Abstract

VILAR GONZALEZ, Santiago et al. Trazodone: A new selective approach to the treatment of hot flushes induced by androgen deprivation in prostate carcinoma?. Actas Urol Esp [online]. 2009, vol.33, n.6, pp.635-638. ISSN 0210-4806.

The growing relevance of prostate carcinoma in the developed world requires serious attention to focus on the risk-benefit relationships of the treatments used. Given the increasingly complex therapeutic approach to prostate carcinoma, an extensive range of knowledge is required. Androgen deprivation plays a central role in this disease. The management of androgen deprivation-derived toxicity in the form of hot flushes, metabolic syndrome, osteoporosis, cognitive disorders, etc., is of growing interest. The drug treatment of hot flushes involves hormone management that is not without oncological risk and moreover generates considerable toxicity. Antidepressants in turn play an important role in the non-hormone treatment of this disorder. Trazodone, a serotonin reuptake inhibitor/5-HT_2A receptor antagonist affording more selective action upon the receptors implicated in hot flushes, could be of great interest. Trazodone shows great affinity for the 5-HT_2A receptors and moderate affinity for the 5-HT_1A receptors. Serotonin (5-hydroxytryptamine, or 5-HT) levels are known to be lowered in postmenopausal women, and normalize when replacement therapy is provided. This suggests that abrupt sexual hormone deprivation gives rise to a reduction in blood serotonin - with a subsequent increase in its hypothalamic 5-HT_2A receptors. These receptors would be implicated in the pathogenesis of hot flushes; as a result, the blocking of such receptors is one of the principal therapeutic measures. The use of trazodone, increasing the serotonin concentrations and blocking the 5-HT_2A and 5-HT_1A receptors, could be viewed as a novel management approach more in line with the physiopathology of hot flushes. Well designed comparative studies are needed to establish the efficacy of such treatment. Other issues pending clarification would be the most effective dose and duration of treatment for controlling hot flashes.

Keywords : Prostate carcinoma; Hot flashes; Hormone deprivation; Treatment, Antidepressants; Trazodone; 5-HT2A receptors.

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