Vaginal Cream: Uses, Types, and How to Apply
FDA Approves Likmez Metronidazole Oral Suspension
The Food and Drug Administration (FDA) has approved Likmez™, a ready-to-use liquid suspension formulation of metronidazole.
Likmez oral suspension is supplied in a 200mL bottle containing 500mg/5mL of metronidazole in a strawberry peppermint flavor. The product does not require refrigeration.
Likmez is indicated for the treatment of:
"Difficulty swallowing tablets and capsules should not be a barrier to accessing appropriate antibiotic therapy," said Don Cilla, PharmD, MBA, Appili's President and CEO. "Likmez provides a convenient alternative for patients who have difficulty taking solid oral medicines."
References:
Appili Therapeutics announces US FDA approval of Likmez™ (ATI-1501) Metronidazole Oral Suspension. News release. Appili Therapeutics. September 25, 2023. Accessed September 26, 2023. Https://www.Businesswire.Com/news/home/20230925938803/en/Appili-Therapeutics-Announces-U.S.-FDA-Approval-of-LIKMEZ%E2%84%A2-ATI-1501-Metronidazole-Oral-Suspension.
Boric Acid Suppositories: Uses, Side Effects And Risks
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Having an imbalance of bacteria present in the vagina can cause an array of uncomfortable symptoms, such as intense itching and irritation. For the millions of people who experience these common conditions every year, quick treatment and relief from symptoms is often top of mind.
Boric acid suppositories are a possible treatment option for yeast infections and bacterial vaginosis. They are available over-the-counter or may be recommended by your health care provider for recurrent vaginal infections or when antibiotics aren't effectively treating your infections.
Read on to learn more about boric acid suppositories, how they're used, potential risk factors and side effects.
What Are Boric Acid Suppositories?"Boric acid suppositories are vaginal suppositories that are used for the treatment of resistant yeast infections and recurrent bacterial vaginosis," explains Jill Purdie, M.D., a board-certified OB-GYN and medical director at Pediatrix Medical Group in Atlanta.
Boric acid is an inorganic acid derived from the element boron. Boric acid is inserted into the vagina in suppository form to help redress acidity levels.
"A disruption in the vagina's naturally acidic environment can lead to infection from other organisms like yeast or bacteria that normally do not live in the vagina," explains Madeline Stark, M.D., an OB-GYN at RUSH in Chicago. Certain conditions impact the bacteria (lactobacillus) that's usually found in the vagina, leading to an imbalance, which in turn can cause a number of symptoms to occur. "Boric acid allows for 're-acidification' of the vagina, which promotes the naturally occurring bacteria (lactobacillus)," she explains.
Uses for Boric Acid SuppositoriesBoric acid may be recommended by a doctor for a number of reasons, including:
According to Dr. Stark, patients who have been diagnosed with VVC or BV may experience a number of symptoms, such as:
Some of these symptoms may be indicative of other health conditions, so it's crucial to consult with your doctor before taking any course of treatment.
Benefits of Boric Acid SuppositoriesWhile evidence regarding the efficacy of boric acid is limited, the suppositories are designed to rebalance the bacteria in the vagina during an infection. In particular, boric acid may be used as an alternative treatment when traditional treatments, such as topical antifungal treatments like clotrimazole or miconazole for VVC, or antibiotics like metronidazole for BV, haven't worked, Dr. Purdy explains.
"Boric acid suppositories offer many benefits for treating vaginal infections that do not respond to traditional antifungal or antibacterial treatments," says Dr. Purdy. "This makes them a great alternative solution for women dealing with persistent infections or resistant infections."
The accessibility of boric acid suppositories also makes them potentially beneficial to those experiencing VVC or BV, with Dr. Purdie noting the treatment is available online and over-the-counter, and that boric acid typically doesn't interact with other medications. "It is a non-antibiotic option," says Dr. Stark. "Studies report anywhere from a 40% to 100% cure rate for patients with yeast infections for whom the typical treatments failed ."
Risks of Boric Acid SuppositoriesBoric acid suppositories carry some risks, and individuals should take the following precautions:
Boric acid suppositories are generally well-tolerated, notes Dr. Stark, meaning that there are usually few side effects. Some side effects of boric acid suppositories include:
The dose required varies depending on your diagnosis and individual needs so it is important to consult a health care provider prior to starting boric acid on your own. "All individuals should consult with their provider prior to using boric acid suppositories to ensure they are using them for the correct problem and amount of time," emphasizes Dr. Purdie. The generally recommended dose of boric acid is as follows:
Boric acid suppositories are sometimes used as a preventative measure in individuals who are experiencing recurrent infections. "You can take it for a few days after exposure to the triggering event that often leads to infection," Dr. Stark explains. "Common triggers include your period, sex, exposure to excess moisture (such as summer time heat and intense exercise) and douching. Alternatively, you can use one suppository weekly for continuous suppression and prevention."
