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Inal A, Sezer Z, Uluözlü B, Oflas M, Reinsch M, Martin W, Mazicioglu MM, Koru SA. Bioequivalence study of low dose drospirenone/ethinyl estradiol 3 mg/0.03 mg film tablets under fasting conditions in Turkish healthy female subjects. Pharmacol Res Perspect 2024; 12:e1253. [PMID: 39044631 PMCID: PMC11266778 DOI: 10.1002/prp2.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/29/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024] Open
Abstract
This bioequivalence research aims to evaluate the relative bioavailability and pharmacokinetic characteristics of ethinyl estradiol and drospirenone in the test preparation in comparison to the reference preparation during fasting conditions. A liquid chromatography method with tandem mass spectrometry was used to determine the concentrations of drospirenone and ethinyl estradiol in plasma. The pharmacokinetic parameters that were analyzed were the maximum plasma concentration (Cmax), time to achieve Cmax (tmax), elimination half life, and area under the concentration time curve of plasma (AUC0-t, AUC0-∞ for ethinyl estradiol, and AUC0-72h for drospirenone). Both the AUC and Cmax parameters were determined to be between 80.00% and 125.00% (90% confidence intervals), which is the acceptable range. Based on the study findings, it was concluded that the test formulation, which includes 3 mg of drospirenone and 0.03 mg of ethinyl estradiol, demonstrated bioequivalence when compared to the reference formulation.
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Affiliation(s)
- Ahmet Inal
- Erciyes University Faculty of Medicine, Department of Pharmacology and Erciyes University Good Clinical Practice and Research CenterKayseriTurkey
| | - Zafer Sezer
- Erciyes University Faculty of Medicine, Department of Pharmacology and Erciyes University Good Clinical Practice and Research CenterKayseriTurkey
| | | | - Melih Oflas
- Biofarma İlaç Sanayi ve Ticaret A.ŞİstanbulTurkey
| | | | | | - Mümtaz M. Mazicioglu
- Erciyes University Faculty of Medicine, Department of Family Medicine and Erciyes University Good Clinical Practice and Research CenterKayseriTurkey
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Genazzani AR, Fidecicchi T, Arduini D, Giannini A, Simoncini T. Hormonal and natural contraceptives: a review on efficacy and risks of different methods for an informed choice. Gynecol Endocrinol 2023; 39:2247093. [PMID: 37599373 DOI: 10.1080/09513590.2023.2247093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
The debate about contraception has become increasingly important as more and more people seek safe and effective contraception. More than 1 billion women of reproductive age worldwide need a method of family planning, and wellbeing, socio-economic status, culture, religion and more influence the reasons why a woman may ask for contraception. Different contraceptive methods exist, ranging from 'natural methods' (fertility awareness-based methods - FABMs) to barrier methods and hormonal contraceptives (HCs). Each method works on a different principle, with different effectiveness.FABMs and HCs are usually pitted against each other, although it's difficult to really compare them. FABMs are a valid alternative for women who cannot or do not want to use hormone therapy, although they may have a high failure rate if not used appropriately and require specific training. HCs are commonly used to address various clinical situations, although concerns about their possible side effects are still widespread. However, many data show that the appropriate use of HC has a low rate of adverse events, mainly related to personal predisposition.The aim of this review is to summarize the information on the efficacy and safety of FABMs and HCs to help clinicians and women choose the best contraceptive method for their needs.
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Affiliation(s)
- Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tiziana Fidecicchi
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Arduini
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Alshabi A, Shaik IH, Zhao Y, Pillai VC, Caritis S, Venkataramanan R. A cocktail probe approach to evaluate the effect of hormones on the expression and activity of CYP enzymes in human hepatocytes with conditions simulating late stage of pregnancy. Eur J Clin Pharmacol 2023; 79:815-827. [PMID: 37060457 PMCID: PMC10105140 DOI: 10.1007/s00228-023-03489-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/28/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Pregnancy-mediated physiological and biochemical changes contribute to alterations in the pharmacokinetics of certain drugs. There is a paucity of data on the systematic evaluation of the underlying mechanisms. The objective of the current study was to examine the impact of changes in circulating and tissue hormonal concentration during the late stage of pregnancy on the activity and expression of hepatic cytochrome P450 (CYP) enzymes using a cocktail probe approach. METHODS Freshly isolated primary human hepatocytes were incubated with third trimester physiologic (plasma) and projected liver (ten-fold higher) concentrations of female hormones: progesterone (2 µM), estradiol (0.3 µM), estriol (0.8 µM), estrone (0.2 µM), 17α-hydroxyprogesterone (0.1 µM), and human growth hormone (0.005 µM). The metabolic activity of the hepatocytes was assessed using a cocktail of isozyme-specific P450 probe substrates (CYP1A2 (phenacetin), CYP2C9 (diclofenac), CYP2C19 (S-mephenytoin), CYP2D6 (dextromethorphan), and CYP3A4 (testosterone)). A validated LC-MS/MS assay was used to measure the corresponding metabolite concentrations. CYP450 protein and mRNA levels were measured using western blot and qRT-PCR, respectively. RESULTS Female hormones at projected third-semester hepatic concentrations significantly enhanced mRNA and protein expression and increased the metabolic activity of CYP3A4. The expression and activity of other CYP450 enzymes studied were not affected by mixtures of female hormones at concentrations used. CONCLUSION The increased activity of CYP3A4 is consistent with the clinically observed increase in clearance of CYP3A4 substrates during pregnancy. Overall expression and activity of CYP450 isozymes are differentially regulated during pregnancy.
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Affiliation(s)
- Ali Alshabi
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15261, USA
- Clinical Pharmacy Department, College of Pharmacy, Najran University, Najran, Saudi Arabia
| | - Imam H Shaik
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15261, USA
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15261, USA
| | - Yang Zhao
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15261, USA
| | - Venkateswaran C Pillai
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15261, USA
| | - Steve Caritis
- Department of Obstetrics and Gynecology, UPMC Magee Women's Hospital, Pittsburgh, PA, 15213, USA
| | - Raman Venkataramanan
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15261, USA.
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Lacasse JM, Gomez-Perales E, Brake WG. Modeling hormonal contraception in female rats: A framework for studies in behavioral neurobiology. Front Neuroendocrinol 2022; 67:101020. [PMID: 35952797 DOI: 10.1016/j.yfrne.2022.101020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022]
Abstract
Research on hormonal contraceptives (HC) in animal models is lacking, and as a result, so is our understanding of the impact of HC on the brain and behavior. Here, we provide a review of the pharmacology of HC, as well as the methodology and best practices for designing a model of HC in female rats. We outline specific methodological considerations regarding dosing, route of administration, exposure time/timing, and selecting a control group. We also provide a framework outlining important levels of analysis for thinking about the impact of HC on behavioral and neurobiological outcomes. The purpose of this review is to equip researchers with foundational knowledge, and some basic elements of experimental design for future studies investigating the impact of HC on the brain and behavior of female rats.
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Affiliation(s)
- Jesse M Lacasse
- Centre for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal H4B 1R6, Canada.
| | - Eamonn Gomez-Perales
- Centre for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal H4B 1R6, Canada
| | - Wayne G Brake
- Centre for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal H4B 1R6, Canada.
