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Osteoporosis What is osteoporosis? Osteoporosis is the thinning of the bones which results in increased risk of fracture particularly in the hip, spine, wrist and upper arm. Multiple fractures of the vertebrae can cause stooped posture and loss of height which is very common in the elderly. Fractures cause chronic and acute pain and can cause disability and loss of mobility. Bone loss is gradual and is usually symptom free until it is advanced. Osteoporosis affects both men and women and is a common problem associated with aging. It is also associated with lack of oestrogen in postmenopausal women; or following treatment with corticosteroids, an anti-inflammatory steroid that can cause bone loss. Risk factors for osteoporosis include, family history, smoking, excessive alcohol intake, thin build, lack of physical activity, lack of dietary calcium and low levels of Vitamin D. Bone turnover and osteoporosis Bone turnover is the normal mechanism for bone remodelling, which is a dynamic process that allows bones to grow and repair. Bone resorption and formation takes place constantly on the surface of bones. Resorption is carried out by osteoclast cells and is the process by which bone is broken down and minerals like calcium and phosphate released into the blood. Bone formation is carried out by osteoblast cells and is the process by which new bone is formed, with a build-up of bone matrix containing proteins, calcium, phosphate and other minerals, which form the scaffolding that gives bone its strength. When the process of bone turnover is out of balance and bone loss is greater than bone formation this results is a loss of bone mass making bones brittle and likely to fracture more easily. Bone density is the amount of bone tissue in a certain volume of bone and when this falls below a certain level, this is defined as osteoporosis. Treatments for osteoporosis Treatments for osteoporosis are based on increasing bone mineral density and reducing bone turnover, thereby restoring the balance between bone resorption and formation, to prevent loss of bone density in people with or at risk of osteoporosis. Bisphosphonates like alendronate and risedronate are an effective treatment for osteoporosis. They are synthetic chemicals similar to the naturally occurring pyrophosphates that are formed form as a product of normal phosphate metabolism. Like pyrophosphates, biphosphonates binds strongly to hydroxyapatite, the mineralised bone scaffolding, at the site of bone resorption. This inhibits the action of osteoclasts in resorbing bone reducing the amount of bone remodelling and loss of calcium from bone. Biphosponates can also be used in combination with cholecalciferol or Vitamin D3, which is converted to its active form, calcitriol, a hormone that regulates calcium metabolism. Calcitriol regulates calcium absorption in the intestine and excretion in the kidneys. If there is a lack of Vitamin D3 then calcium levels may become low and this contributes to brittle bones and to osteoporosis. Calcitriol also regulates bone remodelling. Combining cholecalciferol with bisphosphonates adds another dimension to combatting osteoporosis. Another treatment for osteoporosis is raloxifene, a selective oestrogen receptor modulator. Loss of oestrogen at menopause is associated with increased bone remodelling. Raloxifene mimics the actions of oestrogen and binds to the oestrogen receptor in bone, where it inhibits the actions of osteoclasts.
Estrofem 2mg Estrofem general information What is Estrofem used for? Estrofem 2mg tablets are a hormone replacement therapy (HRT) used to substitute for a lack of oestrogen production by the ovaries that happens during menopause or following surgical removal of the ovaries, to relieve symptoms of menopause caused by oestrogen deficiency, such as hot flushes, night sweats, sleeplessness, vaginal dryness, headaches, mood swings, lack of concentration and loss of energy. Estrofem 2mg tablets also are also used to help prevent postmenopausal bone loss (osteoporosis) and reduce risk of fracture. Estrofem stimulates the development of female sexual characteristics, and is used as part of a transgender hormone therapy for male to female transsexuals. How does Estrofem work? Estrofem contains a synthetic form of 17β-oestradiol, which is the major and most active form of the female sex hormone oestrogen, and is chemically and biologically identical to the natural hormone. Oestrogen is a steroid hormone produced by the ovaries that binds to specific receptors inside oestrogen-responsive cells and stimulates them to make proteins involved in producing secondary sexual characteristics, such as breast development and in regulating the menstrual cycle. Oestrogen also has several other actions in various metabolic processes including maintaining bone mass and lipid (fat) metabolism. What Estrofem doses are available? Estrofem tablets are available to order and buy online from Inhouse Pharmacy in doses of 1mg and 2mg in packs of 28 tablets. What does Estrofem contain? The active ingredient in Estrofem is a synthetic form 17β-oestradiol, of human oestradiol, which is the most active form of the female hormone oestrogen and is responsible for the development of female sexual characteristics and regulation of the menstrual cycle. Estrofem also contains lactose monohydrate, maize starch, gelatine, talc, magnesium stearate, titanium dioxide, methylhydroxypropylcellulose, E132 or E172. Treating symptoms of menopause with Estrofem Estrofem 2mg tablets are used to treat symptoms caused by a lack of endogenous oestrogen (produced by the ovaries), which happens during menopause, such as hot flushes, night sweats, sleeplessness, vaginal dryness, headaches, mood swings, lack of concentration and loss of energy. Estrofem for hormone replacement therapy Estrofem 2mg substitutes for the loss of