lactation inhibition

  • 文章类型: Journal Article
    背景:尽管有其好处,在某些情况下,母乳喂养是不可能的或不建议的。母乳分泌和充血可能会让这些非母乳喂养的妇女感到不安。目前没有关于这些妇女最适当管理的普遍准则。我们的目标是评估卡麦角林的有效性和安全性,多巴胺激动剂,在产后妇女的哺乳期抑制。
    方法:通过电子数据库搜索确定了研究(Cochrane图书馆,EMBASE,Medline,IPA和Scopus),以确定所有相关研究,这些研究评估了卡麦角林作为产后妇女的泌乳抑制剂。考虑到研究设计的异质性,对引文进行了筛选,并进行了叙事综合。
    结果:共有6项随机试验符合纳入标准。大多数研究招募了出于个人原因选择抑制泌乳的健康产后妇女。在递送的0至50小时内给予0.4mg至1mg范围的卡麦角林。建立剂量-反应关系,1毫克卡麦角林的完全成功率最高,停止时间在0到1天之间。卡麦角林在抑制泌乳方面不劣于溴隐亭,同时还伴有较少的反弹症状和不良反应。卡麦角林常见的不良反应(例如,头晕,头痛和恶心)是自限的。
    结论:卡麦角林很简单,当给予希望或需要抑制泌乳的产后妇女时,有效且通常是安全的。需要进一步的研究来改善这些妇女的产后护理。
    BACKGROUND: Despite its benefits, there are some situations where breastfeeding is impossible or not recommended. Breast milk secretion and engorgement can be distressing to these non-breastfeeding women. There is currently no universal guideline on the most appropriate management for these women. Our objective is to evaluate the effectiveness and safety of cabergoline, a dopamine agonist, in lactation inhibition in postpartum women.
    METHODS: Studies were identified through electronic database searching (Cochrane library, EMBASE, Medline, IPA and Scopus) to identify all relevant studies that evaluated the use of cabergoline as a lactation inhibitor in postpartum women. Citations were screened and a narrative synthesis was undertaken given the heterogeneity of study designs.
    RESULTS: A total of six randomized trials met the inclusion criteria. Majority of the studies recruited healthy postpartum women electing for lactation inhibition for personal reasons. A range of 0.4 mg to 1 mg of cabergoline was given within 0 to 50 hrs of delivery. Dose-response relationship is established, and the highest rate of complete success was achieved with 1 mg of cabergoline, with time to cessation between 0 and 1 day. Cabergoline is non-inferior to bromocriptine for lactation inhibition while also associated with fewer rebound symptoms and adverse effects. Commonly reported adverse effects of cabergoline (eg, dizziness, headache and nausea) are self-limited.
    CONCLUSIONS: Cabergoline is simple, effective and generally safe when given to postpartum women either wishing or needing to suppress lactation. Further research is needed to improve postpartum care of these women.
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  • 文章类型: Journal Article
    This study sought to perform a systematic review of adverse events reported with the use of cabergoline for postpartum lactation inhibition or suppression in women aged 15 to 50. Following registration with PROSPERO (CRD42017049894), a comprehensive search of the Ovid databases Medline, Embase, and CENTRAL, along with PubMed, was conducted from January 1, 1985 to January 25, 2018. All study designs investigating cabergoline use for postpartum lactation inhibition or suppression in women aged 15 to 50 were included. A total of 695 articles were retrieved, and 25 articles were eligible for inclusion. Adverse events were then reported in terms of frequency, with percentages calculated according to the total number of women exposed to the intervention. A bias assessment of the articles was also performed. Among a total of 757 women, 108 adverse events were observed in 96 women (14.2%). The most common adverse events were dizziness (35 of 757), headache (30 of 757), and nausea or vomiting (19 of 757). These events were described as short-lived, self-resolving, and dose dependent. One pharmacovigilance study reported 29 \"serious\" events from a total of 175 events in 72 case reports, which included thromboembolic and neurologic events. Four case studies specifically addressed the psychiatric population, with one half reporting psychiatric symptoms following administration of cabergoline. In conclusion, this systematic review demonstrates that adverse events were generally benign and tolerable following the administration of cabergoline. However, pharmacovigilance data reveal that vigilance is still needed given the occurrence of rare but serious events.
