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Stanczyk FZ, McGough A, Chagam L, Sitruk-Ware R. Metabolism of progestogens used for contraception and menopausal hormone therapy. Steroids 2024; 207:109427. [PMID: 38663566 DOI: 10.1016/j.steroids.2024.109427] [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: 02/17/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
A variety of progestogens are widely used by women for contraception and menopausal hormone therapy. The progestogens undergo extensive metabolism by oral and parenteral routes of administration to form many metabolites. Although a small number of metabolites have been shown to be biologically active, most have not been tested for biologic activity. The present review shows that we know most about progesterone metabolism, followed by the metabolism of levonorgestrel and norethindrone. Very few studies have been carried out on metabolism of most of the progestogens. The clinical significance of this deficiency is that those progestogen metabolites that bind to the progesterone receptors may also bind to other steroid receptors and be responsible for some of the well-documented side effects of administered progestogens. We also discuss how obesity and genetic polymorphisms alter progestogen metabolism, and how development of oral progestogen formulations that are targeted to the colon, where the concentration of steroid-metabolizing enzymes is much lower than in the proximal gut, may have a beneficial effect on progestogen metabolism.
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Affiliation(s)
- Frank Z Stanczyk
- Department of Obstetrics & Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
| | - Alexandra McGough
- Department of Obstetrics & Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Laura Chagam
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
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2
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De Simone A, Davani L, Montanari S, Tumiatti V, Avanessian S, Testi F, Andrisano V. Combined Methodologies for Determining In Vitro Bioavailability of Drugs and Prediction of In Vivo Bioequivalence From Pharmaceutical Oral Formulations. Front Chem 2021; 9:741876. [PMID: 34805090 PMCID: PMC8597939 DOI: 10.3389/fchem.2021.741876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022] Open
Abstract
With the aim of developing an in vitro model for the bioavailability (BA) prediction of drugs, we focused on the study of levonorgestrel (LVN) released by 1.5 mg generic and brand-name tablets. The developed method consisted in combining a standard dissolution test with an optimized parallel artificial membrane permeability assay (PAMPA) to gain insights into both drug release and gastrointestinal absorption. Interestingly, the obtained results revealed that the tablet standard dissolution test, combined with an optimized PAMPA, highlighted a significant decrease in the release (15 ± 0.01 μg min−1 vs 30 ± 0.01 μg min−1) and absorption (19 ± 7 × 10–6 ± 7 cm/s Pe vs 41 ± 15 × 10–6 cm/s Pe) profiles of a generic LVN tablet when compared to the brand-name formulation, explaining unbalanced in vivo bioequivalence (BE). By using this new approach, we could determine the actual LVN drug concentration dissolved in the medium, which theoretically can permeate the gastrointestinal (GI) barrier. In fact, insoluble LVN/excipient aggregates were found in the dissolution media giving rise to non-superimposable dissolution profiles between generic and brand-name LVN tablets. Hence, the results obtained by combining the dissolution test and PAMPA method provided important insights confirming that the combined methods can be useful in revealing crucial issues in the prediction of in vivo BE of drugs.
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Affiliation(s)
- A De Simone
- Department of Drug Science and Technology, University of Turin, Torino, Italy
| | - L Davani
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - S Montanari
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - V Tumiatti
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | | | - F Testi
- Valpharma International S.p.A., Rimini, Italy
| | - V Andrisano
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
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3
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Plamberger CP, Van Wijk HE, Kerschbaum H, Pletzer BA, Gruber G, Oberascher K, Dresler M, Hahn MA, Hoedlmoser K. Impact of menstrual cycle phase and oral contraceptives on sleep and overnight memory consolidation. J Sleep Res 2020; 30:e13239. [PMID: 33348471 PMCID: PMC8365641 DOI: 10.1111/jsr.13239] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 01/17/2023]
Abstract
Sleep spindles benefit declarative memory consolidation and are considered to be a biological marker for general cognitive abilities. However, the impact of sexual hormones and hormonal oral contraceptives (OCs) on these relationships are less clear. Thus, we here investigated the influence of endogenous progesterone levels of naturally cycling women and women using OCs on nocturnal sleep and overnight memory consolidation. Nineteen healthy women using OCs (MAge = 21.4, SD = 2.1 years) were compared to 43 healthy women with a natural menstrual cycle (follicular phase: n = 16, MAge = 21.4, SD = 3.1 years; luteal phase: n = 27, MAge = 22.5, SD = 3.6 years). Sleep spindle density and salivary progesterone were measured during an adaptation and an experimental night. A word pair association task preceding the experimental night followed by two recalls (pre‐sleep and post‐sleep) was performed to test declarative memory performance. We found that memory performance improved overnight in all women. Interestingly, women using OCs (characterized by a low endogenous progesterone level but with very potent synthetic progestins) and naturally cycling women during the luteal phase (characterized by a high endogenous progesterone level) had a higher fast sleep spindle density compared to naturally cycling women during the follicular phase (characterized by a low endogenous progesterone level). Furthermore, we observed a positive correlation between endogenous progesterone level and fast spindle density in women during the luteal phase. Results suggest that the use of OCs and the menstrual cycle phase affects sleep spindles and therefore should be considered in further studies investigating sleep spindles and cognitive performance.