oestrogen production by the ovaries that occurs during menopause. Estrofem contains oestradiol, an active form of the female hormone oestrogen that alleviates menopausal symptoms, such as hot flushes, night sweats, sleeplessness, dry vagina, headaches, mood swings, lack of concentration loss of energy and bone loss (osteoporosis). Estrofem for transgender treatment Estrofem 2mg can be used as part of a gender reassignment program for male to female transsexuals, by providing a source of oestradiol, an active form of the female hormone oestrogen. Estrofem 2mg tablets stimulate the development of female secondary sexual characteristics, such as breast development and also induce metabolic changes such as fat distribution to redefine the general body shape. Estrofem for feminising hormone therapy Estrofem 2mg tablets contain 17β-oestradiol, the most feminising form of the female hormone oestrogen, which provides a very effective means of feminisation when used as part of a gender reassignment program for male to female transsexuals. Estrofem 2mg stimulates the development of female secondary sexual characteristics, such as breast development and also induces metabolic changes such as fat distribution to redefine the general body shape, while at the same time Estrofem overrides the effects of testosterone. What are the side effects of Estrofem? The most frequently reported side effects when taking Estrofem 2mg tablets are breast tenderness, breast pain, abdominal pain, nausea, oedema, and headache, skin rash and itching, insomnia and depression. More severe side effects include changes in liver function at higher doses. What are the health risks of Estrofem? Long-term HRT with Estrafem does have associated health risks, including an increased risk of breast cancer, endometrial cancer, stroke and deep vein thrombosis. For women with an intact uterus adding a progestagen to an oestrogen replacement regimen like Estrofem for at least 10 days per cycle is recommended to reduce the risk of endometrial cancer. When should Estrofem not be used? You should not use Estrofem if you: have a past or family history of carcinoma of the breast, endometrial carcinoma or liver disease have deep venous thrombosis, thromboembolic disorders, cerebral vascular accident associated with oestrogen use abnormal genital bleeding of unknown cause are pregnant or planning to become pregnant are allergic to 17β-oestradiol or any of the ingredients in Estrofem tablets are taking other medications that may interact with Estrofem, such as anticonvulsants like phenytoin and carbamazepin, anti-infectives like rifampicin, rifabutin, nevirapine, efavirenz or preparations containing St John's Wort. How should Estrofem be taken? You should take Estrofem 2mg tablets with a glass of water once a day, preferably at the same time each day, until all 28 tablets have been taken. The dose you take depends on your condition and should be as recommended by your doctor. When you have finished each pack, start the next pack immediately. You can start taking Estrofem tablets on any convenient day unless you are still having menstrual bleeding, in which case take the first tablet on day 5 of bleeding. How long should you take Estrofem? Each pack of Estrofem 2mg tablets is a calendar pack of 28 tablets. You should take Estrofem 2mg tablets for as long as your doctor recommends. Missed dose of Estrofem If you miss a dose of Estrofem 2mg tablets, take the tablet as soon as you remember, unless it is time to take the next dose, then skip the missed dose. Do not take a double dose. How should Estrofem be stored? Store Estrofem tablets in their calendar pack at room temperature below 25°C, keep away from direct sunlight and do not refrigerate.
Abdi Ibrahim
Men's Health About androgens Androgens are steroid sex hormones produced mainly in the testes that control the development of the male sex organs, the testes, penis, seminal vesicles and prostate gland. They also regulate and maintain secondary male characteristics like the development of body and facial hair, increase in bone and muscle mass and deepening of the voice at puberty. Females also produce small amounts of androgens in the ovaries, but in some cases over production causes androgenisation with characteristics like unwanted body hair. The main androgens are the male hormone testosterone and its active metabolite dihydrotestosterone (DHT), which is much more potent than testosterone. Both testosterone and DHT bind to the androgen receptor within responsive cells, including brain, bone, hair follicles, testes and prostate cells. Increased production of or sensitivity to testosterone is thought to be involved in conditions like hypersexuality and aggression in male sex offenders. Also increased sensitivity to DHT and increased conversion of testosterone to DHT is thought to contribute to the hair loss process in male pattern baldness. The prostate gland The prostate gland is a small organ that lies just below the bladder and surrounds the top of the urethra, which is the tube that carries urine from the bladder. The prostate gland contributes to the seminal fluid made mainly by the seminal vesicles and the small amount made by the testes, which also contains sperm. Seminal fluid is transported by the urethra through the penis during ejaculation. Growth and development of the prostate gland is controlled by testosterone, which binds to androgen receptors inside prostate cells. Conditions of the prostate gland include: Prostatitis, which is inflammation of the prostate usually due to an infection. Benign Prostatic Hyperplasia (BPH), which is an enlarged prostate but is not cancerous. Prostate cancer, which is an androgen-dependent tumour and needs testosterone for the cancer cells to grow. Erectile dysfunction Erectile dysfunction (ED) is also known as impotence in men and is the inability to achieve or maintain a hard erect