MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

Léčiva off-label

Aromatase inhibitors

Some studies

  • Block the production of estrogen
    • Anastrozole and letrozole, to reduce the symptoms of lipoedema
  • More research is needed to determine the effectiveness of this approach.


Beta-adrenergic agonist

Kazuistika 1

Terbutaline sulfate - 5 mg 5x denně + Theophylline - 200 mg 2x denně



B2-Adrenergic Agonist

  • In case of intact lipolytic response of the MSL fat to catecholamines
    • Oral beta 2- AR specific drug

Salbutamol


Chemotherapy

Methotrexate + infliximab

  • A patient with DD had improved pain and growth of DD SAT slowed

Paclitaxel and carboplatin (unpublished)



Corticosteroid injections

  • Suggested as treatment for lipomatosis such as MSL SAT
    • There are a number of cases demonstrating the development of lipomatosis after steroid use
      • Asi jako dĹŻsledek vysazenĂ­ a vzniku následnĂ©ho deficitu kortikoidĹŻ ?

Dafagliflozin - Forxiga

  • Jedna úspěšná kazuistika začínajícího lipedemu s vymizením pocitů bolestí, otoků a napětí v nohách po požití dafafliflozinu (Forxiga)
    • Glykosurika
  • Nicméně pacientka má zároveň i padání vlasů a to se terapií nezlepšilo
    • Vnímám to tak, že jsme úspěšně zasáhli jeden ze symptomů, nikoliv však skutečnou příčinu toho, proč ji není v těle dobře a proč nohy "prozánětlivě prosakují" a vlasy padají
  • V úvahu z kořenových příčín nemocí připadají: deficit, intoxikace (i intolerance), infekce (i dysmikrobie) a kombinace (autoimunity aj.)
    • k. močová, glukoza, fruktoza a alkohol samozřejmě tento (a snad jakýkoliv jiný stav) mohou zhoršovat, takže glykosurika mohou citelně pomáhat, ale bude to jenom část příčin

Potlačení estrogenní dominance





Fibric acid

  • A man with MSL Type II with a past history of hypertriglyceridemia

Fenofibrate 200mg daily

  • Circumference of his abdomen decreased 119 cm (46.9 in) to 108 cm (42.7 in) within a year
  • Fibric acids are PPARgamma agonists
  • Activation of the PPARgamma receptor may suppress expression of proteins involved in the architecture of BAT
    • Thereby maintaining BAT in a quiescent state
  • www.ncbi.nlm.nih.gov/pmc/articles/PMC4010336/

Growth hormone (GH)

  • Suggested in the community of individuals with MSL (personal communication)
  • But GH levels were normal in one subject with MSL during a glucose tolerance test
  • In three other subjects suggesting a normal GH axis
  • Testing for GH deficiency should be undertaken
    • Replacement considered only for those deficient in this hormone.
  • www.ncbi.nlm.nih.gov/pmc/articles/PMC4010336/

GLP-1 agonists

  • Using these medications should NOT delay surgical treatment and conservative therapies for lipedema.
  • Injectable GLP-1 agonist drugs
    • Had a role in helping the lipedema patients adhere to a lipedema specific diet (Lymphedema andLipedema Nutrition Guide)

Study conducted found


Glucagon-like peptide-1 agonist - Exenatide


Guaifenesin - Mucinex©

  • Over-the-counter expectorant to treat the common cold,
  • May help reduce lipedema swelling and inflammation
  • There are abundant reports from clinicians and lipedema patients stating that Guaifenisn helps lipedema. - Guaifenisn being used for pain relief to treat other diseases
  • Modest but significant analgesic and anti-inflammatory effects in neck and back pain
  • Guaifenesin may be working as a muscle relaxant effect that occurs in these conditions
  • May help pain or it may work as an expectorant in lipedema tissue and thin out extracellular proteins.
  • There are no studies to support these theories in lipedema.
  • Guaifenesin is approved for safe use at 600 mg twice a day (or 1,200 mg twice a day)
    • For no more than 2,400 mg per day
  • Mucinex for other medical conditions report it takes a least a week to see effects
  • Try this medication for Lipedema for two weeks to see if they notice any positive changes in addition to their consistent treatment plans including compression, supplements, and a healthy diet as prescribed
  • May not be suitable for people with a persistent cough due to asthma, bronchitis, emphysema, or smoking, or who have a cough that is producing excessive amounts of phlegm
  • www.lipedema.net/medication-for-lipedema.html


