Which adverse effects can be seen in a client who is taking danazol for endometriosis

Danazol works by altering the levels of some of your body's hormones. It is used to treat a number of different conditions.

Endometriosis is a condition where tissue that normally lines the inside of your womb (uterus) is found elsewhere in your body, often in the pelvic area or abdomen. It can cause painful periods and persistent pain in the pelvic area, as well as other symptoms. By altering the levels of your hormones, danazol will help to relieve these symptoms.

Danazol is also prescribed to ease severe pain and tenderness associated with breast cyst disease (where other treatments have proved unhelpful). Breast cysts are small lumps which are found in the breast, but which are not cancerous.

In addition to the two conditions above, danazol is also prescribed by specialist doctors for people with a condition known as hereditary angio-oedema (although it is not licensed for this condition). If you have been prescribed it for this reason, please speak with your doctor if you have any questions about your treatment.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking danazol it is important that your doctor knows:

• If you are pregnant, trying for a baby or breastfeeding.
• If you have a heart condition.
• If you have any vaginal bleeding other than your regular period.
• If you have ever had an unwanted blood clot (thrombosis), or stroke.
• If you have any of the following conditions: epilepsy, diabetes (diabetes mellitus), high blood pressure, migraine, or a blood fat (lipid) disorder.
• If you have any problems with the way your liver works, or any problems with the way your kidneys work.
• If you have either of the following blood disorders: polycythaemia or porphyria.
• If you know you have a type of cancer which is affected by hormones.
• If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
• If you have ever had an allergic reaction to a medicine.

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about danazol, and will also provide you with a full list of side-effects which you could experience from taking it.
• You should start taking danazol on the first day of your next period unless you have been told otherwise.
• Your doctor will tell you how many capsules to take each day, and when you should take them. As a guide, for the treatment of endometriosis or breast pain, danazol is usually taken 2-4 times daily for 3-6 months. Take the capsules exactly as your doctor tells you to. Your dose will be printed on the label of the pack to remind you about what the doctor said to you.
• Swallow the capsules whole with a drink of water - do not chew or open them before you swallow.
• You can take danazol capsules either before or after meals, but try to take your doses at the same times each day, as this will help you to remember to take them regularly.
• If you forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. Your doctor may want you to have some blood tests during this treatment.
• It is important that you do not become pregnant while you are on danazol. If appropriate, you and your partner should use a non-hormonal method of contraception, such as a condom. This is because hormonal methods (such as 'the pill' or 'mini pill') will not work. Speak with your doctor if you need further advice about what methods of contraception are suitable for you to use.
• It is best not to drink alcohol while you are on danazol. This is because drinking alcohol while taking danazol could make you feel sick or short of breath.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the ones associated with danazol. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: if you experience any of the following rare but possibly serious symptoms, please speak with your doctor straightaway:

• A severe headache and sickness (nausea and vomiting).
• Any yellowing of your skin or of the whites of your eyes (jaundice).
• Any painful swelling of your arms or legs, or sudden chest pain.
• Any bruising that you can't explain. This could be a sign of a blood disorder.

If you experience any other symptoms which you think may be due to the capsules, please speak with your doctor or pharmacist for further advice.

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

The incidence, pathogenesis, staging, and treatment of endometriosis are reviewed, with an emphasis on pharmacologic management of this condition. Endometriosis--the presence of ectopic endometrial tissue--can be found in 15-25% of infertile women and may be found in 1-5% of all women between menarche and menopause. Although the pathogenesis of endometriosis is uncertain, the most tenable etiologic theory is a combination of celomic metaplasia and retrograde menstruation. Staging is based on the American Fertility Society classification scheme, with stage I being the mildest and stage IV the most severe form of the disease. The management of endometriosis depends on the extent of the disease, the severity of the symptoms, the age of the patient, and the patient's desire for future fertility. Treatment modalities include expectant management, surgery, induction of a pseudopregnancy state with hormonal therapy (e.g., oral contraceptives), or induction of a pseudomenopausal state. The induction of a pseudomenopausal state with the use of oral danazol gained widespread favor in the 1970s as the treatment of choice in patients with endometriosis, but therapy is often associated with unpleasant adverse effects. Gonadotropin-releasing hormone (GnRH) agonists may provide a safe and clinically effective alternative to danazol therapy in patients with endometriosis. Results of a multicenter study comparing nafarelin with danazol for treatment of endometriosis indicated no significant differences between treatment groups with respect to improvements in disease state and symptomatology. The most common adverse effect associated with nafarelin therapy is hot flashes. The GnRH agonist nafarelin is as effective as danazol or oral contraceptives for the treatment of endometriosis and causes fewer adverse reactions. GnRH agonists may replace danazol as the treatment of choice in patients with endometriosis.

PIP: The medical management of endometriosis depends on the stage of the disease, the severity of symptoms, the age of the patient, and her future fertility intentions. The most widely utilized treatment modalities are expectant management, surgery, induction of a pseudopregnancy state with hormonal therapy, and induction of a pseudomenopausal state. Over 50% of women with mild endometriosis and 25% of those with moderate disease can conceive without surgical or pharmacologic intervention. Total hysterectomy or bilateral salpingo-oophorectomy represent the only curative form of treatment, but definitive surgery is recommended only in women who do not want to retain their reproductive function or in whom all previous medical and surgical efforts have failed. Pseudopregnancy therapy (administration of low-dose combined oral contraceptives or medroxyprogesterone acetate) eliminates cyclical changes in the endometrium and bleeding, but is associated with the side effects common to these agents and carries a 5-10% annual recurrence rate. During the 1970s, induction of a pseudomenopausal state through administration of oral danazol was the treatment of choice. In dosages of 100-800 mg day, danazol produces symptomatic improvement in 70-95% of patients and disease regression in 8595%; however, recurrence rates as high as 30-40% have been reported, and weight gains of 20-30 pounds are common. Recent studies have shown the gonadotropin releasing hormone agonist nafarelin to be as effective as danazol or combined oral contraceptives for the treatment of endometriosis. Hot flashes are the most common adverse effect, but are tolerated by the majority of patients. Nafarelin has the additional advantage of not requiring intramuscular injection or monthly office visits, but patients must be given detailed instructions about its intranasal administration.