penis suitable for sexual activity, which is normally the natural response to sexual stimulation. ED is due to decreased blood flow into the penis and can be treated by specific medication taken at the time of planned sexual activity. Treatments for men’s health problems Medications available for treating specific men’s health problems include: Anti-androgens that block the production of testosterone and its effects on cells containing androgen receptors, and are used to treat prostate cancer; also hypersexuality in male sex offenders. Inhibitors of the enzyme 5α-reductase that converts testosterone to DHT, and is used to treat BPH and male pattern baldness. Alpha blockers or alpha-adrenergic antagonists that relax muscle cells in the prostate gland and are used to treat symptoms of BPH. Inhibitors of the enzyme phosphodiesterase type 5 (PDE5) that widen blood vessels allowing blood flow into penis, and are used to treat ED. Prostaglandins that relax smooth muscle and are used to treat ED. Dietary supplements containing a naturally occurring 5α-reductase inhibitor, used to support prostate health and to treat BPH and male pattern baldness.
Sotalol 80mg Sotalol general information What is Sotalol used for? Sotalol tablets 80mg are used to treat and prevent arrhythmia, which is abnormal or irregular heart beat, particularly supraventricular and ventricular arrhythmias. Arrhythmias are due to irregular electrical activity of the heart and an arrhythmia refers to any change from the normal sequence of electrical impulses that controls the heart’s normal rhythm, causing abnormal heart rhythms. They include atrial and ventricle arrhythmias and atrial fibrillation is the most common form of arrhythmia. Supraventricular arrhythmia can cause shortness of breath, heart palpitations, chest tightness, and a very fast pulse, but is not usually life-threatening. There are two types of ventricular arrhythmias and ventricular fibrillation is the most serious. It is due to uncontrolled heartbeat causing the heart muscle to quiver instead of contracting so that it can no longer pump blood to the rest of the body and can cause heart attack or result in cardiac arrest. Ventricular tachycardia is a rapid heartbeat due to loss of normal heart pacemaker function and this compromises the supply of blood and therefore, oxygen to the heart itself and the rest of the body. This increases the workload on the heart and results in severe shortness of breath, dizziness, or fainting (syncope), but is not usually life-threatening. Sotalol tablets 80mg help restore the heart’s normal rhythm and prevent irregular heartbeat. How does Sotalol work? Sotalol tablets 80mg contain sotalol, which is a non-selective beta-adrenergic receptor blocker without sympathomimetic activity or membrane stabilising activity. Sotalol in Sotalol tablets 80mg binds to beta receptors that are found in vascular smooth muscle in blood vessel walls and several organs of the body, including the heart lungs and kidney, which blocks the action of chemicals called catecholamines, such as adrenaline (epinephrine) and noradrenaline (nor epinephrine), which are released by the adrenal glands in response to nerve stimulation during physical and mental stress. Adrenaline binds to beta-receptors in the heart to stimulate increased heart rate and constriction (narrowing) of blood vessels. These actions of adrenaline are reduced or inhibited by sotalol in Sotalol tablets 80mg, causing a decrease in heart rate and a reduction in the force of contraction of the heart; also widening of blood vessels, which increases blood flow and oxygen to the heart. Sotalol in Sotalol tablets 80mg also has class III antiarrhythmic activity and interacts with the area of the heart muscle that controls the rate of the heartbeat known as the atrioventricular (AV) node. The AV node sets the rhythm for contraction of the heart that forces blood from the atria or upper chambers to the ventricles or lower chambers of the heart and slows the transmission of current from the atria to the ventricles, to ensure that the atria fill up with blood fully before the next contraction. Sotalol in Sotalol tablets 80mg works by reducing the speed of conduction and increasing the refractory period of the AV node, which lengthens the gap between one heart beat and the next and slows down the heart rate while restoring a regular pace. The action potential, which drives the heart muscle contraction is based on myocardial (heart muscle) depolarisation and repolarisation, which is when sodium and potassium ions build up on one side of the membrane and are then released through special voltage-gated ion channels, causing a rapid rise and fall of membrane potential (the difference in electrical potential between the inside and the outside of the heart muscle cells). Sotalol in Sotalol tablets 80mg is classified as a class III antiarrhythmic, because it works by blocking potassium channels in the myocardial cells, which delays or prolongs repolarisation, increases the duration of the action potential and thereby increases the refractory period. This causes lengthening of the QTc interval on electrocardiographic recordings, which represents depolarisation and depolarisation of the ventricles This action of Sotalol in Sotalol tablets 80mg slows down a fast heartbeat and restores the heart’s normal rhythm. What does Sotalol contain? Sotalol tablets contains the active ingredient sotalol 80mg, a non-selective beta- blocker with class III antiarrhythmic activity, that is used to treat and prevent supraventricular and ventricular arrhythmia. They also contain calcium hydrogen phosphate anhydrous, maize starch, povidone, sodium starch glycollate, purified talc and magnesium stearate. Treating arrhythmia with Sotalol Sotalol tablets 80mg contain sotalol, a non-selective beta-adrenergic receptor blocker with class III antiarrhythmic activity that is used