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  • 文章类型: Journal Article
    在发达国家,不建议对感染人类免疫缺陷病毒(WLWH)的女性进行母乳喂养.然而,对于选择不母乳喂养的女性来说,泌乳症状可能令人痛苦。目前没有关于预防或减少WLWH中泌乳症状的最合适选择的通用指南。这篇综述描述了使用卡麦角林的证据基础,多巴胺能激动剂,用于产后抑制WLWH的泌乳。
    使用PubMed中的搜索,对WLWH的产后药物泌乳抑制进行了范围审查,MedlineOvid,EBM评论Ovid,Embase,WebofScience和Scopus直到2019年。卡麦角林药理特性的叙述性综述,治疗效果,然后进行与泌乳抑制相关的耐受性数据和药物相互作用数据.
    在1366篇文章中,范围审查确定了13种相关出版物。已经发表了八项指南,为WLWH的泌乳抑制提供了指导,并在英国发表了两项有关该主题的医学实践调查。三项研究评估了药物在WLWH中的使用。其中两项研究评估了卡麦角林,并报道它是该人群中抑制泌乳的有效方法。第三项研究评估了乙炔雌二醇和溴隐亭的使用,显示疗效较差。卡麦角林是一种长效多巴胺D2激动剂和麦角衍生物,在分娩后以1mg的单次口服剂量给予时,可以抑制催乳素分泌并抑制生理泌乳。卡麦角林至少与溴隐亭一样有效地抑制泌乳,成功率在78%至100%之间。瞬变,临床试验中描述了卡麦角林的轻度至中度不良事件。很少存在药物相互作用,因为卡麦角林既不是肝细胞色素P450同工酶的底物也不是诱导/抑制剂。在卡麦角林和包括蛋白酶抑制剂的任何抗逆转录病毒药物之间没有临床上显著的药物-药物相互作用的报道。
    卡麦角林是预防非母乳喂养妇女生理性泌乳和相关身体症状的安全有效的药物选择。未来的研究应该关注它的安全性,WLWH的疗效和可接受性。
    In developed countries, breastfeeding is not recommended for women living with human immunodeficiency virus (WLWH). However, lactation symptoms can be distressing for women who choose not to breastfeed. There is currently no universal guideline on the most appropriate options for prevention or reduction of lactation symptoms amongst WLWH. This review describes the evidence base for using cabergoline, a dopaminergic agonist, for the post-partum inhibition of lactation for WLWH.
    A scoping review of post-partum pharmaceutical lactation inhibition specific for WLWH was conducted using searches in PubMed, Medline Ovid, EBM Reviews Ovid, Embase, Web of Science and Scopus until 2019. A narrative review of cabergoline pharmacologic properties, therapeutic efficacy, tolerability data and drug interaction data relevant to lactation inhibition was then conducted.
    Among 1366 articles, the scoping review identified 13 relevant publications. Eight guidelines providing guidance regarding lactation inhibition for WLWH and two surveys of medical practice on this topic in UK have been published. Three studies have evaluated the use of pharmaceutical agents in WLWH. Two of these studies evaluated cabergoline and reported it to be an effective method of lactation inhibition in this population. The third study evaluated ethinyl estradiol and bromocriptine use and showed poor efficacy. Cabergoline is a long-acting dopamine D2 agonist and ergot derivative that inhibits prolactin secretion and suppresses physiologic lactation when given as a single oral dose of 1 mg after delivery. Cabergoline is at least as effective as bromocriptine for lactation inhibition with success rates between 78% and 100%. Transient, mild to moderate adverse events to cabergoline are described in clinical trials. Few drug interactions exist as cabergoline is neither a substrate nor an inducer/inhibitor of hepatic cytochrome P450 isoenzymes. There are no reported clinically significant drug-drug interactions between cabergoline and any antiretroviral medications including protease inhibitors.
    Cabergoline is a safe and effective pharmacologic option for the prevention of physiological lactation and associated physical symptoms in non-breastfeeding women. Future studies should focus on its safety, efficacy and acceptability among WLWH.
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  • 文章类型: Comparative Study
    OBJECTIVE: It has been suggested that pyridoxine has an antilactogenic effect. Studies of the efficacy of pyridoxine in suppressing lactation have reported conflicting results. The aim of this review was to evaluate the effectiveness and safety of high-dose pyridoxine in post-partum lactation inhibition.
    METHODS: This systematic review included published trials that compared the efficacy and/or safety of pyridoxine to placebo or to other pharmacological agents for the inhibition of post-partum lactation. We searched PubMed, Embase, ScienceDirect, CINAHL, AMED, the Cochrane library and the clinical trials registry to identify relevant literature. No limit was imposed on the year of publication of the studies, and the review included studies published until 15 January 2016. Two reviewers independently extracted data and assessed the risk of bias.