When to See a DoctorContact your doctor if you experience any uncomfortable side effects, such as redness, burning or worsening discharge while using boric acid suppositories.
"If vaginal irritation or itching occurs or symptoms worsen, individuals should consult their provider," says Dr. Purdie.
One Dose Of Psychedelic Psilocybin Reduced Depression Symptoms For 6 Weeks
In a Phase 2 clinical trial, study participants who had received just one dose of psilocybin had ... [+] significantly less severe depression symptoms than those receiving placebo 43 days into the trial (Photo by John Moore/Getty Images)
Getty ImagesCould psilocybin be on a trip to become a standard treatment for depression? Well, things are looking quite promising if you read the 'shroom correctly. The latest evidence comes from a Phase 2 clinical trial that studied the use of psilocybin to treat people with major depressive disorder. Study participants who had received just one dose of psilocybin had significantly less severe symptoms than those receiving placebo as long as 43 days into the trial, as described in a new publication in JAMA.
Now, just because psilocybin is the psychedelic substance found in magic mushrooms, doesn't mean that it simply acts via magic. Previous scientific studies have suggested that psilocybin can have a real effect on your brain by binding and activating serotonin 2A (5-HT2A) receptors there. Serotonin is a pretty important naturally-occurring neurotransmitter...That's if you think your mood, your thinking, your memory, and whether or not you vomit are important. Yes, you can thank serotonin levels at least to some degree the next time you vomit when thinking about your past significant others. By activating such serotonin receptors, psilocybin could actually help rewire the brain and increasing its interconnectedness and flexibility, as I have described previously for Forbes. And a more connected and flexible brain could be better than a disconnected and rigid brain.
Previous studies have also already suggested that psilocybin might be an effective treatment for depression. The key operative word here. Though, is "suggested" since these prior studies have had relatively small numbers of participants. They haven't really shown how long the beneficial effects of psilocybin may persist either. So, the long and short of it is that more studies have been needed.
Enter this latest trial—which was conducted from December 2019 through June 2022 across 11 different sites in the U.S. For this trial, the research team recruited 104 participants who had documented diagnoses of moderate-to-more severe major depressive disorder for at least 60 days. All of the participants were in the 21 to 65 year age range with an average age of 41.1 years and Half of the participants were women.
The research team then randomly assigned about half (51) of the participants to receive a single 25 mg dose of psilocybin and the rest (53) to receive a single 100 mg dose of niacin, a placebo. This was a double-blinded study, as neither the study personnel nor participants could tell who was receiving what during the trial. Hey even made the capsules to look identical so that one couldn't tell which was psilocybin and which was niacin until after the trials was completed. This wasn't done simply to confuse the heck out of everyone. It was important to do so to help make sure that people weren't reporting changes in symptoms simply because they believed that psilocybin would have an effect.
In addition to getting these treatments, participants also received psychological support. After all, no one should expect any pill to "magically" remove depression symptoms whether it is an anti-depressant medication manufactured by a pharmaceutical company or something like psilocybin. Treatment of depression should always include at least some form of counseling.
Pictured here are capsuled psilocybin mushrooms. (Photo by Hyoung Chang/The Denver Post)
Denver Post via Getty ImagesIn order to track what happened to the symptoms of depression, the researchers took MADRS into their own hands, so to speak. They used the Montgomery-Asberg Depression Rating Scale (MADRS) to measure the severity of the participants' depression symptoms at different points during the trial. In case it MADRS, this scale produces a score that can range from 0 to 60, the higher the score the more severe the depression. They also used the Sheehan Disability Scale to measure the impact of the depression symptoms.
Here's a re-cap of what the researchers found in this magic mushroom substance trial. Those in the psilocybin treatment group experienced greater drops in MADRS scores than those in the placebo group at the eight-day (on average 12 points greater) and 43-day mark (on average 12.3 points greater). The psilocybin treatment group also had on average a 2.31 lower score on Sheehan Disability Scale baseline to day 43.
One caveat is that those in the psilocybin treatment group did appear to experience more adverse events. A significantly higher percentage (82%) of the people in the psilocybin group than those in the placebo group (44%) reporting having at least one treatment-related adverse event. Most of these were considered mild-to-moderate adverse events, though. Through Day 9, four of the 50 participants who had received psilocybin had reported serious adverse events: with one having a migraine, another having a headache, a third experiencing illusions, and a fourth suffering a panic attack and paranoia. By comparison, no one in the niacin placebo group reported any serious adverse events.
Consider all of this to be growing evidence that the stuff in magic mushrooms could potentially be an effective treatment for depression. Of course, this isn't the end of the trip to its approval as a treatment. More studies will be needed to determine the safety and efficacy of psilocybin over longer periods of time and across broader populations. But the results to date have been encouraging. There is certainly 'shroom for more depression treatments since existing medications have many potential drawbacks, including a range of side effects. So, this is a real opportunity to really break the mold, so to speak, when it comes to depression treatment.
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