to treat and prevent arrhythmia, which is abnormal or irregular heart beat, particularly supraventricular and ventricular arrhythmias. Arrhythmia refers to any change from the normal sequence of electrical impulses that controls the heart’s normal rhythm, causing abnormal heart rhythms. They include atrial and ventricle arrhythmias and atrial fibrillation is the most common form of arrhythmia. Supraventricular arrhythmia can cause shortness of breath, heart palpitations, chest tightness, and a very fast pulse, but is not usually life-threatening. There are two types of ventricular arrhythmias and ventricular fibrillation is the most serious. It is due to uncontrolled heartbeat causing the heart muscle to quiver instead of contracting so that it can no longer pump blood to the rest of the body and can cause heart attack or result in cardiac arrest. Ventricular tachycardia is a rapid heartbeat due to loss of normal heart pacemaker function and this compromises the supply of blood and therefore, oxygen to the heart itself and the rest of the body. This increases the workload on the heart and results in severe shortness of breath, dizziness, or fainting (syncope), but is not usually life-threatening. Sotalol in Sotalol tablets 80mg has two mechanisms of action to control arrhythmias. As a beta blocker, it blocks the action of chemicals called catecholamines, such as adrenaline (epinephrine) and noradrenaline (nor epinephrine), which stimulate increased heart rate and constriction (narrowing) of blood vessels. This action of sotalol causes a decrease in heart rate and a reduction in the force of contraction of the heart; also widening of blood vessels, which increases blood flow and oxygen to the heart. As a class III antiarrhythmic, Sotalol in Sotalol tablets 80mg acts works by blocking potassium channels in the myocardial cells of the heart, which delays or prolongs repolarisation, increases the duration of the action potential, which drives the heartbeat and thereby increases the refractory period. This slows down a fast heartbeat and restores the heart’s normal rhythm. What are the side effects of Sotalol? The most commonly reported side effects when taking Sotalol tablets 80mg include dyspnoea (shortness of breath), fatigue, dizziness, headache, fever, bradycardia (slow heartbeat), hypotension (low blood pressure), cold extremities, chest pain, palpitations, oedema, rash, mood changes, anxiety, depression, sexual dysfunction, visual and hearing disturbances, taste changes, paraesthesia (tingling). When should Sotalol not be used? You should not use Sotalol tablets 80mg if you: are allergic to sotalol or any ingredients in Sotalol are pregnant or are breastfeeding have kidney disease suffer from bronchospasm, including bronchial asthma or chronic obstructive airway disease; also allergic disorders (including allergic rhinitis) which may predispose to bronchospasm have right ventricular failure secondary to pulmonary hypertension have certain other heart conditions such as uncontrolled heart failure or an enlarged heart have sinus bradycardia (a very low heartbeat of less than 45-50 beats/minute) are in shock due to low blood volume (hypovolaemic) or inadequate pumping of the heart (cardiogenic) have congenital or acquired long QT syndromes. have AV block or sick sinus syndrome (unless pacemaker in situ) are taking medicines that interact with Sotalol, including calcium channel blockers like verapamil or diltiazem for hypertension, angina or other heart conditions; insulin or other oral diabetes medications; anaesthetics like chloroform and cyclopropane; beta agonists such a salbutamol and terbutaline for bronchospasm and isoprenaline for bradycardia; catecholamine-depleting agents like reserpine the antipsychotic and guanethidine the antihypertensive; clonidine for hypertension; certain other medicines used to treat arrhythmias, such as quinidine, disopyramide, flecainide, mexiletine and amiodarone; potassium depleting diuretics; digoxin for heart failure; alcohol; tricyclic antidepressants; the antihistamines terfenadine and astemizole for allergy What medications interact with Sotalol? Several medications interact with Sotalol tablets 80mg and should either not be taken while you are taking Sotalol or only after discussion and instruction from your doctor: Drugs that cause a serious reaction with Sotalol: calcium channel blockers like verapamil or diltiazem for hypertension, angina or other heart conditions, anaesthetics like chloroform and cyclopropane, catecholamine-depleting agents like reserpine the antipsychotic and antihypertensive and guanethidine the antihypertensive, clonidine for hypertension, certain other medicines used to treat arrhythmias, such as quinidine, disopyramide, flecainide, mexiletine and amiodarone, potassium depleting diuretics, tricyclic antidepressants, the antihistamines terfenadine and astemizole for allergy, may prolong theQT interval Drugs that affect Sotalol: alcohol Drugs that are affected by Sotalol: insulin or other oral diabetes medications, digoxin for heart failure How should Sotalol be taken? You should take your Sotalol tablets 80mg swallowed whole with a glass of water twice daily and 1-2 hours before meals. The dose you take depends on you doctor’s recommendations and what you are being treated for and your dose may be increased gradually over a few days. You should continue to take your Sotalol tablets 80mg regularly for as long as recommend by your doctor and may be for long term. How long should you take Sotalol? You should continue to take your Sotalol tablets 80mg regularly for as long as recommend by your doctor and may be for long term. Missed dose of Sotalol If you miss a dose of Sotalol tablets 80mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose. Do not take a double dose. How should Sotalol be stored? You should store your Sotalol below 25°C in a cool dry place.

