tag:blogger.com,1999:blog-1379882158469607859.post5266545860863274822..comments2022-02-21T12:29:42.897+09:00Comments on ピルとその周辺: 頭痛とピルAnonymoushttp://www.blogger.com/profile/15708490026898021442noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-1379882158469607859.post-27155095938664440112013-02-19T11:50:33.026+09:002013-02-19T11:50:33.026+09:00添付文書改正私案
絶対禁忌条項
●35歳以上の片頭痛の患者
[片頭痛の患者は、虚血性脳卒中が発生しや...添付文書改正私案<br />絶対禁忌条項<br />●35歳以上の片頭痛の患者<br />[片頭痛の患者は、虚血性脳卒中が発生しやすくなるとの報告がある.]<br />●前兆を伴う片頭痛の患者<br />[前兆を伴う片頭痛の患者は、虚血性脳卒中が発生しやすくなるとの報告がある.]<br />●局在性神経徴候を伴う頭痛のある患者<br />[髄膜腫の成長を促進するとの報告がある.]<br /><br />相対禁忌条項<br />●35歳未満の前兆を伴わない片頭痛の患者。ただし、頭痛の激化や頻度の増加が見られる場合は服用を中止させる。<br />[片頭痛の患者は、虚血性脳卒中が発生しやすくなるとの報告がある.]Anonymoushttps://www.blogger.com/profile/15708490026898021442noreply@blogger.comtag:blogger.com,1999:blog-1379882158469607859.post-31822902209649564232013-02-19T11:48:59.251+09:002013-02-19T11:48:59.251+09:00本文の画像は、WHOMEC第3版です。2009年には第4版が出ていますが、片頭痛の評価は変わっていま...本文の画像は、WHOMEC第3版です。2009年には第4版が出ていますが、片頭痛の評価は変わっていません。(Medical eligibility criteria for contraceptive use – 4th ed.2009.)<br />説明は以下のようになっています。<br /><br />Clarification: <br />Classification depends on accurate diagnosis of those severe headaches that are migrainous and those that are not.<br />Any new headaches or marked changes in headaches should be evaluated. Classification<br />is for women without any other risk factors for stroke. <br />Risk of stroke increases with age,hypertension and smoking.<br />解説:<br /><br />リスク分類は、片頭痛との正確な診断のついている重症頭痛についてです。<br />新たに頭痛が生じたり頭痛に顕著な変化のある場合には、評価が必要です。<br /><br />リスク分類は他のリスク要因のない女性の脳卒中リスクについてです。<br />脳卒中リスクは、年齢、高血圧、喫煙により増加します。<br /><br /><br />Evidence: <br />Among women with migraine,women who also had aura had a higher risk of stroke than those without aura.(267-269)<br />Women with a history of migraine who use COCs are about two to four times as likely to have an ischaemic stroke as non-users with a history of migraine. <br />(174;189;210;211;268-273)<br />エビデンス<br />片頭痛を有する女性の中でも、前兆を伴う片頭痛のある女性は、前兆を伴わない片頭痛の女性よりもより高い脳卒中リスクを有します。<br />片頭痛歴のあるピル服用者は、片頭痛歴のある非服用者と比較して、約2ないし4倍の虚血性脳卒中リスクを有するでしょう。<br /><br />(174) Gillum LA, Mamidipudi SK, Johnston SC. Ischaemic stroke risk with oral contraceptives: a meta-analysis. Journal of American Medical Association, 2000, 4:72-78.<br />(189) Schwartz SM, Petitti DB, Siscovick DS et al. Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke, 1998, 29:2277-2284.<br />(210) Lidegaard O. Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study. British Medical Journal, 1993, 306:956-963.<br />(211) Lidegaard O. Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease. British Journal of Obstetrics & Gynaecology, 1995, 102:153-159.<br />(267) Carolei A, Marini C, De Matteis G. History of migraine and risk of cerebral ischaemia in young adults. The Italian National Research Council Study Group on Stroke in the Young. Lancet, 1996, 347:1503-1506.<br />(268) Chang CL, Donaghy M, Poulter N. Migraine and stroke in young women: case-control study. The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. British Medical Journal, 1999, 318:13-18.<br />(269) Tzourio C, Tehindrazanarivelo A, Iglesias S et al. Case-control study of migraine and risk of ischaemic stroke in young women. British Medical Journal, 1995, 310:830-833.<br />(270) Oral contraceptives and stroke in young women. Associated risk factors. Journal of American Medical Association, 1975, 231:718-722.<br />(271) Etminan M, Takkouche B, Isorna FC et al. Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. British Medical Journal, 2005, 330:63.<br />(272) Lidegaard O. Oral contraceptives, pregnancy, and the risk of cerebral thromboembolism: the influence of diabetes, hypertension,migraine and previous thrombotic disease. (Letter). British Journal of Obstetrics & Gynaecology, 1996, 103:94.<br />(273) Nightingale AL, Farmer RD. Ischaemic stroke in young women: a nested case-control study using the UK General Practice Research Database. Stroke, 2004, 35:1574-1578.Anonymoushttps://www.blogger.com/profile/15708490026898021442noreply@blogger.com