Lexapro® (LEX-a-pro) Escitalopram oxalate (ES-sigh-talo-pram OX-a-late) Consumer Medicine Information (CMI) What is in this leaflet Before you take it When you must not take it Do not take Lexapro if you are allergic to it, to any medicine containing citalopram, or any of the ingredients listed at the end of this leaflet. If you have any concerns about usi
Advantag of ingestion administration way is its easiness even when applied at home. But with their help necessary treatment concentration in blood cannot be always quickly achieve amoxil online transaction is carried out on anonymity and mutual profit principles, and in addition customers will be positively surprised with quality and speed of service.
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O THE EDITOR: A 46-year-old woman with estrogen receptor–
positive breast cancer presented to us with impressive “youth enhanc- ing results” after 4 weeks of daily application of a commercially available skin moisturizer after bathing.
We were concerned about the possible presence of estrogenically active substances in the cream, despite the absence of any mention in the ingredient list. A sample similar to the patient’s cream along with samples of other commercially available moisturizers that were ob- tained from department stores and pharmacies were sent for measure- ment of estradiol, estrone, and estriol.
Products were selected based on their claims of “rejuvenating” or “youth enchancing” capabilities. The price for the moisturizers ranged from a high of several hundred dollars to a low of 10 dollars perunit. None of the ingredient lists contained any mention of an estro- using estradiol vaginal tablets while on aromatase inhibitors. They gen or estrogenic molecules. Unopened samples were mailed to Ana- advised caution when using these products concurrently. The extent lytic Research Laboratories (Oklahoma City, OK). Each of the 16 to which chemicals applied to the skin are absorbed is unknown.
products was tested for estradiol, estriol, and estrone.
Darbre3 notes personal care products are left on the skin, allowing for High performance liquid chromatography analysis equipped absorption through the dermis, with the net result of a chemical with ultraviolet detection was used to provide component analysis.
deposition in underlying local tissues. Donovan et al4 documented Four samples contained more than 0.40% estriol, one contained multiple cases of clinical effects from topically absorbed hormone 0.17% estriol, and one contained 0.05% estrone. A summary of the products. Harvey and Everett5 emphasized that human exposure to increasingly sophisticated cosmetic formulations is largely regulated This testing was only a screening process. Levels of estadiol, by the manufacturers. Reviewing Chadwick et al,6 Cheibowski et al,7 estrone, and estriol were documented only above 0.05%. For refer- Harvey et al,8 and Mai et al9 may provide helpful background infor- ence, Estrace vaginal cream produced by Warner Chilcott is 0.01% mation, raise related questions, and suggest additional complemen- estradiol. Testing was done only for the three estrogens noted. No designer estrogens, estrogen-like molecules, or progesterones were We believe that women, especially patients with a history of evaluated. These samples were obtained in April 2007, and since cos- breast cancer, should be able to understand the potential risks when metic companies frequently change their formulations, contents of exposed to estrogenically active molecules in commercially available each product may not currently be similar to those obtained at that topical moisturizers. Because our testing methodology was only in- time. It is our belief that the release of the brand names may tended as a screening process, we strongly encourage the scientific community and the US Food and Drug Administration to repeat Cosmetic laws are based on an outdated concept that an intact and expand on the results of these screening tests.
skin is a barrier to topically applied substances. Manufacturers ofcosmetics (including moisturizers) are relied on to ensure the safety of Adrienne C. Olson
their products and to provide accurate ingredient labels. No govern- ment agency (ie, the US Food and Drug Administration) tests these John S. Link and James R. Waisman
products unless a problem is reported.
Daily application of topical “youth enhancing” moisturizers con- Thomas C. Kupiec
taining estrogen or estrognically active compounds could theoretically Analytical Research Laboratories, Oklahoma City, OK be a risk to women with breast cancer, particularly those with estrogen ACKNOWLEDGMENT
receptor–positive breast cancers who take aromatase inhibitors.
Supported by a donation from Lawrence H. and Adrienne C. Olson.
Komori et al1 described a 93-year-old patient with a history of Presented in part as a poster at the San Antonio Breast Cancer extensive topical use of an estradiol-containing cream. She pre- Symposium, San Antonio, TX, December 10-14, 2008.
sented with a hyperplastic uterus as large as an adult menstruatingfemale, and also with invasive breast cancer. Kendall et al2 docu- AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
mented short-term elevation of systemic estradiol levels in patients The author(s) indicated no potential conflicts of interest.
Journal of Clinical Oncology, Vol 27, No 26 (September 10), 2009: pp e103-e104 2009 by American Society of Clinical Oncology Downloaded from jco.ascopubs.org on September 22, 2010. For personal use only. No other uses without permission.
Copyright 2009 American Society of Clinical Oncology. All rights reserved.
6. Chadwick LR, Pauli GF, Farnsworth NR: The pharmacognosy of Humulus
1. Komori S, Ito Y, Nakamura Y, et al: A long-term user of cosmetic cream
Lupulus L (hops) with an emphasis on estrogenic properties. Phytomedicine containing estrogen developed breast cancer and endometrial hyperplasia.
7. Chlebowski RT, Hendrix SL, Langer RD, et al: Influence of estrogen plus
2. Kendall A, Dowsett M, Folkerd E, et al: Caution: Vaginal estradiol appears to
progestin on breast cancer and mammography in healthy postmenopausal be contraindicated in postmenopausal women on adjuvant aromatase inhibitors.
8. Harvey PW, Darbre P: Endocrine disrupters and human health: Could
3. Darbre PD: Environmental oestrogens, cosmetics and breast cancer. Best
oestrogenic chemicals in body care cosmetics adversely affect breast cancer Pract Res Clin Endocrinol Metab 20:121-143, 2006 incidence in women? J App Toxicol 24:167-176, 2004 4. Donovan M, Tiwary C, Axelrod D, et al: Personal care products that contain
9. Mai Z, Blackburn GL, Zhou J: Soy phytochemicals synergistically enhance
estrogens or xenoestrogens may increase breast cancer risk. Med Hypotheses the preventive effect of tamoxifen on the growth of estrogen dependent human breast carcinoma in mice. Carcinogenesis 28:1217-1223, 2007 5. Harvey PW, Everett DJ: Regulation of endocrine-disrupting chemicals:
Critical overview and deficiencies in toxicology and risk assessment for human DOI: 10.1200/JCO.2009.23.1225; published online ahead of print at health. Best Pract Res Clin Endocrinol Metab 20:145-165, 2006 2009 by American Society of Clinical Oncology Downloaded from jco.ascopubs.org on September 22, 2010. For personal use only. No other uses without permission.
Copyright 2009 American Society of Clinical Oncology. All rights reserved.
BMJ 2012;344:e2232 doi: 10.1136/bmj.e2232 (Published 22 March 2012) EDITOR'S CHOICE Will doctors now take a lead on climate change? Fiona Godlee editor, BMJ Last week was Climate Week in the UK, featuring a host ofon the political agenda when the problems of the global economyawareness raising activities across the country. And nextare so pressing. The question is, can we find a new e