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우두현 대한임상약리학회 2005 Translational and Clinical Pharmacology Vol.13 No.1
Drugs are one of the most common causes that induce galactorrhea, though other various factors such as hypothalamic-pituitary disorders, idiopathic causes and some systemic diseases are known to cause galactorrhea. Among the medications, antidepressants, antihypertensives, phenothiazine and H2-blocker are known as common causes of non-puerperal lactation. Paroxetine is a potent antidepressant of SSRI (selective serotonin reuptake inhibitor) class, and there are few reports of galactorrhea induced by paroxetine. We experienced two cases of galactorrhea following treatment with paroxetine. In the first case, a 24-year-old woman, who took daily 10 mg paroxetine for her depression, developed galactorrhea four months later. Paroxetine was maintained because her depression continued. Thus bromocriptine, a dopamine agonist, was added to her regimen. The galactorrhea ceased approximately four weeks after the bromocriptine started. Thereafter paroxetine and bromocriptine were discontinued, and galactorrhea ceased. In the second case, a 30-year-old woman taking 10~20 mg paroxetine daily to treat her post-traumatic syndrome, developed galactorrhea three months later. The medication was discontinued the next morning and the discharge ceased three weeks later. Both of the patients showed normal findings of brain MRI and their serum prolactin levels are 5.7 ng/mL and 7.5 ng/mL respectively. They all revealed hypersensitivity in TRH stimulation test.
송란 ( Ran Song ),우두현 ( Doo Hyun Woo ),이연아 ( Yeon Ah Lee ),이상훈 ( Sang Hoon Lee ),이향이 ( Hyang Ie Lee ),신준범 ( Joon Beom Shin ),홍승재 ( Seung Jae Hong ),한정수 ( Chung Soo Han ),유명철 ( Myung Chul Yoo ),양형인 ( Hyu 대한내과학회 2007 대한내과학회지 Vol.73 No.2
목적: Methotrexate (MTX)로는 충분한 질병활성억제를 보지 못했거나, 부작용으로 인해 MTX를 사용할 수 없었던 류마티스 관절염 환자에서 mizoribine의 치료효과를 알아보고자 하였다. 방법: Mizoribine (100 mg/day)을 투여 받은 류마티스 관절염 환자 50명을 대상으로 MTX와 mizoribine의 병합 치료군과 mizoribine 단독 치료군으로 나누어 분석하였으며, mizoribine 투여 전과 16주간의 투여 이후 평가된 질병 활성도와 부작용 등을 비교하였다. 결과: 임상지표를 보면 MTX와 mizoribine 병합 치료 군에서 VAS, 압통관절의 수, 종창관절의 수, DAS28이 치료 전에 비해 유의하게 감소하였으나 mizoribine 단독 치료 군에서는 VAS만이 유의한 차이를 보였다. 또한, 검사실 소견에서는 병합 치료 군에서 치료 후 ESR과 CRP가 유의하게 감소하였다. 치료 약제와 관련된 부작용은 위장장애가 가장 많았고, 기타 다른 부작용도 관찰되었지만 대부분 경미하였으며 부작용으로 인해 투약을 중단한 사례는 없었다. 결론: MTX에 충분한 반응을 보이지 않는 류마티스 관절염 환자에서 mizoribine은 비교적 안전한 치료 약제이며, MTX에 효과가 불충분했을 경우 mizoribine를 추가하면 질병활성도 억제에 좀 더 효과적임을 알 수 있었다. Background: This retrospective study was performed to investigate the clinical effects of mizoribine with using methotrexate (MTX) or mizoribine alone on those patients with rheumatoid arthritis (RA) who showed an ineffective response or intolerance to the MTX. Methods: The patients were divided into two groups: (1) combination therapy of mizoribine with MTX and (2) mizoribine alone. All the patients took 100 mg mizoribine daily for at least 16 weeks. Before and after administration of mizoribine for 16 weeks, we assessed the clinical variables such as the visual analogue pain scale (VAS), the tender joint counts (TJC), and the swollen joint counts (SJC). At each time, the laboratory parameters including the ESR, CRP, complete blood count (CBC), liver enzymes and creatinine were also measured. Disease activity scores (by the DAS28) and the adverse effects were determined at baseline and after 16 weeks. Results: Fifty patients were recruited in this study (mizoribine plus MTX group: n=35, mizoribine group: n=15). There were no significant differences in the initial laboratory values between the two treatment groups. After treatment for 16 weeks, the DAS28 was decreased significantly in the mizoribine plus MTX group (4.7±1.14 vs. 3.9±0.97, respectively, p<0.05). Yet the mizoribine alone group did not showed any significant change of the DAS28 (4.3±0.56 vs. 3.9±0.37, respectively, p=0.076). Mild gastrointestinal disturbance was the most common adverse effect. The incidence of adverse effects was similar in both treatment groups (20% vs. 27%, respectively). Conclusions: Mizoribine in combination with MTX was effective for RA patients who showed an ineffective response or intolerance to MTX. Furthermore, this treatment can be considered to be relatively safe.(Korean J Med 73:192-199, 2007)