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Osteoporosis

What is osteoporosis?

Osteoporosis is the thinning of the bones which results in increased risk of fracture particularly in the hip, spine, wrist and upper arm. Multiple fractures of the vertebrae can cause stooped posture and loss of height which is very common in the elderly. Fractures cause chronic and acute pain and can cause disability and loss of mobility. Bone loss is gradual and is usually symptom free until it is advanced.

Osteoporosis affects both men and women and is a common problem associated with aging. It is also associated with lack of oestrogen in postmenopausal women; or following treatment with corticosteroids, an anti-inflammatory steroid that can cause bone loss. Risk factors for osteoporosis include, family history, smoking, excessive alcohol intake, thin build, lack of physical activity, lack of dietary calcium and low levels of Vitamin D.

Bone turnover and osteoporosis

Bone turnover is the normal mechanism for bone remodelling, which is a dynamic process that allows bones to grow and repair. Bone resorption and formation takes place constantly on the surface of bones. Resorption is carried out by osteoclast cells and is the process by which bone is broken down and minerals like calcium and phosphate released into the blood. Bone formation is carried out by osteoblast cells and is the process by which new bone is formed, with a build-up of bone matrix containing proteins, calcium, phosphate and other minerals, which form the scaffolding that gives bone its strength.

When the process of bone turnover is out of balance and bone loss is greater than bone formation this results is a loss of bone mass making bones brittle and likely to fracture more easily. Bone density is the amount of bone tissue in a certain volume of bone and when this falls below a certain level, this is defined as osteoporosis.

Treatments for osteoporosis

Treatments for osteoporosis are based on increasing bone mineral density and reducing bone turnover, thereby restoring the balance between bone resorption and formation, to prevent loss of bone density in people with or at risk of osteoporosis.

Bisphosphonates like alendronate and risedronate are an effective treatment for osteoporosis. They are synthetic chemicals similar to the naturally occurring pyrophosphates that are formed form as a product of normal phosphate metabolism. Like pyrophosphates, biphosphonates binds strongly to hydroxyapatite, the mineralised bone scaffolding, at the site of bone resorption. This inhibits the action of osteoclasts in resorbing bone reducing the amount of bone remodelling and loss of calcium from bone. Biphosponates can also be used in combination with cholecalciferol or Vitamin D3, which is converted to its active form, calcitriol, a hormone that regulates calcium metabolism. Calcitriol regulates calcium absorption in the intestine and excretion in the kidneys. If there is a lack of Vitamin D3 then calcium levels may become low and this contributes to brittle bones and to osteoporosis. Calcitriol also regulates bone remodelling. Combining cholecalciferol with bisphosphonates adds another dimension to combatting osteoporosis.

Another treatment for osteoporosis is raloxifene, a selective oestrogen receptor modulator. Loss of oestrogen at menopause is associated with increased bone remodelling. Raloxifene mimics the actions of oestrogen and binds to the oestrogen receptor in bone, where it inhibits the actions of osteoclasts.

Estrofem 2mg

Estrofem general information

What is Estrofem used for?

Estrofem 2mg tablets are a hormone replacement therapy (HRT) used to substitute for a lack of oestrogen production by the ovaries that happens during menopause or following surgical removal of the ovaries, to relieve symptoms of menopause caused by oestrogen deficiency, such as hot flushes, night sweats, sleeplessness, vaginal dryness, headaches, mood swings, lack of concentration and loss of energy. Estrofem 2mg tablets also are also used to help prevent postmenopausal bone loss (osteoporosis) and reduce risk of fracture. Estrofem stimulates the development of female sexual characteristics, and is used as part of a transgender hormone therapy for male to female transsexuals.

How does Estrofem work?

Estrofem contains a synthetic form of 17β-oestradiol, which is the major and most active form of the female sex hormone oestrogen, and is chemically and biologically identical to the natural hormone. Oestrogen is a steroid hormone produced by the ovaries that binds to specific receptors inside oestrogen-responsive cells and stimulates them to make proteins involved in producing secondary sexual characteristics, such as breast development and in regulating the menstrual cycle. Oestrogen also has several other actions in various metabolic processes including maintaining bone mass and lipid (fat) metabolism.

What Estrofem doses are available?

Estrofem tablets are available to order and buy online from Inhouse Pharmacy in doses of 1mg and 2mg in packs of 28 tablets.

What does Estrofem contain?

The active ingredient in Estrofem is a synthetic form 17β-oestradiol, of human oestradiol, which is the most active form of the female hormone oestrogen and is responsible for the development of female sexual characteristics and regulation of the menstrual cycle. Estrofem also contains lactose monohydrate, maize starch, gelatine, talc, magnesium stearate, titanium dioxide, methylhydroxypropylcellulose, E132 or E172.

Treating symptoms of menopause with Estrofem

Estrofem 2mg tablets are used to treat symptoms caused by a lack of endogenous oestrogen (produced by the ovaries), which happens during menopause, such as hot flushes, night sweats, sleeplessness, vaginal dryness, headaches, mood swings, lack of concentration and loss of energy.

