Journal of pain and symptom management
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J Pain Symptom Manage · Mar 2004
Case ReportsHot flashes refractory to HRT and SSRI therapy but responsive to gabapentin therapy.
There is a need for alternative therapies for hot flashes, as hormone replacement therapy (HRT) is associated with increased rates of breast cancer and heart disease, and some women fail to respond to HRT. A 32-year-old woman with surgically-induced menopause experienced 20-30 severe hot flashes per day and failed to respond to various formulations of HRT and selective serotonin reuptake inhibitor (SSRI) therapy for 17 years. She markedly responded to gabapentin therapy. Gabapentin, SSRIs, and estrogen may act at different cellular targets in the treatment of hot flashes.
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J Pain Symptom Manage · Mar 2004
Case ReportsTreatment of opioid-induced delirium with acetylcholinesterase inhibitors: a case report.
A 55-year-old woman with advanced ovarian cancer and severe pain developed hypoactive delirium after an increase in her opioid dosage. Myoclonus and delirium improved dramatically with the intravenous injection of the acetylcholinesterase inhibitor physostigmine, and this improvement was maintained during the administration of donepezil, an oral medication with similar pharmacodynamic properties. Evidence for a disorder of cholinergic neurotransmission in opioid-induced delirium is discussed, as is the rationale for treatment with acetylcholinesterase inhibitors and other cholinomimetic agents.