RESUMEN
ABSTRACT Objective To compare the efficacy and safety of amoxapine and vitamin B12 for treating retrograde ejaculation (RE). Materials and Methods Between May 2009 and November 2012, this open-label, randomized, crossover study enrolled 26 men suffering with RE at Department of Reproductive Medicine, Omori Hospital. Patients were randomly allocated into two groups (n=13 each). The amoxapine-B12 group received amoxapine (50 mg daily for 4 weeks, orally) followed (after a 1-week washout period) by vitamin B12 (500 μg three-times daily for 4 weeks). The B12-amoxapine group received the opposite regimen. All patients masturbated to ejaculation at least twice during each treatment period. The primary outcome was antegrade ejaculation of semen, as reported by the patient, on more than one occasion during either treatment period (defined as treatment success). Any adverse events were noted. Success rates were compared between treatments using Fisher’s exact test. Results One patient (B12-amoxapine group) withdrew for personal reasons (breakdown of marital relations); all other patients completed the study. Overall success rate was 88% (22/25). Success rate was higher for amoxapine than for vitamin B12 (80%, 20/25 vs 16%, 4/25; P<0.0001). 18 patients were responsive to amoxapine but not to vitamin B12, 2 patients were responsive to vitamin B12 but not amoxapine, 2 patients were responsive to both drugs, and 3 patients had no response to either drug. One patient (4%) reported sleepiness and 2 (8%) reported constipation while receiving amoxapine. No adverse events were reported during vitamin B12 treatment. Conclusions Amoxapine may be an effective, safe and well-tolerated therapy for RE.
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Humanos , Masculino , Adulto , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Vitamina B 12/uso terapéutico , Complejo Vitamínico B/uso terapéutico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Eyaculación , Amoxapina/uso terapéutico , Vitamina B 12/efectos adversos , Deficiencia de Vitamina B 12 , Resultado del Tratamiento , Estudios Cruzados , Amoxapina/efectos adversos , Persona de Mediana EdadRESUMEN
OBJECTIVE: To compare the efficacy and safety of amoxapine and vitamin B12 for treating retrograde ejaculation (RE). MATERIALS AND METHODS: Between May 2009 and November 2012, this open-label, randomized, crossover study enrolled 26 men suffering with RE at Department of Reproductive Medicine, Omori Hospital. Patients were randomly allocated into two groups (n=13 each). The amoxapine-B12 group received amoxapine (50 mg daily for 4 weeks, orally) followed (after a 1-week washout period) by vitamin B12 (500 µg three-times daily for 4 weeks). The B12-amoxapine group received the opposite regimen. All pa-tients masturbated to ejaculation at least twice during each treatment period. The primary outcome was antegrade ejaculation of semen, as reported by the patient, on more than one occasion during either treatment period (defined as treatment success). Any adverse events were noted. Success rates were compared between treatments using Fisher's exact test. RESULTS: One patient (B12-amoxapine group) withdrew for personal reasons (breakdown of marital relations); all other patients completed the study. Overall success rate was 88% (22/25). Success rate was higher for amoxapine than for vitamin B12 (80%, 20/25 vs 16%, 4/25; P<0.0001). 18 patients were responsive to amoxapine but not to vitamin B12, 2 patients were responsive to vitamin B12 but not amoxapine, 2 patients were responsive to both drugs, and 3 patients had no response to either drug. One patient (4%) reported sleepiness and 2 (8%) reported constipation while receiving amoxapine. No adverse events were reported during vitamin B12 treatment. CONCLUSIONS: Amoxapine may be an effective, safe and well-tolerated therapy for RE.
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Amoxapina/uso terapéutico , Eyaculación , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Vitamina B 12/uso terapéutico , Complejo Vitamínico B/uso terapéutico , Adulto , Amoxapina/efectos adversos , Estudios Cruzados , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Vitamina B 12/efectos adversos , Deficiencia de Vitamina B 12RESUMEN
OBJECTIVE: Amoxapine is marketed as an antidepressant. However, its receptor occupancy, in vitro and in vivo, and its effects in pre-clinical models are very similar to atypical antipsychotics. To examine if this leads to an atypical antipsychotic effect in the clinical context, the authors examined the antipsychotic and side-effect profile of amoxapine in acutely psychotic patients with schizophrenia. METHODS: Seventeen patients were enrolled and 15 completed a prospective open-label 6-week study of amoxapine starting with a fixed-starting dose (150 mg/h) with standardized titration up to 250 mg/h, if required. Positive, negative, affective symptoms and side-effects were monitored using standardized weekly assessments. RESULTS: Amoxapine (median final dose 210 mg/h) was well-tolerated and showed significant improvement in positive and negative symptoms (both p<0.001), with a trend towards improvement in mood symptoms and no treatment-emergent extrapyramidal side-effects, akathisia or weight gain. Prolactin elevation was observed. CONCLUSION: These clinical data lend support to the pre-clinical suggestions that amoxapine may be an atypical antipsychotic. Given its lack of weight gain and that it is considerably less expensive than current options, amoxapine could be a valuable alternative for some patients. These considerations strongly call for more systematic, double-blind studies of amoxapine as an atypical antipsychotic.
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Amoxapina/uso terapéutico , Antipsicóticos/uso terapéutico , Inhibidores de la Captación de Neurotransmisores/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Adolescente , Adulto , Amoxapina/efectos adversos , Amoxapina/farmacología , Análisis de Varianza , Antipsicóticos/efectos adversos , Antipsicóticos/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Captación de Neurotransmisores/efectos adversos , Inhibidores de la Captación de Neurotransmisores/farmacología , Estudios ProspectivosRESUMEN
Os autores salientam a importância do diagnóstico de depressäo na populaçäo idosa e as peculiaridades do seu tratamento com as diferentes drogas antidepressivas, principalmente, em relaçäo à farmacocinética e efeitos colaterais das mesmas