    CONCLUSIONS: Seven studies were included, with a total of 1155 women, of which 471 women received pyridoxine. Three studies were randomized controlled trials, whereas the remaining four studies were non-randomized controlled trials. All of the included studies were relatively small (n=18-482). The studies compared pyridoxine with placebo, bromocriptine and/or stilboestrol. Pyridoxine was given orally, with a total daily dose of 450-600 mg for 5-7 days. Two trials (n=349 participants) indicated that pyridoxine was effective in inhibiting lactation in approximately 95% of the enrolled patients. All other studies failed to demonstrate pyridoxine efficacy through either clinical assessment or prolactin level measurements. Pyridoxine safety was assessed by two trials in which no serious untoward side effects were reported. Overall, the risk of bias for most of the studies was low to moderate.
    CONCLUSIONS: Current evidence supporting the effectiveness of high-dose pyridoxine in the inhibition of post-partum lactation is inconsistent and insufficient. Larger randomized trials are needed to confirm the efficacy of pyridoxine in post-partum lactation inhibition.
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  • 文章类型: Journal Article
    BACKGROUND: Breastfeeding is considered as gold standard for infant nutrition and should be interrupted only when a compelling indication exists. Certain medical conditions such as abortion, stillbirth, HIV infection, or infant galactosemia and certain medications such as chemotherapy necessitate lactation inhibition to protect the health of mother and infant. Drug use evaluation (DUE) studies are done to explore the current practice in a setting and help to identify areas in which further information and education may be needed by clinicians.
    OBJECTIVE: The aim of this study was to conduct a DUE of cabergoline to assess indications for lactation inhibition, dosage regimen, and its safety.
    METHODS: A retrospective cross-sectional DUE study was conducted over a period of 4 months from September 1, 2013, till December 31, 2013, at the Women\'s Hospital, Qatar. All cabergoline prescriptions written for lactation inhibition within 10 days of delivery or abortion were included in the study. A descriptive data analysis was undertaken.
    RESULTS: Of the 85 patients included, stillbirth (50.6%) was considered as the main reason for lactation inhibition, followed by abortion (27.1%) and neonatal death (12.9%). The remaining 9.4% of the patients had live baby, and the majority of them were prescribed cabergoline for lactation inhibition because their maternal medical conditions required the use of drugs with insufficient safety data (n=6). Seventy-four percent of patients received cabergoline at accurate time and dose. However, 14% of the patients had preexisting hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension.
    CONCLUSIONS: The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern can be further enhanced through informing health care providers regarding appropriate cabergoline dosage regimen and its safety in patients with uncontrolled hypertension.
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  • 文章类型: Journal Article
    目的:提供宫内胎儿死亡(IUFD)患病率的一致数据,评估与IUFD相关的风险因素和原因,为了评估IUFD的预防,评估胎儿尸检和MRI,并确定泌乳抑制的管理。
    方法:使用PubMed搜索法语和英语出版物,科克伦图书馆。
    结果:全世界2%的孕妇发生宫内胎儿死亡,在法国(NP1)约有0.5%的怀孕。与IUFD相关的主要危险因素是产妇超重,产妇年龄,吸烟,胎龄小的胎儿或胎盘早剥,和孕前孕产妇疾病,如高血压和糖尿病(NP1)。IUFD最相关的原因是胎盘异常,其次是异常核型和先天性畸形(NP3)。数据不足以推荐IUFD原因的分类。有关一级和二级预防的数据不建议对怀孕后的具体管理。胎儿尸检仍然是胎儿检查的金标准,但是当胎儿尸检被拒绝时,可以提供胎儿尸检(NP4)。应在产后24小时内使用卡麦角林开始抑制泌乳,如果患者需要治疗(NP4)。
    OBJECTIVE: To give consistent data of the prevalence of intrauterine fetal death (IUFD), to assess risk factors and causes related to IUFD, to evaluate prevention of IUFD, to evaluate fetal autopsy and MRI and to determine the management of inhibition of lactation.
    METHODS: French and English publications were searched using PubMed, Cochrane Library.
    RESULTS: Intrauterine fetal death occurs in 2% of the pregnancies worldwide, and in around 0,5% of pregnancies in France (NP1). Major risk factors related to IUFD are maternal overweight, maternal age, and smoking, small for gestational age fetuses or placental abruption, and pre-gestational maternal diseases such as hypertension and diabetes (NP1). The most relevant causes of IUFD are placental anomalies, followed by abnormal karyotypes and congenital malformations (NP3). Data are insufficient to recommend a classification for causes of IUFD. Data concerning primary and secondary prevention do not recommend a specific management for the following of pregnancy. Fetal autopsy is still the gold standard of fetal examination, but fetal post-mortem MRI can be offered when fetal autopsy is refused (NP4). Inhibition of lactation should be started within 24hours postpartum with cabergoline, if the patient demands a treatment (NP4).
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