Paliação de instabilidade vasomotora ("ondas de calor") usando pregabalina

Vasomotor instability (“hot flashes”) is a common problem in postmenopausal women, breast can cer patients, and prostate cancer patients. Hot flashes have been controlled by various nonestrogenic measures, including environmental control (eg, fan cooling); vitamin E; a proprietary combination of ergotamine, belladonna alkaloids, and phenobarbital (formerly marketed as Bellergal-S); venlafaxine (Effexor) and other antidepressants; progestins; and gabapentin. In particular, treatment with gabapentin has led to a 31%–66% reduction in hot flash scores in breast cancer patients with hormone-related vasomotor instability. Recently, pregabalin (Lyrica), a gamma-aminobutyric acid (GABA) analog related to gabapentin, has been approved for the management of post- herpetic neuralgia, partial-onset seizures, and neuropathic pain associated with diabetic peripheral neuropathy. Because of the chemical similarity of pregabalin to gabapentin, and because of the widespread use of gabapentin in patients with cancer and various pain or neuropathic syndromes, we evalu ated the efficacy of pregabalin in breast or prostate cancer patients experiencing treatment-related hot flashes METHODS: Patients were eligible for this openlabel, non–placebo-controlled trial if they had breast or prostate cancer, were receiving some type of hormonal therapy, and had been experiencing hot flashes after initiating hormonal therapy. Patients were considered for pregabalin therapy if they had some type of pain for ç which pregabalin might be therapeutic, had hot flashes that were refractory to environmental changes, and desired therapy for their vasomotor symptoms. Voluntary informed consent was given for receiving pregabalin Patients were initially prescribed pregabalin 50 mg orally once daily. If there was no response and no toxicity, doses were escalated to 50 mg orally twice daily and, if still needed and tol erated, 50 mg orally 3 times daily. By comparison, the recommended start ing dose for pregabalin’s approved in dications is 150 mg/d Patients underwent semi-structured interviews to determine the frequency and severity of their vasomotor symp toms before treatment with pregabalin and after 4 weeks of treatment with the drug. The number of hot flashes per day and their severity were estimated by the patients. A hot flash score was deter mined by multiplying the severity of the patient’s symptoms (mild = 1, moderate = 2, severe = 3) by the number of hot flashes per day. The presence and sever ity of other symptoms were also record ed by patients. Side effects of pregabalin were reviewed with the patients every 4 weeks