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Schoretsanitis G, Deligiannidis KM, Paulzen M, Spina E, de Leon J. Drug-drug interactions between psychotropic medications and oral contraceptives. Expert Opin Drug Metab Toxicol 2022; 18:395-411. [DOI: 10.1080/17425255.2022.2106214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York. USA
- Department of Psychiatry at the Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Kristina M. Deligiannidis
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York. USA
- Department of Psychiatry at the Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
- The Departments of Obstetrics & Gynecology and Molecular Medicine at the Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Michael Paulzen
- Alexianer Hospital Aachen, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA– Translational Brain Medicine, Aachen, Germany
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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Pasvol TJ, Bloom S, Segal AW, Rait G, Horsfall L. Use of contraceptives and risk of inflammatory bowel disease: a nested case-control study. Aliment Pharmacol Ther 2022; 55:318-326. [PMID: 34662440 PMCID: PMC7612921 DOI: 10.1111/apt.16647] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/28/2021] [Accepted: 10/02/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND How contraceptive formulation, dose, duration of therapy and mode of delivery affects the risk of inflammatory bowel disease (IBD) is poorly described. AIM To examine associations between types of hormonal contraception and development of IBD. METHODS This was a nested case-control study using IQVIA Medical Research Data. Women aged 15-49 years with a new diagnosis of IBD were matched with up to six controls by age, practice and year. Odds ratios (OR) and 95% confidence intervals (95% CI) for incident IBD and use of contraception were calculated. RESULTS 4932 incident cases of IBD were matched to 29 340 controls. Use of combined oral contraceptive pills (COCPs) was associated with the development of Crohn's disease and ulcerative colitis (OR 1.60 [1.41-1.82] and 1.30 [1.15-1.45], respectively). Each additional month of COCP exposure per year of follow-up increased risk of Crohn's disease by 6.4% (5.1%-7.7%) and ulcerative colitis by 3.3% (2.1%-4.4%). Progestogen-only pills had no effect on Crohn's disease risk (OR 1.09 [0.84-1.40]) but there was a modest association with ulcerative colitis (OR 1.35 [1.12-1.64]). Parenteral contraception was not associated with the development of Crohn's disease or ulcerative colitis (OR 1.15 [0.99-1.47] and 1.17 [0.98-1.39], respectively). CONCLUSIONS We observed an increase in the risk of IBD with increasing duration of exposure to COCPs. Progestogen-only pills were not associated with Crohn's disease but there was a modest association with ulcerative colitis. There was no association between parenteral progestogen-only contraception and IBD. These findings are broadly consistent with a hypothesis that the oestrogen component of contraception may drive IBD pathogenesis.
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Affiliation(s)
- Thomas Joshua Pasvol
- The Research Department of Primary Care and Population Health, University College London, London, UK
| | - Stuart Bloom
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Greta Rait
- The Research Department of Primary Care and Population Health, University College London, London, UK
| | - Laura Horsfall
- The Research Department of Primary Care and Population Health, University College London, London, UK
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Farris M, Bastianelli C, Rosato E, Brosens I, Benagiano G. Pharmacodynamics of combined estrogen-progestin oral contraceptives: 2. effects on hemostasis. Expert Rev Clin Pharmacol 2017; 10:1129-1144. [DOI: 10.1080/17512433.2017.1356718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Manuela Farris
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
- AIED, Rome, Italy
| | - Carlo Bastianelli
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Elena Rosato
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Ivo Brosens
- LIFE, Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Giuseppe Benagiano
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
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Kim H, Yu T, Cam-Etoz B, van Groen T, Hubbard WJ, Chaudry IH. Treatment of traumatic brain injury with 17α-ethinylestradiol-3-sulfate in a rat model. J Neurosurg 2017; 127:23-31. [DOI: 10.3171/2016.7.jns161263] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE17α-ethynylestradiol-3-sulfate (EE-3-SO4) is a highly water-soluble synthetic estrogen that has an extended half-life (∼ 10 hours) over that of naturally occurring estrogen (∼ 10 minutes). In this study, EE-3-SO4 was evaluated in a lateral fluid percussion–induced traumatic brain injury (TBI) model in rats.METHODSA total of 9 groups of Sprague-Dawley rats underwent craniectomy. Twenty-four hours later, lateral fluid percussion was applied to 6 groups of animals to induce TBI; the remaining 3 groups served as sham control groups. EE-3-SO4 (1 mg/kg body weight in 0.4 ml/kg body weight) or saline (vehicle control) was injected intravenously 1 hour after TBI; saline was injected in all sham animals. One day after EE-3-SO4/saline injection, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and partial brain oxygen pressure (PbtO2) were measured in Groups 1–3 (2 TBI groups and 1 sham group), and brain edema, diffusion axonal injury, and cerebral glycolysis were assessed in Groups 4–6 using MRI T2 mapping, diffusion tensor imaging (DTI), and FDG-PET imaging, respectively. Four days after dosing, the open-field anxiety of animals was assessed in Groups 7–9 by measuring the duration that each animal spent in the center area of an open chamber during 4 minutes of monitoring.RESULTSEE-3-SO4 significantly lowered ICP while raising CPP and PbtO2, compared with vehicle treatment in TBI-induced animals (p < 0.05). The mean size of cerebral edema of TBI animals treated with EE-3-SO4 was 25 ± 3 mm3 (mean ± SE), which was significantly smaller than that of vehicle-treated animals (67 ± 6 mm3, p < 0.001). Also, EE-3-SO4 treatment significantly increased the fractional anisotropy of the white matter in the ipsilateral side (p = 0.003) and cerebral glycolysis (p = 0.014). The mean duration that EE-3-SO4-treated animals spent in the center area was 12 ± 2 seconds, which was significantly longer than that of vehicle-treated animals (4 ± 1 seconds; p = 0.008) but not different from that of sham animals (11 ± 3 seconds; p > 0.05).CONCLUSIONSThese data support the clinical use of EE-3-SO4 for early TBI treatment.
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Affiliation(s)
| | | | - Betul Cam-Etoz
- 3Department of Physiology, Uludag University, Bursa, Turkey
| | - Thomas van Groen
- 4Developmental and Integrative Biology, University of Alabama at Birmingham, Alabama; and
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Development and Validation of an HPLC Method with Mass Spectrometric Detection for Quantitative Determination of Chlormadinone Acetate and Ethinyl Estradiol in Human Blood Plasma. Pharm Chem J 2017. [DOI: 10.1007/s11094-017-1573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Perreault M, Maltais R, Roy J, Dutour R, Poirier D. Design of a Mestranol 2-N-Piperazino-Substituted Derivative Showing Potent and Selective in vitro and in vivo Activities in MCF-7 Breast Cancer Models. ChemMedChem 2017; 12:177-182. [PMID: 28060448 DOI: 10.1002/cmdc.201600482] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/21/2016] [Indexed: 11/10/2022]
Abstract
Anticancer structure-activity relationship studies on aminosteroid (5α-androstane) derivatives have emerged with a promising lead candidate: RM-133 (2β-[1-(quinoline-2-carbonyl)pyrrolidine-2-carbonyl]-N-piperazine-5α-androstane-3α,17β-diol), which possesses high in vitro and in vivo activities against several cancer cells, and selectivity over normal cells. However, the relatively weak metabolic stability of RM-133 has been a drawback to its progression toward clinical trials. We investigated the replacement of the androstane backbone by a more stable mestranol moiety. The resulting compound, called RM-581 ({4-[17α-ethynyl-17β-hydroxy-3-methoxyestra-1,3,5(10)-trien-2-yl]piperazin-1-yl}[(2S)-1-(quinolin-2-ylcarbonyl)pyrrolidin-2-yl]methanone), was synthesized efficiently in only five steps from commercially available estrone. In comparison with RM-133, RM-581 was found to be twice as metabolically stable, retains potent cytotoxic activity in breast cancer MCF-7 cell culture, and fully blocks tumor growth in a mouse xenograft model of breast cancer. Advantageously, the selectivity over normal cells has been increased with this estrane version of RM-133. In fact, RM-581 showed a better selectivity index (15.3 vs. 3.0) for breast cancer MCF-7 cells over normal breast MCF-10A cells, and was found to be nontoxic toward primary human kidney proximal tubule cells at doses reaching 50 μm.
