AUGUST 2011 NORLAND AVENUE PHARMACY PRESCRIPTION COMPOUNDING N ORLANDA VENUEP HARMACY. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: BHRT for Menopause 2 Irritable Bowel Syndrome 3 PRESCRIPTION COMPOUNDING FOR OBSTETRICS & GYNECOLOGY Female Sexual Dysfunction 4 757 Norland Avenue, Suite 105 Chambersburg, PA 17201 Phone: (717) 217-6790 Fax: (717) 217-6925 Web: www.norlandavenuepharmacy.com
Page 2 BHRT FOR MENOPAUSE The following clinical paper reports a 12 plus months follow up on 189 patients who were administered natural estrogen plus progesterone with or without DHEA or testosterone - Natural hormone therapy for menopause (Gynecol Endocrinol. 2009 Aug 19:1-5). ABSTRACT: Menopausal women are deficient in estrogen, progesterone, and frequently in testosterone and DHEA. Hormone replacement therapy (HRT) in the United States has generally consisted of one or two agents, typically equine estrogen and medroxyprogesterone, with increased risk of heart attack, stroke, dementia, and breast cancer [WHI trials]. Bio-identical hormones [chemically endogenous hormones] have gained popularity and can be mixed according to physician's orders by compounding pharmacists in the United States. However, there is little published information about the use of such hormones. This paper reports a 12 plus months follow up on 189 patients who were administered natural estrogen plus progesterone with or without DHEA or testosterone according to a rationalized protocol described later. Ninetyseven percent of the patients experienced varying degrees of symptom control, whereas three had minimal or questionable benefit. Mental symptoms experienced upon presentation improved in 90% of the patients. Sixty percent of the patients, who had gained weight during menopause, lost an average of 14.8 lbs [SD 11.98 lbs]. Complications described with traditional HRT did not develop in this group of patients. These findings point out a need for larger controlled trials of similar protocols in the management of menopause. PMID: 19701840 We have the ability to compound bioidentical hormones to meet the unique needs of each one of your patients. We would be happy to discuss specific medical cases with you and provide assistance in treating those patients that you deem appropriate for BHRT.
Page 3 IRRITABLE BOWEL SYNDROME The following clinical study found that low dose naltrexone improves pain and overall feeling, and is well tolerated in patients suffering from IBS - Low-dose naltrexone for the treatment of irritable bowel syndrome: a pilot study (Dig Dis Sci. 2006 Dec;51(12):2128-33). ABSTRACT: Preclinical studies have shown that a very low dose of naltrexone hydrochloride (NTX), an opiate antagonist, can block excitatory opioid receptors without affecting inhibitory opioid receptors, resulting in analgesic potency without side effects. The present study assessed the efficacy and safety of PTI-901 (lowdose NTX) treatment in Irritable bowel syndrome (IBS) patients. Forty-two IBS patients participated in an open-label study. Participants received 0.5 mg PTI-901/day for 4 weeks and were evaluated during baseline, during treatment, and at 4-week follow-up. Patients recorded degree of abdominal pain, stool urgency, consistency, and frequency. Primary outcomes were number of pain-free days and overall symptom relief, evaluated by a global assessment score. Data were analyzed per protocol. Global assessment improved in 76% of 42 patients. During treatment, the mean weekly number of pain-free days increased from 0.5+/-1 to 1.25+/-2.14 (P=0.011). There were no significant adverse reactions. PTI-901 improves pain and overall feeling, and is well tolerated by IBS patients. A large, randomized, double-blind, placebo-controlled study is justified. PMID: 17080248 With our state of the art compounding lab and pharmaceutical knowledge and experience, we have the ability to compound naltrexone into capsules; in strengths that meet the needs of each of your unique patients. An example of how you might prescribe follows: COMPOUNDED MEDICATION Naltrexone 0.5mg Capsules #30 Take 1 capsule QD
Page 4 FEMALE SEXUAL DYSFUNCTION The following clinical paper states that local estrogens may be safely used to treat urogenital atrophy with a significant improvement of sexual health and quality of life - Local estrogens for quality of life and sexuality in postmenopausal women with cardiovascular disease (Climacteric. 2009;12 Suppl 1:112-6). ABSTRACT: Urogenital aging and female sexual dysfunction (FSD) are significant problems following menopause. Estrogen decline is one of the key factors contributing to sexual functioning because of its crucial role for genital arousal (vasocongestion and lubrication) and other domains of the sexual response. Several common medical conditions, including cardiovascular disease (CVD), may interfere with women's sexual response across the aging process. FSD is one of the most common CVD-related quality-of-life complications with a major impact on patients' and their sexual partners' life. There is no evidence that FSD may represent an early indication of cardiovascular risk in postmenopausal women. In spite of the high prevalence, FSD remains largely underrecognized and sexual counseling is an important consideration for the proper management of postmenopausal women with CVD. Many local estrogen products are available (creams, tablets, suppositories, pessaries and rings) and are equally effective for treatment of vaginal atrophy. When a history of CVD is present, local estrogens may be safely used to treat urogenital atrophy with a significant improvement of sexual health and quality of life. PMID: 19811254 This paper finds that a tailored approach to the individual patient is preferred when treating with estrogen - The use of estrogen therapy in women's sexual functioning (J Sex Med. 2009 Mar;6 (3):603-16). INTRODUCTION: Estrogen is relevant to women's well-being including sexual functioning. Aim. The goal of this Continuing Medical Education article was to provide a comprehensive review of the effect of exogenous estrogen use on women's sexual function. Main Outcome Measures. We present a literature review. METHODS: The medical literature was accurately searched (1990-2008) with regard to estrogen therapy in menopausal women by using several terms related to and including the terms "estrogen" and "sexual function." RESULTS: A review of the studies most useful to guide menopausal practice. CONCLUSIONS: Estrogen decline is one of the key factors contributing to sexual functioning during menopausal transition and beyond. Systemic estrogen treatments are associated with significant benefits in some domains of menopausal sexual function, especially when estradiol is delivered transdermally, whereas local estrogens are effective in preventing urogenital aging. Even tibolone, a selective tissue estrogenic activity regulator, displays positive effects in postmenopausal women with sexual complaints. However, a tailored approach to the individual woman is always needed. PMID: 19284468 With our state of the art compounding laboratory and pharmaceutical knowledge and experience, we have the ability to compound estrogen into its individual components to meet the needs of each of your individual patients. An example of how you might prescribe follows: COMPOUNDED MEDICATION Bi-Est (Estradiol 0.5mg/gm + Estriol 2mg/gm) Intravaginal Cream 30gm Apply 1gm intravaginally HS
Prescriber Name Prescriber Address City State Zip Phone Fax Date Patient Name DOB Address City/State/Zip Phone Patient will pick up at pharmacy Please ship to patient Bill Insurance Plan: ID# BHRT for Menopause All topical compound %s are per 1 ml or 1 gm unless otherwise noted We would be happy to discuss specific medical cases with you, and provide assistance in treating those patients that you deem appropriate for BHRT. Irritable Bowel Syndrome [ ] Naltrexone 0.5mg Capsules Quantity #30 Female Sexual Dysfunction Directions: Take 1 capsule QD [ ] Bi-Est (Estradiol 0.5mg/gm + Estriol 2mg/gm) Intravaginal Cream Quantity 30gm Directions: Apply 1 gm intravaginally HS Directions Prescriber s Signature Refills: 1 2 3 4 5 6 7 8 9 10 11 12 NR 757 Norland Avenue, Suite 105 Chambersburg, PA 17201 Phone: (717) 217-6790 Fax: (717) 217-6925