Estrofem for hormone replacement therapy

Estrofem 2mg substitutes for the loss of oestrogen production by the ovaries that occurs during menopause. Estrofem contains oestradiol, an active form of the female hormone oestrogen that alleviates menopausal symptoms, such as hot flushes, night sweats, sleeplessness, dry vagina, headaches, mood swings, lack of concentration loss of energy and bone loss (osteoporosis).

Estrofem for transgender treatment

Estrofem 2mg can be used as part of a gender reassignment program for male to female transsexuals, by providing a source of oestradiol, an active form of the female hormone oestrogen. Estrofem 2mg tablets stimulate the development of female secondary sexual characteristics, such as breast development and also induce metabolic changes such as fat distribution to redefine the general body shape.

Estrofem for feminising hormone therapy

Estrofem 2mg tablets contain 17β-oestradiol, the most feminising form of the female hormone oestrogen, which provides a very effective means of feminisation when used as part of a gender reassignment program for male to female transsexuals. Estrofem 2mg stimulates the development of female secondary sexual characteristics, such as breast development and also induces metabolic changes such as fat distribution to redefine the general body shape, while at the same time Estrofem overrides the effects of testosterone.

What are the side effects of Estrofem?

The most frequently reported side effects when taking Estrofem 2mg tablets are breast tenderness, breast pain, abdominal pain, nausea, oedema, and headache, skin rash and itching, insomnia and depression. More severe side effects include changes in liver function at higher doses.

What are the health risks of Estrofem?

Long-term HRT with Estrafem does have associated health risks, including an increased risk of breast cancer, endometrial cancer, stroke and deep vein thrombosis. For women with an intact uterus adding a progestagen to an oestrogen replacement regimen like Estrofem for at least 10 days per cycle is recommended to reduce the risk of endometrial cancer.

When should Estrofem not be used?

You should not use Estrofem if you:

have a past or family history of carcinoma of the breast, endometrial carcinoma or liver disease
have deep venous thrombosis, thromboembolic disorders, cerebral vascular accident associated with oestrogen use
abnormal genital bleeding of unknown cause
are pregnant or planning to become pregnant
are allergic to 17β-oestradiol or any of the ingredients in Estrofem tablets
are taking other medications that may interact with Estrofem, such as anticonvulsants like phenytoin and carbamazepin, anti-infectives like rifampicin, rifabutin, nevirapine, efavirenz or preparations containing St John's Wort.

How should Estrofem be taken?

You should take Estrofem 2mg tablets with a glass of water once a day, preferably at the same time each day, until all 28 tablets have been taken. The dose you take depends on your condition and should be as recommended by your doctor. When you have finished each pack, start the next pack immediately. You can start taking Estrofem tablets on any convenient day unless you are still having menstrual bleeding, in which case take the first tablet on day 5 of bleeding.

How long should you take Estrofem?

Each pack of Estrofem 2mg tablets is a calendar pack of 28 tablets. You should take Estrofem 2mg tablets for as long as your doctor recommends.

Missed dose of Estrofem

If you miss a dose of Estrofem 2mg tablets, take the tablet as soon as you remember, unless it is time to take the next dose, then skip the missed dose. Do not take a double dose.

How should Estrofem be stored?

Store Estrofem tablets in their calendar pack at room temperature below 25°C, keep away from direct sunlight and do not refrigerate.

Abdi Ibrahim

Men's Health

About androgens

Androgens are steroid sex hormones produced mainly in the testes that control the development of the male sex organs, the testes, penis, seminal vesicles and prostate gland. They also regulate and maintain secondary male characteristics like the development of body and facial hair, increase in bone and muscle mass and deepening of the voice at puberty. Females also produce small amounts of androgens in the ovaries, but in some cases over production causes androgenisation with characteristics like unwanted body hair.

The main androgens are the male hormone testosterone and its active metabolite dihydrotestosterone (DHT), which is much more potent than testosterone. Both testosterone and DHT bind to the androgen receptor within responsive cells, including brain, bone, hair follicles, testes and prostate cells.

Increased production of or sensitivity to testosterone is thought to be involved in conditions like hypersexuality and aggression in male sex offenders. Also increased sensitivity to DHT and increased conversion of testosterone to DHT is thought to contribute to the hair loss process in male pattern baldness.

The prostate gland

The prostate gland is a small organ that lies just below the bladder and surrounds the top of the urethra, which is the tube that carries urine from the bladder. The prostate gland contributes to the seminal fluid made mainly by the seminal vesicles and the small amount made by the testes, which also contains sperm. Seminal fluid is transported by the urethra through the penis during ejaculation.
Growth and development of the prostate gland is controlled by testosterone, which binds to androgen receptors inside prostate cells. Conditions of the prostate gland include:

Prostatitis, which is inflammation of the prostate usually due to an infection.
Benign Prostatic Hyperplasia (BPH), which is an enlarged prostate but is not cancerous.
Prostate cancer, which is an androgen-dependent tumour and needs testosterone for the cancer cells to grow.

Erectile dysfunction

Erectile dysfunction (ED) is also known as impotence in men and is the inability to achieve or maintain a hard erect penis suitable for sexual activity, which is normally the natural response to sexual stimulation. ED is due to decreased blood flow into the penis and can be treated by specific medication taken at the time of planned sexual activity.