HIV-associated lipodystrophy treatment

  • And highly active antiretroviral treatment (HAART)-associated lipodystrophy
  • Associated with insulin resistance
    • In HIV+ men
    • Intermuscular fat and SAT on the legs in HIV+ women
  • Large breasts
    • Part of HIV lipodystrophy in Black women and other non-Caucasian ethnicities
  • Women with HIV may also develop increased SAT on the upper part of the arm
    • Out of context with the usual lipoatrophy in this area in HIV+ men
    • V.s. estrogen and/or progesterone component to location of the SAT

Excision of excess SAT

Tesamorelin

  • Synthetic analogue of human growth hormone-releasing hormone
  • FDA-approved for the reduction of excess visceral adipose tissue in HIV-infected patients with lipodystrophy
  • Visceral adipose tissue was reduced up to 18% during active use of tesamorelin

Glucagon-like peptide-1 agonist, exenetide

Ketoprofen

  • Non-steroidal anti-inflammatory drug (NSAID)
  • Commonly used to relieve pain, inflammation and swelling

Some studies

  • To reduce the symptoms of lipoedema
  • More research is needed to determine its effectiveness in this context.

Ketotifen

  • Antihistamine drug
  • Anti-inflammatory properties

Some studies

  • Ketotifen to reduce the symptoms of lipoedema
  • More research is needed to determine its effectiveness in this context.
  • Silné sedativní uspávací vlastnosti, silně proti svědění, tak max. na noc


Pain Control




GLP-1 Agonists

  • Dulaglutide (Trulicity) (weekly)
  • Exenatide extended release (Bydureon bcise) (weekly)
  • Exenatide (Byetta) (twice daily)
  • Semaglutide (Ozempic) (weekly)
  • Liraglutide (Victoza, Saxenda) (daily)
  • Should not be used in lieu of surgical or conservative intervention.
  • Aids in patient compliance with anti-inflammatory diets
  • Anti-inflammatory properties
  • Helps to reduce non lipedema affected adipose tissue, improving overall health

Oral Anti Diabetic Drug

  • Metformin 1g. 2x/day Inhibits fibrosis in fat tissue and can reverse some fibrosis

Sympathomimetic amines



Lidocaine i.v.



Metformin


Metformin

  • Treat type 2 diabetes
  • Improve insulin sensitivity and reduce the size of fat cells in preclinical studies.


Mexilitene



Pregabalin



Propranolol

  • A beta-blocker drug
  • Reduce the size of fat cells in preclinical studies.

Rosiglitazone

  • A drug that belongs to the class of thiazolidinediones
  • Improve insulin sensitivity
  • Shown to reduce the size of fat cells in preclinical studies.

Selective estrogen receptor modulators (SERMs)

Some studies

  • Use of drugs that target specific estrogen receptors, such as raloxifene and tamoxifen
  • More research is needed to determine the effectiveness of this approach.

SGLT2 inhibitors

  • Reduce body weight, body fat and improve insulin sensitivity
  • May be beneficial in treating lipoedema
  • More research is needed to determine the effectiveness of SGLT2 inhibitors in treating lipoedema

Hormonal testing for thyroid function , pituitary hormones



Sympathomimetika


Tetracyclines

  • Antibiotics that have anti-inflammatory properties
  • Shown to reduce the size of fat cells in preclinical studies.

Doxycycline

  • A tetracycline antibiotic
  • Reduce the size of fat cells in preclinical studies.

Doxyhexal - doxycycline

  • Type of antibiotic that is commonly used to treat a wide range of bacterial infections

Some studies - suggested that doxycycline may have anti-inflammatory properties

    • May be beneficial for managing the symptoms of lipoedema.

Journal of Lipoedema

  • Women with lipoedema who took doxycycline for six months
  • Had a significant reduction in the size of their affected limbs
  • Reduction in pain and discomfort.

Another study published in the Journal of Lipoedema

  • Doxycycline had a significant effect on the reduction of pain and stiffness in women with lipoedema.
  • More research is needed
O úroveň výše

Poslední aktualizace: 6. 10. 2024 22:43:26