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Affiliation(s)
- Martin Perreault
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec-Research Center (CHUL, T4-42), 2705 Laurier Boulevard, Québec City, Québec, G1V 4G2, Canada
| | - René Maltais
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec-Research Center (CHUL, T4-42), 2705 Laurier Boulevard, Québec City, Québec, G1V 4G2, Canada
| | - Jenny Roy
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec-Research Center (CHUL, T4-42), 2705 Laurier Boulevard, Québec City, Québec, G1V 4G2, Canada
| | - Raphaël Dutour
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec-Research Center (CHUL, T4-42), 2705 Laurier Boulevard, Québec City, Québec, G1V 4G2, Canada
| | - Donald Poirier
- Laboratory of Medicinal Chemistry, Endocrinology and Nephrology Unit, CHU de Québec-Research Center (CHUL, T4-42), 2705 Laurier Boulevard, Québec City, Québec, G1V 4G2, Canada.,Department of Molecular Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
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Pharmacokinetic overview of ethinyl estradiol dose and bioavailability using two transdermal contraceptive systems and a standard combined oral contraceptive. Int J Clin Pharmacol Ther 2016; 52:1059-70. [PMID: 25295716 PMCID: PMC4285808 DOI: 10.5414/cp202064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/18/2022] Open
Abstract
Objective: To determine the relative bioavailability of ethinyl estradiol (EE) and gestodene (GSD) after application of a novel transdermal contraceptive patch vs. a standard combined oral contraceptive (COC) pill (study 1), and to evaluate the pharmacokinetics (PK) of EE after application of the EE/GSD patch compared with an EE/norelgestromin (NGMN) patch (study 2). Materials: Participants were healthy, non-obese women aged 18 – 45 years (study 1) or 18 – 35 years (study 2). Compositions of study treatments were as follows: 0.55 mg EE/2.1 mg GSD (EE/GSD patch); 0.02 mg EE/0.075 mg GSD (standard COC); 0.6 mg EE/6 mg NGMN (EE/NGMN patch). Methods: In study 1, which consisted of 3 treatment periods (each followed by 7 patch- or pill-free days), treatments were administered in one of two randomized orders: either P–M–E (EE/GSD patch (P) every 7 days for 28 days → COC (M) once-daily for 21 days → two 7-day patch-wearing periods followed by one 10-day patch-wearing phase (E)), or the same treatments administered in sequence M–P–E. For study 2, participants received either the EE/GSD patch or EE/NGMN patch for seven treatment cycles (one patch per week for 3 weeks followed by a 7-day patch-free interval). Results: In study 1, average daily exposure to EE was similar for treatments P and M; the mean daily area under the concentration-time curve (AUC) ratio of treatment P vs. treatment M for EE was 1.06 (90% confidence interval (CI): 0.964 – 1.16), indicating average daily delivery similar to oral administration of 0.019 – 0.023 mg EE. For unbound GSD, average daily exposure was lower for treatment P vs. treatment M. The mean AUC ratio of treatment P vs. treatment M for unbound GSD was 0.820 (90% CI: 0.760 – 0.885), indicating average daily delivery from the patch of 0.057 – 0.066 mg GSD. Prolonged patch wearing did not result in a distinct decline in GSD and EE serum concentrations. In study 2, AUC at steady state (AUC0–168,ss), average steady-state serum concentration, and maximum steady-state serum concentration for EE was 2.0 – 2.7-fold higher for the EE/NGMN patch vs. the EE/GSD patch. The EE/GSD patch was well tolerated in both studies. Conclusions: Based on the 90% CI of the AUC ratio of oral treatment vs. patch application for unbound GSD and EE, the daily doses of GSD and EE released from the EE/GSD patch over the 7-day application period provided the same systemic exposure as those recorded after daily oral administration of a COC containing 0.02 mg EE and 0.06 mg GSD. The EE/GSD patch showed reduced EE exposure compared with the EE/NGMN patch. Together with its good tolerability, these properties support the EE/GSD patch as an effective and well-tolerated alternative to available transdermal and oral contraceptives.
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Ho KL, Yau MS, Murphy MB, Wan Y, Fong BMW, Tam S, Giesy JP, Leung KSY, Lam MHW. Urinary bromophenol glucuronide and sulfate conjugates: Potential human exposure molecular markers for polybrominated diphenyl ethers. CHEMOSPHERE 2015; 133:6-12. [PMID: 25817024 DOI: 10.1016/j.chemosphere.2015.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/18/2015] [Accepted: 03/01/2015] [Indexed: 05/17/2023]
Abstract
One possible source of urinary bromophenol (BP) glucuronide and sulfate conjugates in mammalian animal models and humans is polybromodiphenyl ethers (PBDEs), a group of additive flame-retardants found ubiquitously in the environment. In order to study the correlation between levels of PBDEs in human blood plasma and those of the corresponding BP-conjugates in human urine, concentrations of 17 BDE congeners, 22 OH-BDE and 13 MeO-BDE metabolites, and 3 BPs in plasma collected from 100 voluntary donors in Hong Kong were measured by gas chromatograph tandem mass spectrometry (GC-MS). Geometric mean concentration of ΣPBDEs, ΣOH-BDEs, ΣMeO-BDEs and ΣBPs in human plasma were 4.45 ng g(-1) lw, 1.88 ng g(-1) lw, 0.42 ng g(-1) lw and 1.59 ng g(-1) lw respectively. Concentrations of glucuronide and sulfate conjugates of 2,4-dibromophenol (2,4-DBP) and 2,4,6-tribromophenol (2,4,6-TBP) in paired samples of urine were determined by liquid chromatography tandem triple quadrupole mass spectrometry (LC-MS/MS). BP-conjugates were found in all of the parallel urine samples, in the range of 0.08-106.49 μg g(-1)-creatinine. Correlations among plasma concentrations of ΣPBDEs/ΣOH-BDEs/ΣMeO-BDEs/ΣBPs and BP-conjugates in urine were evaluated by multivariate regression and Pearson product correlation analyses. These urinary BP-conjugates were positively correlated with ΣPBDEs in blood plasma, but were either not or negatively correlated with other organobromine compounds in blood plasma. Stronger correlations (Pearson's r as great as 0.881) were observed between concentrations of BDE congeners having the same number and pattern of bromine substitution on their phenyl rings in blood plasma and their corresponding BP-conjugates in urine.
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Affiliation(s)
- Ka-Lok Ho
- State Key Laboratory for Marine Pollution, Department of Biology and Chemistry, City University of Hong Kong, Hong Kong Special Administrative Region
| | - Man-Shan Yau
- State Key Laboratory for Marine Pollution, Department of Biology and Chemistry, City University of Hong Kong, Hong Kong Special Administrative Region
| | - Margaret B Murphy
- State Key Laboratory for Marine Pollution, Department of Biology and Chemistry, City University of Hong Kong, Hong Kong Special Administrative Region.
| | - Yi Wan
- Department of Biomedical Veterinary Sciences and Toxicology Centre, University of Saskatchewan, Canada
| | - Bonnie M-W Fong
- Division of Clinical Biochemistry, Queen Mary Hospital, Hong Kong Special Administrative Region; Department of Chemistry, Hong Kong Baptist University, Hong Kong Special Administrative Region
| | - Sidney Tam
- Division of Clinical Biochemistry, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - John P Giesy
- State Key Laboratory for Marine Pollution, Department of Biology and Chemistry, City University of Hong Kong, Hong Kong Special Administrative Region; Department of Biomedical Veterinary Sciences and Toxicology Centre, University of Saskatchewan, Canada; Department of Zoology and Center for Integrative Toxicology, Michigan State University, USA; School of Biological Sciences, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Zoology and Center for Integrative Toxicology, Michigan State University, East Lansing, MI, USA; State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, People's Republic of China
| | - Kelvin S-Y Leung
- Department of Chemistry, Hong Kong Baptist University, Hong Kong Special Administrative Region
| | - Michael H-W Lam
- State Key Laboratory for Marine Pollution, Department of Biology and Chemistry, City University of Hong Kong, Hong Kong Special Administrative Region.