Treatments for men’s health problems

Medications available for treating specific men’s health problems include:

Anti-androgens that block the production of testosterone and its effects on cells containing androgen receptors, and are used to treat prostate cancer; also hypersexuality in male sex offenders.

Inhibitors of the enzyme 5α-reductase that converts testosterone to DHT, and is used to treat BPH and male pattern baldness.

Alpha blockers or alpha-adrenergic antagonists that relax muscle cells in the prostate gland and are used to treat symptoms of BPH.

Inhibitors of the enzyme phosphodiesterase type 5 (PDE5) that widen blood vessels allowing blood flow into penis, and are used to treat ED.

Prostaglandins that relax smooth muscle and are used to treat ED.

Dietary supplements containing a naturally occurring 5α-reductase inhibitor, used to support prostate health and to treat BPH and male pattern baldness.

Sotalol 80mg

Sotalol general information

What is Sotalol used for?

Sotalol tablets 80mg are used to treat and prevent arrhythmia, which is abnormal or irregular heart beat, particularly supraventricular and ventricular arrhythmias. Arrhythmias are due to irregular electrical activity of the heart and an arrhythmia refers to any change from the normal sequence of electrical impulses that controls the heart’s normal rhythm, causing abnormal heart rhythms. They include atrial and ventricle arrhythmias and atrial fibrillation is the most common form of arrhythmia. Supraventricular arrhythmia can cause shortness of breath, heart palpitations, chest tightness, and a very fast pulse, but is not usually life-threatening. There are two types of ventricular arrhythmias and ventricular fibrillation is the most serious. It is due to uncontrolled heartbeat causing the heart muscle to quiver instead of contracting so that it can no longer pump blood to the rest of the body and can cause heart attack or result in cardiac arrest. Ventricular tachycardia is a rapid heartbeat due to loss of normal heart pacemaker function and this compromises the supply of blood and therefore, oxygen to the heart itself and the rest of the body. This increases the workload on the heart and results in severe shortness of breath, dizziness, or fainting (syncope), but is not usually life-threatening. Sotalol tablets 80mg help restore the heart’s normal rhythm and prevent irregular heartbeat.

How does Sotalol work?

Sotalol tablets 80mg contain sotalol, which is a non-selective beta-adrenergic receptor blocker without sympathomimetic activity or membrane stabilising activity. Sotalol in Sotalol tablets 80mg binds to beta receptors that are found in vascular smooth muscle in blood vessel walls and several organs of the body, including the heart lungs and kidney, which blocks the action of chemicals called catecholamines, such as adrenaline (epinephrine) and noradrenaline (nor epinephrine), which are released by the adrenal glands in response to nerve stimulation during physical and mental stress. Adrenaline binds to beta-receptors in the heart to stimulate increased heart rate and constriction (narrowing) of blood vessels. These actions of adrenaline are reduced or inhibited by sotalol in Sotalol tablets 80mg, causing a decrease in heart rate and a reduction in the force of contraction of the heart; also widening of blood vessels, which increases blood flow and oxygen to the heart. Sotalol in Sotalol tablets 80mg also has class III antiarrhythmic activity and interacts with the area of the heart muscle that controls the rate of the heartbeat known as the atrioventricular (AV) node. The AV node sets the rhythm for contraction of the heart that forces blood from the atria or upper chambers to the ventricles or lower chambers of the heart and slows the transmission of current from the atria to the ventricles, to ensure that the atria fill up with blood fully before the next contraction. Sotalol in Sotalol tablets 80mg works by reducing the speed of conduction and increasing the refractory period of the AV node, which lengthens the gap between one heart beat and the next and slows down the heart rate while restoring a regular pace. The action potential, which drives the heart muscle contraction is based on myocardial (heart muscle) depolarisation and repolarisation, which is when sodium and potassium ions build up on one side of the membrane and are then released through special voltage-gated ion channels, causing a rapid rise and fall of membrane potential (the difference in electrical potential between the inside and the outside of the heart muscle cells). Sotalol in Sotalol tablets 80mg is classified as a class III antiarrhythmic, because it works by blocking potassium channels in the myocardial cells, which delays or prolongs repolarisation, increases the duration of the action potential and thereby increases the refractory period. This causes lengthening of the QTc interval on electrocardiographic recordings, which represents depolarisation and depolarisation of the ventricles This action of Sotalol in Sotalol tablets 80mg slows down a fast heartbeat and restores the heart’s normal rhythm.

What does Sotalol contain?

Sotalol tablets contains the active ingredient sotalol 80mg, a non-selective beta- blocker with class III antiarrhythmic activity, that is used to treat and prevent supraventricular and ventricular arrhythmia. They also contain calcium hydrogen phosphate anhydrous, maize starch, povidone, sodium starch glycollate, purified talc and magnesium stearate.

