Leigongteng belongs to the traditional Chinese medicine, has anti-inflammatory, immune suppressing, vasodilating, improving microcirculation and hormone-like effects, and has been used since 1981 for the treatment of rheumatic immune diseases such as systemic lupus erythematosus and rheumatoid arthritis. Its efficacy and advantages are there, especially in reducing proteinuria in lupus, relieving joint pain in rheumatoid arthritis, and no hormone-induced side effects of round face and fat body, and it is not expensive. But the side effects really should not be ignored. Ma Wukai, Department of Rheumatology and Immunology, Second Affiliated Hospital of Guiyang Traditional Chinese Medicine
In addition to the common adverse effects of drugs such as gastrointestinal discomfort, leukopenia, liver function damage and weakened bone density, there are also effects on reproductive organs that deserve the most attention, which can cause menstrual irregularities, menopause and amenorrhea and male sexual dysfunction. It has been reported that up to 65% of female patients who have used Radix Polygoni have menstrual disorders or amenorrhea, and when the total amount reaches 8000 mg, the incidence of amenorrhea reaches 95%. In the past, it was thought that 60%-70% of patients recovered spontaneously, but the natural recovery rate was not as high for those with high total doses, high age and long duration of use.
The mechanism by which tretinoin causes amenorrhea is that it acts on the ovaries, causing ovarian hypofunction and failure, and a decrease in ovarian secretion of estrogen, which feeds back to the pituitary gland causing hypersecretion of follicle-stimulating hormone and luteinizing hormone, producing amenorrhea. The problem of amenorrhea is not only the inability to have children, but also a series of other problems, such as the loss of protection of the cardiovascular, motor and nervous systems, the gradual loss of youthful beauty and the aging process of the body. How to use it rationally in patients with rheumatic immune diseases?
1, choose the right patient, the minimum effective dose and good dosage form: in general, young people who desire to have children try not to use it, indeed older, close to the onset of menopause age, early menopause 1-2 years not yet unavailable to patients can be considered for use, use the minimum effective amount, try to use some dosage forms with few side effects such as Leigongteng double-layer tablets, compound preparations (such as tricolor tablets, triton syrup, triton tablets), etc. Additional facts show that Leigengtengoside is no better than cyclophosphamide in treating lupus (especially IV lupus nephritis) and no better than methotrexate and leflunomide in treating rheumatoid arthritis, and is only used as a substitute for other cytotoxic drugs. 2. Carefully observe the side effects: discontinue the drug as soon as menstrual disorders occur or symptoms of perimenopause appear, such as hot flashes, insomnia, palpitations and agitation. However, some patients have no aura of short periods and low volume before menopause, so a more accurate method is to regularly measure whether follicle-stimulating hormone levels in the blood are increased, which can detect damage to the ovaries early. 3. Replace other cytotoxic drugs: you can replace them with cyclosporine, azelaic acid and primaquine, but do not interchange them with cyclophosphamide. Cyclophosphamide also has ovarian toxic effects and is related to the age of the patient and the total amount of the drug. The older the patient is when using cyclophosphamide, the greater the likelihood of amenorrhea, up to 62% in those over 31 years of age, and the likelihood of amenorrhea is significantly higher when the total amount exceeds 25 grams. Relatively speaking, rehmannoside is more toxic to the ovaries of young people, while cyclophosphamide-induced amenorrhea seems to be more difficult to recover from, and interchangeable or combined use is very dangerous. 4. Estrogen and progestin therapy: If the person does not recover after 3 months of discontinuation, estrogen and progestin replacement therapy can be administered for 6 months, preferably under the close observation of a gynecologist. However, it is worth noting that the use of estrogen-containing drugs in lupus patients is likely to cause the disease to recur, while progestins rarely cause the disease to recur, so it is better to choose progestin-containing drugs for treatment.
In fact, among the above methods, the best is to stop the medication in time and observe it closely.