← Dr. Chapa’s OBGYN Clinical Pearls 
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No one goes to Hank's for spreadsheets. They go for a darn good pizza. Lately, though, the shop's been quiet, so Hank decides to bring back the $1 slice. He asks Copilot in Microsoft Excel to look at his sales and costs and help him see if he can afford it. Copilot shows Hank where the money's going and which little extras make the dollar slice work. Now Hanks has a line out the door. Hank makes the pizza. Copilot handles the spreadsheets. Learn more@m365copilot.com work foreign.
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We're back with another very quick video segment on something that one of my former medical students, now OBGYN attending in the heartland of America, sent me that I thought was super interesting. I actually had not heard about this thing, but I looked it up, did a lot of research on it, and this is what I concluded. This has to do with the social media trend of combining a typical, very common over the counter anti histamine like Allegra, which is fexofenadine, with a separate medication used for ulcers like Pepcid. Now, they're both distinct medications, but they are related because the allergy medication is a histamine 1 blocker. Pepcid is an H2 blocker. Those both work on histamine receptors. Well, the social media trend says that by combining these two medications, an H1 and an H2 blocker, it can be remarkable in shutting off the symptoms of PMDD or even of depression. However, the problem is there's no clinical trial, there's no robust clinical evidence that says that's a thing. As always, a little bit of truth in social media gets blown out of proportion maybe ahead of time. Now it is true there is absolute histamine receptors in the BR and during PET scans you can actually see their change in activity in patients with depression. So histamine and the brain? Absolutely. And we know that estradiol and progesterone, the two main hormones in the menstrual cycle, absolutely. Affect mast cell degranulation and histamine release. That's why chronic pain patients have an increased amount of histamine in the body and sometimes addressing that with an antihistamine can help, like amitriptyline. However, the data for both of Those medications, an H1 and an H2 blocker helping PMDD, is just not there. There is, however, one medication that is completely separate and FDA approved to work on the brain as a histamine antagonist and reversed agonist. That's an H3 agent. Yep. That is wake I. That medication actually is an atypical anti histamine that works in the brain to paradoxically increase histamine levels. And it keeps people awake when they suffer from narcolepsy. Yeah, excessive daytime sleeping. So There is an H3 medication which works on the brain to increase histamine, but there's no data that it does anything for depression or pmdd. There's some very, very early lab studies that say maybe it could help, like in rats, but we're far from using that as mainstream. Now. I'm all for making people feel better, and if they happen to be on an allergy medication, they happen to be on Pepcid, I'll ask them, but I'm not going to be recommending that. As for us first line, because it's just without any evidence, the first line for PMDD remains an SSRI medication as well as combined estrogen and progesterone. Birth control or in severe cases, a GNRH agonist. But combining an antihistamine with an anti ulcer medicine to take away PMDD sounds great and I want it to work. We just don't have the evidence as of this time that it does anything. We're just trying to fulfill our life calling and our mission. This is Dr. Chapa's OBGYN no Spin podcast.