Treating arrhythmia with Sotalol

Sotalol tablets 80mg contain sotalol, a non-selective beta-adrenergic receptor blocker with class III antiarrhythmic activity that is used to treat and prevent arrhythmia, which is abnormal or irregular heart beat, particularly supraventricular and ventricular arrhythmias. Arrhythmia refers to any change from the normal sequence of electrical impulses that controls the heart’s normal rhythm, causing abnormal heart rhythms. They include atrial and ventricle arrhythmias and atrial fibrillation is the most common form of arrhythmia. Supraventricular arrhythmia can cause shortness of breath, heart palpitations, chest tightness, and a very fast pulse, but is not usually life-threatening. There are two types of ventricular arrhythmias and ventricular fibrillation is the most serious. It is due to uncontrolled heartbeat causing the heart muscle to quiver instead of contracting so that it can no longer pump blood to the rest of the body and can cause heart attack or result in cardiac arrest. Ventricular tachycardia is a rapid heartbeat due to loss of normal heart pacemaker function and this compromises the supply of blood and therefore, oxygen to the heart itself and the rest of the body. This increases the workload on the heart and results in severe shortness of breath, dizziness, or fainting (syncope), but is not usually life-threatening. Sotalol in Sotalol tablets 80mg has two mechanisms of action to control arrhythmias. As a beta blocker, it blocks the action of chemicals called catecholamines, such as adrenaline (epinephrine) and noradrenaline (nor epinephrine), which stimulate increased heart rate and constriction (narrowing) of blood vessels. This action of sotalol causes a decrease in heart rate and a reduction in the force of contraction of the heart; also widening of blood vessels, which increases blood flow and oxygen to the heart. As a class III antiarrhythmic, Sotalol in Sotalol tablets 80mg acts works by blocking potassium channels in the myocardial cells of the heart, which delays or prolongs repolarisation, increases the duration of the action potential, which drives the heartbeat and thereby increases the refractory period. This slows down a fast heartbeat and restores the heart’s normal rhythm.

What are the side effects of Sotalol?

The most commonly reported side effects when taking Sotalol tablets 80mg include dyspnoea (shortness of breath), fatigue, dizziness, headache, fever, bradycardia (slow heartbeat), hypotension (low blood pressure), cold extremities, chest pain, palpitations, oedema, rash, mood changes, anxiety, depression, sexual dysfunction, visual and hearing disturbances, taste changes, paraesthesia (tingling).

When should Sotalol not be used?

You should not use Sotalol tablets 80mg if you:

are allergic to sotalol or any ingredients in Sotalol
are pregnant or are breastfeeding
have kidney disease
suffer from bronchospasm, including bronchial asthma or chronic obstructive airway disease; also allergic disorders (including allergic rhinitis) which may predispose to bronchospasm
have right ventricular failure secondary to pulmonary hypertension
have certain other heart conditions such as uncontrolled heart failure or an enlarged heart
have sinus bradycardia (a very low heartbeat of less than 45-50 beats/minute)
are in shock due to low blood volume (hypovolaemic) or inadequate pumping of the heart (cardiogenic)
have congenital or acquired long QT syndromes.
have AV block or sick sinus syndrome (unless pacemaker in situ)
are taking medicines that interact with Sotalol, including calcium channel blockers like verapamil or diltiazem for hypertension, angina or other heart conditions; insulin or other oral diabetes medications; anaesthetics like chloroform and cyclopropane; beta agonists such a salbutamol and terbutaline for bronchospasm and isoprenaline for bradycardia; catecholamine-depleting agents like reserpine the antipsychotic and guanethidine the antihypertensive; clonidine for hypertension; certain other medicines used to treat arrhythmias, such as quinidine, disopyramide, flecainide, mexiletine and amiodarone; potassium depleting diuretics; digoxin for heart failure; alcohol; tricyclic antidepressants; the antihistamines terfenadine and astemizole for allergy

What medications interact with Sotalol?

Several medications interact with Sotalol tablets 80mg and should either not be taken while you are taking Sotalol or only after discussion and instruction from your doctor:

Drugs that cause a serious reaction with Sotalol: calcium channel blockers like verapamil or diltiazem for hypertension, angina or other heart conditions, anaesthetics like chloroform and cyclopropane, catecholamine-depleting agents like reserpine the antipsychotic and antihypertensive and guanethidine the antihypertensive, clonidine for hypertension, certain other medicines used to treat arrhythmias, such as quinidine, disopyramide, flecainide, mexiletine and amiodarone, potassium depleting diuretics, tricyclic antidepressants, the antihistamines terfenadine and astemizole for allergy, may prolong theQT interval
Drugs that affect Sotalol: alcohol
Drugs that are affected by Sotalol: insulin or other oral diabetes medications, digoxin for heart failure

How should Sotalol be taken?

You should take your Sotalol tablets 80mg swallowed whole with a glass of water twice daily and 1-2 hours before meals. The dose you take depends on you doctor’s recommendations and what you are being treated for and your dose may be increased gradually over a few days. You should continue to take your Sotalol tablets 80mg regularly for as long as recommend by your doctor and may be for long term.

How long should you take Sotalol?

You should continue to take your Sotalol tablets 80mg regularly for as long as recommend by your doctor and may be for long term.

Missed dose of Sotalol

If you miss a dose of Sotalol tablets 80mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose. Do not take a double dose.

How should Sotalol be stored?

You should store your Sotalol below 25°C in a cool dry place.

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