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Nelson AL. Transdermal contraception methods: today’s patches and new options on the horizon. Expert Opin Pharmacother 2015; 16:863-73. [DOI: 10.1517/14656566.2015.1022531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Merz M, Kroll R, Lynen R, Bangerter K. Bleeding pattern and cycle control of a low-dose transdermal contraceptive patch compared with a combined oral contraceptive: a randomized study. Contraception 2014; 91:113-20. [PMID: 25453585 DOI: 10.1016/j.contraception.2014.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 09/25/2014] [Accepted: 10/04/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE(S) The aim of this study was to investigate the bleeding pattern and cycle control of a contraceptive patch containing 0.55 mg ethinyl estradiol (EE) and 2.1 mg gestodene (GSD) compared with a combined oral contraceptive (COC) containing 0.02 mg EE and 0.1 mg levonorgestrel (LNG). STUDY DESIGN In this phase III, randomized, controlled, double-blind, double-dummy, multicenter trial, healthy women aged 18-45 years (smokers aged 18-35 years) received either the EE/GSD patch and a placebo tablet (n=171), or a placebo patch and the COC (n=175) for seven 28-day cycles. Bleeding control was assessed in two 90-day reference periods. RESULTS Mean number of bleeding/spotting days was comparable across treatment groups in both reference periods (p>.05). Mean number of bleeding/spotting episodes was also comparable in reference period 1; however, there were fewer bleeding/spotting episodes for COC in reference period 2 (3.4 versus 3.1; p=.01). Mean length of bleeding/spotting episodes was comparable across treatment groups for both reference periods (p>.05). Withdrawal bleeding occurred consistently in both groups over the entire treatment period, but its absence was more common in the COC group in cycles 4 and 6 of reference period 2 (p<.01). Intracyclic bleeding was comparable between groups. CONCLUSION(S) Bleeding pattern and cycle control with the EE/GSD patch was comparable to an EE/LNG-containing COC. IMPLICATIONS STATEMENT The findings suggest that bleeding patterns with the EE/GSD patch are similar to an EE/LNG-containing COC, except for absence of withdrawal bleeding, which was less common in patch users. The EE/GSD patch may constitute an additional contraceptive option for women.
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Affiliation(s)
- M Merz
- Bayer Pharma AG, 13353 Berlin, Germany.
| | - R Kroll
- Women's Clinical Research Center, Seattle, WA, USA
| | - R Lynen
- Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ, USA
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Gruber D, Skřivánek A, Serrani M, Lanius V, Merz M. A comparison of bleeding patterns and cycle control using two transdermal contraceptive systems: a multicenter, open-label, randomized study. Contraception 2014; 91:105-12. [PMID: 25453582 DOI: 10.1016/j.contraception.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 09/25/2014] [Accepted: 10/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE(S) To investigate the bleeding pattern and cycle control parameters of a contraceptive patch containing 0.55 mg ethinyl estradiol (EE) and 2.1 mg gestodene (GSD) compared with a patch containing 0.6 mg EE and 6 mg norelgestromin (NGMN). STUDY DESIGN In this phase III, open-label, randomized, parallel-group trial, healthy women aged 18-35 years (smokers aged 18-30 years) received either the EE/GSD patch (n=200) or the EE/NGMN patch (n=198). Treatment consisted of one patch per week for 3 weeks followed by a 7-day, patch-free interval for seven cycles. Bleeding control was assessed in two 90-day reference periods. RESULTS In reference period 1, mean number of bleeding/spotting days was comparable across treatment groups (p>0.05). However, in reference period 2, there were fewer bleeding/spotting days in the EE/GSD patch group (15.7 versus 18.4; p<0.0001). Mean number of bleeding/spotting episodes was comparable across groups for both reference periods, but bleeding/spotting episodes were shorter for the EE/GSD patch than the EE/NGMN patch during reference period 1 (5.13 days versus 5.53 days, respectively; p<0.05) and reference period 2 (5.07 versus 5.66; p=0.0001). Both treatment groups showed a similar frequency of withdrawal bleeding episodes; however, across all seven cycles, the length of these episodes was consistently shorter with the EE/GSD patch (p<0.01). There were no notable treatment differences in intracyclic bleeding. CONCLUSION(S) Bleeding pattern and cycle control achieved with the EE/GSD patch was similar to that of the EE/NGMN patch. IMPLICATIONS STATEMENT The paper presents data on the bleeding pattern and cycle control parameters of an investigational transdermal contraceptive patch containing EE and GSD compared with an approved contraceptive patch containing EE and NGMN. This descriptive study found that bleeding patterns associated with the EE/GSD patch were similar to those of an EE/NGMN patch providing higher EE exposure.
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Affiliation(s)
- D Gruber
- University Clinic, General Hospital Vienna, Department of Gynecological Endocrinology and Reproductive Medicine, Vienna, Austria
| | | | - M Serrani
- Bayer Pharma AG, 13353 Berlin, Germany
| | - V Lanius
- Bayer Pharma AG, 13353 Berlin, Germany
| | - M Merz
- Bayer Pharma AG, 13353 Berlin, Germany.
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Pharmacokinetic drug–drug interaction between ethinyl estradiol and gestodene, administered as a transdermal fertility control patch, and two CYP3A4 inhibitors and a CYP3A4 substrate. Eur J Drug Metab Pharmacokinet 2014; 40:389-99. [DOI: 10.1007/s13318-014-0215-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 06/25/2014] [Indexed: 10/25/2022]
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Wiegratz I, Bassol S, Weisberg E, Mellinger U, Merz M. Effect of a low-dose contraceptive patch on efficacy, bleeding pattern, and safety: a 1-year, multicenter, open-label, uncontrolled study. Reprod Sci 2014; 21:1518-25. [PMID: 24784719 DOI: 10.1177/1933719114532840] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This Phase III, uncontrolled, open-label, multicenter study was conducted to investigate the contraceptive efficacy, bleeding pattern, and cycle control of a novel once-a-week contraceptive patch, delivering low-dose ethinyl estradiol (EE) and gestodene (GSD) at the same systemic exposure seen after oral administration of a combined oral contraceptive containing 0.02 mg EE/0.06 mg GSD. Participants were women aged 18 to 35 years, all of whom received the EE/GSD patch for 13 cycles each of 21 treatment days (one patch per week for 3 weeks) followed by a 7-day, patch-free interval. The primary efficacy variable was the occurrence of unintended pregnancies during the study period as assessed by life table analysis and the Pearl Index. Secondary efficacy variables were days with bleeding during four 90-day reference periods and during 1 treatment year, bleeding pattern, and cycle control. The Kaplan-Meier probability of contraceptive protection after 364 treatment days was 98.8% and the adjusted Pearl Index was 0.81. The percentage of participants with intracyclic bleeding/spotting decreased over time, from 11.4% to 6.8% in cycles 1 and 12, respectively. Almost all participants (range: 90.8%-97.6%) experienced withdrawal bleeding across the study period. Compliance was very high (mean: 97.9%; median: 100%). The most frequent adverse events were headache (9.5%) and application site reaction (8.5%); no clinically significant safety concerns were observed. Results suggest the EE/GSD patch is highly effective in preventing pregnancy. Menstrual bleeding pattern was favorable and within the ranges expected of a healthy female population. The patch was well tolerated and treatment compliance was high.
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MESH Headings
- Administration, Cutaneous
- Administration, Oral
- Adolescent
- Adult
- Australia
- Chile
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Drug Administration Schedule
- Ethinyl Estradiol/administration & dosage
- Ethinyl Estradiol/adverse effects
- Europe
- Female
- Humans
- Medication Adherence
- Menstruation/drug effects
- Mexico
- Norpregnenes/administration & dosage
- Norpregnenes/adverse effects
- Pregnancy
- Pregnancy, Unplanned
- Pregnancy, Unwanted
- Time Factors
- Transdermal Patch
- Young Adult
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Affiliation(s)
- Inka Wiegratz
- Department of Obstetrics and Gynecology, MVZ Kinderwunschzentrum Wiesbaden GmbH, Wiesbaden, Germany Faculty of Medicine of the Johann Wolfgang Goethe-University Frankfurt/Main, Germany
| | - Susana Bassol
- Department of Reproductive Biology, Biomedical Research Centre, University of Coahuila, Coahuila, Mexico
| | - Edith Weisberg
- Sydney Centre for Reproductive Health Research, FPNSW and University of Sydney, Sydney, Australia
| | | | - Martin Merz
- Women's Health, Bayer Pharma AG, Berlin, Germany
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Investigation of the hemostatic effect of a transdermal patch containing 0.55 mg ethinyl estradiol and 2.1 mg gestodene compared with a monophasic oral contraceptive containing 0.03 mg ethinyl estradiol and 0.15 mg levonorgestrel: an open-label, randomized, crossover study. Drugs R D 2014; 13:223-33. [PMID: 24043457 PMCID: PMC3784047 DOI: 10.1007/s40268-013-0028-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Transdermal delivery of contraceptives offers several advantages over combined oral contraceptives (COCs), including effective absorption and the provision of relatively constant serum concentrations. Ethinyl estradiol (EE) and the progestin gestodene are well-absorbed through the skin and, therefore, well-suited for use in a transdermal contraceptive patch. Objective The objective of this study was to investigate the impact of a once-weekly transparent, transdermal patch delivering low doses of EE and gestodene equivalent to a COC containing 0.02 mg EE and 0.06 mg gestodene on hemostasis parameters compared with a monophasic COC containing 0.03 mg EE and 0.15 mg levonorgestrel. Methods In this single-center, open-label, randomized, crossover study, 30 women (aged 18–35 years) received three cycles of each treatment, separated by a two-cycle washout period. The primary outcome measure was the absolute change from baseline in prothrombin fragments 1 + 2 and d-dimer. Results For both treatments, prothrombin fragments 1 + 2 remained stable during the first treatment period, and increased only slightly in the second period (mean absolute change 0.025 and 0.028 nmol/L in the novel Bayer patch and COC groups, respectively). Increases in d-dimer were observed in both periods (mean absolute change 107.0 ± 147.2 ng/L for the novel Bayer patch and 113.7 ± 159.0 ng/L for the COC). There were no statistically significant treatment differences in prothrombin 1 + 2 or d-dimer (p = 0.667 and p = 0.884, respectively) and no statistically significant treatment sequence or period effects. Conclusion A COC containing 0.03 mg EE and 0.15 mg levonorgestrel and the novel Bayer patch have comparable influence on hemostatic endpoints. Both treatments were well-tolerated by subjects.
