such as pregnenolone to youthful levels has been shown to lower cholesterol. In one study, women received hormone restoration therapy with pregnenolone, DHEA, estrogen gel, progesterone gel, and testosterone gel to correct high cholesterol levels. Their average total cholesterol at the beginning of this study-263.5 mg/dL-was reduced to 187.9 mg/dL after treatment. The study results suggest that when hormones are in optimal proportions, the body's tendency to manufacture excess cholesterol may be normalized.¹

Stress activates cortisol, and an abnormal cortisol pattern has been associated with an increased risk of heart attacks. Researchers at The University of Texas at Tyler, led by Kenna Stephenson, M.D., showed that use of progesterone in a topical cream (20 mg per day) in women with high cholesterol reduced nocturnal cortisol levels to normal range while they were using the progesterone cream as compared to placebo.²

The Women's Health Initiative (WHI) study was designed to identify the potential risks and benefits of HRT. The estrogen-progestin portion of the clinical trial was stopped in 2002 after results showed that a synthetic hormone combination containing conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) increased the women's risks of developing invasive breast cancer, heart disease, stroke, and pulmonary embolism. The "estrogen-only" portion of the WHI study was halted in March 2004 after analysis of data suggested that synthetic CEE alone had no impact either way on heart disease (the main focus of the study), but may increase the risk of stroke.

A review of the medical literature concluded that oral estrogen replacement is associated with an increased risk for venous thromboembolism (blood clots).³ The use of oral conjugated estrogens plus synthetic progestins in postmenopausal women may double the risk of development of venous thrombosis.⁴ However, the choice of transdermal route of administration of estradiol and the use of natural progesterone might offer significant benefits and added safety. ⁵

Ask our compounding pharmacist about customized hormone therapy.

References
1 Med Hypotheses. 2002 Dec;59(6):751-6.
2 Blood 2004 Nov; 104(11):16
3 Ann Intern Med. 2002 May 7;136(9):680-90.
4 JAMA. 2004 Oct 6;292(13):1573-80.
5 Maturitas. 2008 Jul-Aug;60(3-4):185-201.

January 2011

Topical Therapy for Acute Pain in Adults

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medications that include ibuprofen (the active ingredient in Motrin® and Advil®), ketoprofen, diclofenac, piroxicam and indomethacin. Topical NSAIDs are widely used to treat acute musculoskeletal conditions due to their potential to provide pain relief without the side effects associated with these medications when they are taken orally.

Researchers at the University of Oxford, UK, reviewed the medical databases for randomized, double-blind, active or placebo-controlled trials in which treatments were administered to adult patients with acute pain resulting from strains, sprains or sports or overuse-type injuries (twisted ankle, for instance). Forty-seven studies were included in a meta-analysis; most compared topical NSAIDs in the form of a gel, spray, or cream with a similar placebo, with 3455 participants in the overall analysis of efficacy.

Clinical success was defined as 50% pain relief. For treatment periods of 6 to 14 days, topical diclofenac, ibuprofen, ketoprofen, and piroxicam were of similar efficacy, but indomethacin was not significantly better than placebo. Local skin reactions were generally mild and transient, and did not differ from placebo. With these topical medications, there were very few systemic adverse events or withdrawals due to adverse events. The analysis concluded: "Topical NSAIDs can provide good levels of pain relief, without the systemic adverse events associated with oral NSAIDs, when used to treat acute musculoskeletal conditions."

Cochrane Database Syst Rev. 2010 Jun 16;6:CD007402.

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