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Merz M, Grunert J. Effects of an ethinyl estradiol/gestodene transdermal contraceptive patch on the endometrium: a single-center, uncontrolled study. WOMENS HEALTH 2013; 10:37-43. [PMID: 24328597 DOI: 10.2217/whe.13.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM This study aims to investigate the effect of a transdermal contraceptive patch containing ethinyl estradiol and gestodene on endometrial proliferation over 1 year. MATERIALS & METHODS In this open-label, uncontrolled, Phase IIb study, women (aged 18-35 years) used the patch for 13 cycles of 28 days. The primary variable was histologic endometrial effects at cycle 13. Secondary objectives included contraceptive efficacy and safety. RESULTS Overall, 89 women were treated. At all visits, endometrial biopsies were devoid of any abnormalities. One woman became pregnant. The patch was well tolerated, with no safety concerns. CONCLUSION The ethinyl estradiol and gestodene patch had an endometrial effect consistent with suppression of endometrial proliferation in most patients. No endometrial abnormalities or other concerns were reported; compliance was good.
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Babić Ž, Tariba B, Kovačić J, Pizent A, Varnai VM, Macan J. Relevance of serum copper elevation induced by oral contraceptives: a meta-analysis. Contraception 2013; 87:790-800. [DOI: 10.1016/j.contraception.2012.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/28/2012] [Accepted: 10/05/2012] [Indexed: 11/16/2022]
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Choi SY, Koh KH, Jeong H. Isoform-specific regulation of cytochromes P450 expression by estradiol and progesterone. Drug Metab Dispos 2013; 41:263-9. [PMID: 22837389 PMCID: PMC3558868 DOI: 10.1124/dmd.112.046276] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 07/26/2012] [Indexed: 12/26/2022] Open
Abstract
Results from clinical studies suggest that pregnancy alters hepatic drug metabolism in a cytochrome P450 (P450) isoform-specific manner, and rising concentrations of female hormones are potentially responsible for the changes. The objective of this study was to comprehensively characterize the effects of estrogen and progesterone on the expression and activity of major drug-metabolizing P450s. To this end, primary human hepatocytes were treated with estradiol and progesterone, and mRNA expression and activity levels of 10 different P450 isoforms were determined. The results showed that estradiol enhances CYP2A6, CYP2B6, and CYP3A4 expression, whereas progesterone induces CYP2A6, CYP2B6, CYP2C8, CYP3A4, and CYP3A5 expression. The induction was mainly observed when the average hormone concentrations were at the levels reached during pregnancy, suggesting that these effects are likely pregnancy-specific. Estradiol also increased enzyme activities of CYP2C9 and CYP2E1 without affecting the mRNA expression levels by unknown mechanisms. Taken together, our results show differential effects of estrogen and progesterone on P450 expression, suggesting involvement of different regulatory mechanisms in female hormone-mediated P450 regulation. Our findings potentially provide a basis in mechanistic understanding for altered drug metabolism during pregnancy.
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Affiliation(s)
- Su-Young Choi
- Department of Pharmacy Practice (MC 886), College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.
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22
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Westhoff CL, Petrie KA, Cremers S. Using changes in binding globulins to assess oral contraceptive compliance. Contraception 2012; 87:176-81. [PMID: 22795088 DOI: 10.1016/j.contraception.2012.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/05/2012] [Accepted: 06/06/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Validity of oral contraceptive pill (OCP) clinical trial results depends on participant compliance. Ethinyl estradiol (EE2) induces increases in hepatic binding globulin (BG) levels. Measuring these BG increases may provide an effective and convenient approach to distinguish noncompliant from compliant OCP users in research settings. This analysis evaluated the usefulness of measuring increases in corticosteroid-, sex-hormone- and thyroxine-binding globulins (CBG, SHBG and TBG, respectively) as measures of OCP compliance. METHODS We used frozen serum from a trial that compared ovarian suppression between normal-weight and obese women randomized to one of two OCPs containing EE2 and levonorgestrel (LNG). Based on serial LNG measurements during the trial, 17% of participants were noncompliant. We matched noncompliant participants with compliant participants by age, body mass index, ethnicity and OCP formulation. We measured CBG, SHBG and TBG levels and compared change from baseline to 3-month follow-up between the noncompliant and compliant participants. Construction of receiver operator characteristic (ROC) curves allowed comparison of various BG measures. RESULTS Changes in CBG and TBG distinguished OCP noncompliant users from compliant users [area under the ROC curve (AUROC), 0.86 and 0.89, p<.01]. Changes in SHBG were less discriminating (AUROC 0.69) CONCLUSIONS EE2-induced increases in CBG and TBG provide a sensitive integrated marker of compliance with an LNG-containing OCP.
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Affiliation(s)
- Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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Benagiano G. Joseph W. Goldzieher and the birth of hormonal contraception. Contraception 2010; 82:119-24. [PMID: 20654749 DOI: 10.1016/j.contraception.2010.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 03/09/2010] [Indexed: 11/25/2022]
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Visser M, Holinka CF, Coelingh Bennink HJT. First human exposure to exogenous single-dose oral estetrol in early postmenopausal women. Climacteric 2009; 11 Suppl 1:31-40. [DOI: 10.1080/13697130802056511] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lynch AM, McKay B, Murray L. Assessment of short-term outcomes following unintentional ingestions of “oral contraceptive pills” by toddlers. Clin Toxicol (Phila) 2009; 47:174-7. [DOI: 10.1080/15563650802438076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Ovulation inhibition by estetrol in an in vivo model. Contraception 2008; 77:186-90. [DOI: 10.1016/j.contraception.2007.11.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 11/02/2007] [Accepted: 11/02/2007] [Indexed: 11/20/2022]
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Convenient Synthesis of Alkenyl-, Alkynyl-, and Allenyl-Substituted Imidazo[1,2-a]pyridinesvia Palladium-Catalyzed Cross-Coupling Reactions. Helv Chim Acta 2007. [DOI: 10.1002/hlca.200790241] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Terlinden R, Uragg H, Göhler K, Kneip C. Pharmacokinetics of chlormadinone acetate following single and multiple oral dosing of chlormadinone acetate (2 mg) and ethinylestradiol (0.03 mg) and elimination and clearance of a single dose of radiolabeled chlormadinone acetate. Contraception 2006; 74:239-44. [PMID: 16904418 DOI: 10.1016/j.contraception.2006.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 03/14/2006] [Accepted: 03/20/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Published data on pharmacokinetic parameters for chlormadinone acetate (CMA) are in part contradictory, especially with regard to terminal half-life (t(1/2,z)). MATERIALS AND METHODS Single and multiple doses of CMA (2 mg) and ethinylestradiol (EE; 0.03 mg) were administered to healthy female volunteers for six menstrual cycles. Plasma concentrations of CMA and EE were determined by gas chromatography-mass spectrometry. Single-dose and steady-state pharmacokinetic parameters were calculated. In a separate study, healthy female volunteers were given a single 2-mg dose of radiolabeled CMA. Concentrations of radioactivity in fecal and urine samples were determined via liquid scintillation. Excretion of total radioactivity was calculated as percentage of administered dose. RESULTS Eighteen women completed the repeated-dose study. Peak plasma concentrations for CMA and EE were reached within 1 and 2 h after taking the study drug. Peak plasma concentrations of CMA were approximately 1600 pg/mL after single-dose administration and 2000 pg/mL after multiple dosing. CMA and EE showed linear pharmacokinetics throughout six cycles, with constant trough values of approximately 400-500 pg/mL for CMA and 20-40 pg/mL for EE. Mass balance factors were 1.2-1.4 for CMA and 1.6-1.7 for EE, and accumulation factors were 1.7-2 for CMA and 1.7-1.8 for EE. Mean t(1/2,z) of CMA was approximately 25 h after single dosing and 36-39 h at steady state. In the excretion balance study, mean dose of CMA recovered was 87.3+/-6.4%, with urinary and fecal excretion accounting for 45% and 42%, respectively. CONCLUSIONS The pharmacokinetics of CMA and EE is linear after multiple dosing and remains stable during long-term administration, once steady state is reached. The t(1/2,z) of CMA was 36-39 h after multiple dosing, which is considerably shorter than the 80 h often quoted in the literature.
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Affiliation(s)
- Rolf Terlinden
- Department of Pharmacokinetics, Grünenthal GmbH, D-52099 Aachen, Germany
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Jjemba PK. Excretion and ecotoxicity of pharmaceutical and personal care products in the environment. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2006; 63:113-30. [PMID: 16399163 DOI: 10.1016/j.ecoenv.2004.11.011] [Citation(s) in RCA: 237] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 10/26/2004] [Accepted: 11/29/2004] [Indexed: 05/03/2023]
Abstract
The presence and fate of pharmaceutical and personal care products (PPCPs) in the environment is undergoing increasing scrutiny. The existing clinical pharmacokinetics and pharmacodynamics data for 81 common compounds were examined for cues of ecotoxicity. Of these the proportions excreted were available for 60 compounds (i.e., 74%). The compounds had a low (< or =0.5%), a moderately low (6-39%), a relatively high (40-69%), or a high (> or =70%) proportion of the parent compound excreted. More than half of the compounds evaluated have low or moderately low proportions of the parent compound excreted. However, the proportions excreted were negatively but moderately correlated (r = -0.50; n = 13; P = 0.08) with the concentrations of the compounds in the aquatic environment, suggesting that the compounds that have low proportions excreted may also have inherently low degradability in the environment. Solubility, logK(ow), and pKa work well in predicting the behavior of PPCPs under clinical conditions and have been used in the environmental assessment of PPCPs prior to approval. However, these parameters did not correlate with the proportion of PPCPs excreted in the environment or their concentration in the environment, underscoring the need for research into the behavior of PPCPs in the environment. PPCPs occur in low concentrations in the environment and are unlikely to elicit acute toxicity. An ecotoxicity potential that is based on chronic toxicity, bioavailability, and duration of exposure to nontarget organisms is described as a guide in assessing the potency of these compounds in the environment.
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Affiliation(s)
- Patrick K Jjemba
- Biological Sciences Department, University of Cincinnati, P.O. Box 210006, Cincinnati, OH 45221-0006, USA.
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Penney G, Brechin S, Allerton L. FFPRHC Guidance (July 2005): The use of contraception outside the terms of the product licence. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2005; 31:225-41; quiz 242. [PMID: 16105289 DOI: 10.1783/1471189054483780] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This Guidance provides information for clinicians and women considering the use of contraception outside the terms of the product licence. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: CEU, Clinical Effectiveness Unit; COC, combined oral contraception/contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; IUD, copper-bearing intrauterine contraceptive device; LNG-IUS, levonorgestrel-releasing intrauterine system; NET-EN, norethisterone enantate; PGD, Patient Group Direction; PIL, Patient Information Leaflet; POC, progestogen-only contraception/contraceptive; POEC, progestogen-only emergency contraception; POP, progestogen-only pill; RCT, randomised controlled trial; SPC, Summary of Product Characteristics; UPSI, unprotected sexual intercourse; WHO, World Health Organization; WHOMEC, WHO Medical Eligibility Criteria for Contraceptive Use; WHOSPR, WHO Selected Practice Recommendations for Contraceptive Use.
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FFPRHC Guidance (April 2005) Drug interactions with hormonal contraception. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2005; 31:139-51. [PMID: 15921558 DOI: 10.1783/1471189053629356] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Vitzthum VJ, Ringheim K. Hormonal Contraception and Physiology: A Research-based Theory of Discontinuation Due to Side Effects. Stud Fam Plann 2005; 36:13-32. [PMID: 15828522 DOI: 10.1111/j.1728-4465.2005.00038.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Side effects influence the acceptability and continuation of hormonal contraceptives. Counseling the client about the management of side effects is a principal approach advocated for increasing continuation. Evidence of a biological basis for variation in women's tolerance of hormonal contraceptives argues, however, that greater attention should be given to altering the product rather than principally attempting to alter a woman's ability to deal with the product. Discontinuation rates for hormonal contraceptives, largely attributable to side effects and health concerns, are high in nearly all less-developed countries for which Demographic and Health Survey data are available. Oral contraceptives appear to be particularly problematic for Latin American women, most notably in Bolivia. Clinical trials suggest substantial variation in the physiological response to exogenous hormones, and new evidence confirms the hypothesis that the normal hormonal profiles of Bolivian women are significantly lower than those of women in the United States. These findings suggest a need for more population-specific physiological research linked to analyses of the possible association between endogenous hormone differences and contraceptive continuation. Appropriately adjusting the level of the steroid delivered may benefit women's health and improve the acceptability and continuation of hormonal contraceptives.
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Affiliation(s)
- Virginia J Vitzthum
- Department of Anthropology, Student Building 130, Indiana University, Bloomington, IN 47405, USA.
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Baisini O, Benini F, Petraglia F, Kuhnz W, Scalia S, Marschall HU, Brunetti G, Tauschel HD, Lanzini A. Ursodeoxycholic acid does not affect ethinylestradiol bioavailability in women taking oral contraceptives. Eur J Clin Pharmacol 2004; 60:481-7. [PMID: 15289960 DOI: 10.1007/s00228-004-0796-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Contraception is recommended for female patients during ursodeoxycholic acid (UDCA) treatment for the potential teratogenic effect of this bile acid, and the aim of our study was to determine whether this treatment affects the bioavailability of ethinylestradiol (EE2). METHODS In this double-blind, randomised study, we measured EE2 pharmacokinetics in eight healthy volunteers randomly allocated to receive oral contraceptive (30 microg EE2 and 75 microg gestodene) plus either UDCA (8-10 mg/kg per day) or placebo for 21 days during the first of three consecutive menstrual cycles. After a washout period during the second cycle, the subjects received the alternative treatment during the third menstrual cycle. Serum EE2 and UDCA were measured using radioimmunoassay and gas chromatography-mass spectrometry, respectively. RESULTS The profile for serum EE2 concentration was similar during UDCA (mean maximum serum concentration 177 pg/ml, SEM 59) and during placebo treatment (153 pg/ml, SEM 62), and mean area under the curve (AUC) was 1374 pg/h per ml (SEM 580) and 1320 pg/h per ml (SEM 551) during the two regimens, respectively. The point estimates and 90% confidence intervals of UDCA/placebo ratios for EE2 AUC and for maximum serum concentration were 1.1 (0.8-1.5) and 1.2 (1.0-1.4), respectively. Mean serum triglycerides concentration increased from 58.3 mg/dl (SEM 6.8) at enrolment to 91.4 mg/dl (SEM 10.7) during placebo (P < 0.01) and to 88.6 mg/dl (SEM 13.7) during UDCA treatment (P < 0.05). During UDCA treatment, serum enrichment with this bile acid and with the metabolite iso-UDCA was 29% (16%) and 3% (2%), respectively. CONCLUSION Co-administration with UDCA does not affect the bioavailability of EE2 in healthy volunteers, indicating that contraceptive efficacy is not affected.
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Affiliation(s)
- Ornella Baisini
- Gastroenterology Unit, Medicine 1, University and Spedali Civili of Brescia, 25125 Brescia, Italy
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de Visser SJ, Uchida N, van Vliet-Daskalopoulou E, Fukazawa I, van Doorn MBA, van den Heuvel MW, Machielsen CSM, Uchida E, Cohen AF. Pharmacokinetic differences between Caucasian and Japanese subjects after single and multiple doses of a potential combined oral contraceptive (Org 30659 and EE). Contraception 2004; 68:195-202. [PMID: 14561540 DOI: 10.1016/s0010-7824(03)00140-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the pharmacokinetic parameters and safety of the progestagen, Org 30659, (17alpha)-17-hydroxy-11-methylene-19-norpregna-4,15-dien-20-yn-3-one), and ethinyl estradiol (EE) in Caucasian and Japanese women after single and multiple doses. METHODS This was an open-label parallel design of a single dose followed by a multiple dose period in healthy young Japanese and Caucasian subjects. RESULTS The area under the curve (AUC) of Org 30659 after single dosing was increased by a factor of 1.75 [90% confidence interval (CI): 1.48-2.08] in Japanese women compared to Caucasian women. At steady state, this difference increased to a factor of 1.90 (90% CI: 1.60-2.25). The AUC of EE after single dosing was similar in Caucasian and Japanese women, but at steady state it was increased by a factor 1.38 (90% CI: 1.15-1.64) in the Japanese group. Weight normalization reduced, but did not remove, all the observed differences. Sex hormone binding globulin played no significant role in the differences between Caucasian and Japanese subjects. Both the single- and multiple-dose treatments with Org 30659/EE were generally well tolerated by all subjects. The Japanese population reported more and different treatment-related adverse events than the Caucasian population. CONCLUSIONS The peak concentration and extent of exposure of Org 30659, and to a lesser extent of EE, in Japanese women are higher than in Caucasian women. Furthermore, the peak concentration and extent of exposure at steady state of Org 30659, and to a lesser extent of EE, are higher than would be predicted assuming linear pharmacokinetics over time. No major safety issues were observed.
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Affiliation(s)
- S J de Visser
- Centre for Human Drug Research, Zernikedreef 10, 2333 CL Leiden, The Netherlands.
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de Souza A, Brechin S, Penney G. The members' enquiry service: frequently asked questions. ACTA ACUST UNITED AC 2004; 29:225-6. [PMID: 14662056 DOI: 10.1783/147118903101197845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alison de Souza
- Clinical Effectiveness Unit, Faculty of Family Planning and Reproductive Health Care, London, UK.
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FFPRHC Guidance (October 2003): First Prescription of Combined Oral Contraception. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2003; 29:209-22. [PMID: 14662054 DOI: 10.1783/147118903101198114] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Guidance provides information for clinicians on the steps to be taken before providing a woman with her first prescription for combined oral contraception. It updates and replaces previous Faculty Guidance. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance, and evidence tables summarising the research basis of the recommendations, are available on the Faculty website (www.ffprhc.org.uk). Abbreviations used include: blood pressure (BP), body mass (BMI), bone mineral density (BMD), breakthrough bleeding (BTB), British National Formulary (BNF), combined oral contraception (COC), Committee on Safety of Medicines (CSM), confidence interval (CI), deep vein thrombosis (DVT), emergency contraception (EC), ethinyl oestradiol (EE), Faculty Aid to Continuing Professional Development Topics (FACT), Family Planning Association (fpa), follicule-stimulating homone (FSH), general practitioner (GP), intermenstrual bleeding (IMB), luteinising hormone (LT), microgram, myocardial infarction (MI), odds ratio (OR), oral contraception (OC), pulmonary embolism (PE), relative risk (RR), Scottish Intercollegiate Guideline Network (SIGN), sexually transmitted infection (STI), Summary of Product Characteristics (SPCs), venous thomboembolism (VTE), World Health Organization (WHO), WHO Medical Eligibility Criteria (WHOMEC), WHO Selected Practice Recommendations (WHOSPR).
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Bjornsson TD, Wagner JA, Donahue SR, Harper D, Karim A, Khouri MS, Murphy WR, Roman K, Schneck D, Sonnichsen DS, Stalker DJ, Wise SD, Dombey S, Loew C. A review and assessment of potential sources of ethnic differences in drug responsiveness. J Clin Pharmacol 2003; 43:943-67. [PMID: 12971027 DOI: 10.1177/0091270003256065] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The International Conference on Harmonization (ICH) E5 guidelines were developed to provide a general framework for evaluating the potential impact of ethnic factors on the acceptability of foreign clinical data, with the underlying objective to facilitate global drug development and registration. It is well recognized that all drugs exhibit significant inter-subject variability in pharmacokinetics and pharmacologic response and that such differences vary considerably among individual drugs and depend on a variety of factors. One such potential factor involves ethnicity. The objective of the present work was to perform an extensive review of the world literature on ethnic differences in drug disposition and responsiveness to determine their general significance in relation to drug development and registration. A few examples of suspected ethnic differences in pharmacokinetics or pharmacodynamics were identified. The available literature, however, was found to be heterologous, including a variety of study designs and research methodologies, and most of the publications were on drugs that were approved a long time ago.
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Dumeaux V, Alsaker E, Lund E. Breast cancer and specific types of oral contraceptives: a large Norwegian cohort study. Int J Cancer 2003; 105:844-50. [PMID: 12767072 DOI: 10.1002/ijc.11167] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of our study was to examine the risk of breast cancer according to specific types of estrogens and progestagens in oral contraceptives (OCs) based on the prospective Norwegian Women and Cancer study (NOWAC). Between 1991-97 women aged 30-70 years were drawn at random from the central person register and mailed an invitation and a questionnaire. Women (102,443) were enrolled with follow-up information collected throughout 1999 by linkage with national registries of cancer, mortality and emigration based on the unique national identification number. Among the 96,362 women included in the present analysis 851 invasive breast cancer were diagnosed. The adjusted risk of breast cancer increased with 25% for ever use of OCs and the risk increased with increasing duration of use (test for trend: p = 0.007). No association between time since last use and breast cancer risk was found after stratification on duration of use. Positive trend was still found for total duration of use among women who used OCs more than 5 years ago. Second generation of OCs had an increased risk with increasing duration of use. Classifying progestagens according to chemical groups, the relative risk increased significantly with increasing cumulative dose of levonorgestrel progestagen. It was difficult to conclude for the other groups due to lack of power. In a multivariate analysis the cumulative dose for all progestagen groups were non-significant, although we observed a significant increased risk with increasing milligram-months of estrogen exposure (p = 0.002). In conclusion, the increased risk of breast cancer related with OC formulations could be due mostly to estrogen component.
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Affiliation(s)
- Vanessa Dumeaux
- University of Tromsø, Institute of Community Medicine, Tromsø, Norway
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Sukeda M, Ichikawa S, Matsuda A, Shuto S. A new entry to the stereoselective introduction of an ethynyl group by a radical reaction: synthesis of the potential antimetabolite 2'-deoxy-2'-C-ethynyluridine. Angew Chem Int Ed Engl 2002; 41:4748-50. [PMID: 12481347 DOI: 10.1002/anie.200290037] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Makoto Sukeda
- Graduate School of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan
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Sukeda M, Ichikawa S, Matsuda A, Shuto S. A New Entry to the Stereoselective Introduction of an Ethynyl Group by a Radical Reaction: Synthesis of the Potential Antimetabolite 2′-Deoxy-2′-C-ethynyluridine. Angew Chem Int Ed Engl 2002. [DOI: 10.1002/ange.200290036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kutteh WH, Franklin RD. Quantification of immunoglobulins and cytokines in human cervical mucus during each trimester of pregnancy. Am J Obstet Gynecol 2001; 184:865-72; discussion 872-4. [PMID: 11303193 DOI: 10.1067/mob.2001.113853] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our aims were to determine immunoglobulin and cytokine levels in cervical mucus obtained from women during each trimester of pregnancy and to compare these levels with those reported in normally menstruating women and in women taking oral contraceptives. STUDY DESIGN Cervical mucus samples were collected at specified intervals from 36 pregnant women. An enzyme-linked immunosorbent assay was used to quantitate the presence of immunoglobulins A and G and interleukins 1 beta, 6, and 10 in cervical mucus. RESULTS Immunoglobulin A in cervical mucus remained stable during each trimester of pregnancy (26 mg/dL). Cervical mucus immunoglobulin G decreased from a first-trimester high of 44.4 mg/dL to lower levels in the second and third trimesters. Levels of interleukin 1 beta increased significantly from the first trimester (4261 pg/mL) to 12,899 pg/mL in the second trimester (P <.01). CONCLUSION These data suggest a possible correlation of reproductive hormones and immunologic factors in the female reproductive tract during pregnancy.
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Affiliation(s)
- W H Kutteh
- Division of Reproductive Endocrinology and Immunology, Department of Obstetrics and Gynecology, University of Tennessee, Memphis, 38163-2116, USA
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Sarkola T, Ahola L, von der Pahlen B, Eriksson CJ. Lack of effect of alcohol on ethinylestradiol in premenopausal women. Contraception 2001; 63:19-23. [PMID: 11257244 DOI: 10.1016/s0010-7824(00)00194-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An acute elevation in estradiol during alcohol intake has been reported in postmenopausal women on estrogen replacement therapy. The objective of the present study was to investigate the acute and long-term effect of alcohol on ethinylestradiol, the estrogen component found in most oral contraceptives. Nine healthy premenopausal women with regular use of an oral contraceptive containing 30 microg ethinylestradiol and 75 microg gestodene were challenged with alcohol (0.4 g/kg p.o., approximately 2-3 standard drinks) 2 h after intake of the oral contraceptive pill at menstrual cycle day 14. Blood samples were taken at 0, 2, 3, 4, 5, and 6 h from intake of alcohol. The challenge was repeated after a 7-day period of controlled alcohol intake (0.8 g/kg/day) at cycle day 21. The same experiments were carried out during placebo conditions. At day 21 an increase in the alcohol elimination rate was observed compared with day 14. No significant acute or long-term effect of alcohol on ethinylestradiol was found. The lack of an acute effect comparable to that reported for estradiol may be due to the protection of the ethinyl group at the 17-position of ethinylestradiol.
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Affiliation(s)
- T Sarkola
- Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
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Franklin RD, Kutteh WH. Characterization of immunoglobulins and cytokines in human cervical mucus: influence of exogenous and endogenous hormones. J Reprod Immunol 1999; 42:93-106. [PMID: 10221733 DOI: 10.1016/s0165-0378(98)00086-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mucosal immunity in the female reproductive tract is influenced by immunoglobulins (Igs), cytokines, and reproductive hormones. Previous studies of reproductive-aged women demonstrated that IgA and IgG increases in cervical mucus corresponded to elevated levels of IL-1beta which occurred 1 day before the peak of endogenous estradiol production prior to ovulation. We sought to determine the effect of exogenous hormones on reproductive tract immunity in women on oral contraceptive pills (OCPs) and to compare the results with respect to naturally cycling women. Twelve women of reproductive age who had negative cervical cultures, a normal pap smear, and agreed to abstain from sexual intercourse during the study initiated OCPs. Cervical mucus and vaginal washes were collected at six intervals (2-3 days apart) throughout the treatment cycle. Fifteen naturally cycling women had similar samples collected prior to, during, and subsequent to ovulation. Cervical mucus samples were assayed for IgA, IgG, IL-1beta, IL-6, and IL-10 by enzyme-linked immunosorbent assay (ELISA). IgA, IgG and IL-1beta levels in women on OCPs paralleled increasing levels of norethindrone. Mean values of IgA increased from a low of 14.4+/-3.1 to 41.1+/-9.4 mg/dl and decreased significantly after the cessation of the pills (P < 0.001). In naturally cycling women, the largest quantities of Igs were detected prior to ovulation. By comparison, mean values of IgA in the cervical mucus of women on OCPs (24.4 mg/dl) exceeded peak levels of IgA in the cervical mucus of naturally cycling women (14.6 mg/dl). IgA was the predominant Ig detected in cervical mucus of women on OCPs. Both immunoglobulins in each group exhibited changes relative to their hormonal status. The increased levels of IgA in the cervical mucus of women on OCPs may explain the clinical observation of a lower incidence of sexually transmitted diseases.
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Affiliation(s)
- R D Franklin
- Department of Obstetrics and Gynecology and Division of Reproductive Endocrinology, University of Tennessee, Memphis 38163-2116, USA
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Tacey RL, Harman WJ, Kelly LL. Development of a highly sensitive and specific assay for plasma ethinylestradiol using combined extraction, liquid chromatography and radioimmunoassay. J Pharm Biomed Anal 1994; 12:1303-10. [PMID: 7841227 DOI: 10.1016/0731-7085(94)00065-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A highly sensitive and specific assay for ethinylestradiol (EE2) in human plasma was developed. The assay procedure combined solid-phase extraction of plasma samples, isolation of extracted EE2 by liquid chromatography (LC), and radioimmunoassay. Samples were extracted to remove polar plasma constituents and steroid binding proteins. Chromatography was employed to separate EE2 from other steroids that were candidates for assay cross-reactivity. The radioimmunoassay was shown to be sensitive (lower limit of quantitation = 2 pg ml-1 EE2 in plasma) and accurate (mean accuracy = 102%). Recovery of EE2 through extraction and LC steps was 76.1 +/- 4.5% (mean +/- SD; n = 42). Overall assay intra- and inter-assay coefficients of variation were 3.6 and 8.9%, respectively. The analyte was stable in assay buffer and assay accuracy was influenced minimally by four sample freeze-thaw cycles. This assay protocol enables the precise monitoring of low circulating levels of EE2, a prominent and potent synthetic oestrogen.
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Affiliation(s)
- R L Tacey
- Chemistry Department, Hazleton Washington, Inc., Vienna, VA 22182-1699
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Jennings JC. Advances in Hormonal Contraception. J Pharm Pract 1993. [DOI: 10.1177/089719009300600507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Breakthroughs involving innovative methods of hormonal and nonhormonal birth control have been severely limited in the United States over the last 30 years. This trend has changed with the introduction of new choices in birth control in the 1990s. This article focuses on these advances in hormonal contraception and provides information on the use of oral contraceptives, hormonal implants, and injectable methods of contraception currently available in the United States. Each method is assessed and recommendations are made for proper patient and method selection. This information is intended to supply the pharmacist with sufficient information to appropriately counsel patients on the use of hormonal contraception in the 1990s.
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Affiliation(s)
- Jenifer C. Jennings
- Department of Pharmacy Practice, College of Pharmacy, University of Utah
- University Hospital Inpatient Obstetrics/Gynecology Service
- Family Health Services Division, Utah State Department of Health, Salt Lake City, UT
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Abstract
Our knowledge of the peculiarities of prohormones is rather limited, both pharmacologically and clinically. Generalizations cannot be made except that the lapse of time until peak blood values of the active drug have been reached are always greater after intake of the prodrug than after intake of the drug. This finding is presumably of no clinical importance. If pharmacokinetic differences are limited to the phase of distribution, bioequivalence may be assumed. If, on the other hand, the area under the curve during the elimination phase is smaller for the prodrug than for the drug, the potency of the former should be decreased. A shift in the spectrum of endocrine actions as a result of the biotransformation of the prodrug into the active drug is rather the exception than the rule, and so is a change in side effects. If there are major differences in this respect, metabolic pathways in addition to those leading to the respective active drug must also be taken into consideration.
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Affiliation(s)
- J Hammerstein
- Obstetrics and Gynecology Department, Klinikum Steglitz, Freie Universität Berlin, West Germany
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