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Affiliation(s)
| | - Helen Elisabeth Van Wijk
- Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.,Radboud University, Nijmegen, The Netherlands
| | - Hubert Kerschbaum
- Department of Cell Biology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Belinda Angela Pletzer
- Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Georg Gruber
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Oberascher
- Department of Cell Biology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | | | - Michael Andreas Hahn
- Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Kerstin Hoedlmoser
- Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
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4
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Liu Z, Qiu S, Gu Y, Ning M. Quantitative determination of levonorgestrel in beagle dog plasma after vaginal administration of intravaginal ring by high-performance liquid chromatography-tandem mass spectrometry. Biomed Chromatogr 2018; 32:e4367. [PMID: 30120779 DOI: 10.1002/bmc.4367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 11/11/2022]
Abstract
A specific and sensitive high-performance liquid chromatography-tandem mass spectrometry method that could be used to determine the concentration of levonorgestrel (LNG) in beagle dog plasma was developed. Specifically, terfenadine was used as the internal standard (IS). The separation was achieved on a Kinetex-C18 110A column (3 × 30 mm i.d., 2.6 um, Phenomenex) and a gradient mobile phase consists of methanol (0.1% formic acid) and water (0.1% formic acid) was used. The flow rate was 0.8 mL/min and the injection volume was 10 μL. The detection was performed on a triple-quadruple tandem mass spectrometer by multiple reaction monitoring mode via electrospray ionization. Quantitative analysis was carried out at m/z 313.0 → 108.9 and m/z 472.6 → 436.2 for LNG and IS respectively. This method demonstrated the linearity of LNG over a concentration range of 0.5-50 ng/mL with a coefficient correlation (r) of 0.9973. The lower limit of quantification was 0.5 ng/mL. The intra- and inter-assay precisions were 2.9 and 11.2%, with an accuracy range from 94.8 to 108.4%. The stability data indicated that sample preparation and storage process had little effect on the concentration of LNG QC sample. The validated method was successfully applied to study the pharmacokinetics of LNG in beagle dog after vaginal administration of intravaginal ring.
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Affiliation(s)
- Zhenqi Liu
- Science and Technology Research Center for Reproductive Health, National Research Institute for Family Planning, Beijing, China
| | - Shunchen Qiu
- Science and Technology Research Center for Reproductive Health, National Research Institute for Family Planning, Beijing, China
| | - Yiqun Gu
- Science and Technology Research Center for Reproductive Health, National Research Institute for Family Planning, Beijing, China
| | - Meiying Ning
- Science and Technology Research Center for Reproductive Health, National Research Institute for Family Planning, Beijing, China
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5
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Zhang J, Li C, Zhao WH, Xi X, Cao SJ, Ping H, Qin GJ, Cheng L, Huang HF. Association between levonorgestrel emergency contraception and the risk of ectopic pregnancy: a multicenter case-control study. Sci Rep 2015; 5:8487. [PMID: 25674909 PMCID: PMC4325579 DOI: 10.1038/srep08487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/14/2015] [Indexed: 12/30/2022] Open
Abstract
Cases of ectopic pregnancy (EP) following levonorgestrel emergency contraception (LNG-EC) failure have been reported continuously, but whether there is an association between EP risk and LNG-EC is unclear. We concluded a case-control study to explore this association by recruiting 2,411 EP patients as case group, and 2,416 women with intrauterine pregnancy and 2,419 non-pregnant women as control groups. Odds ratios (ORs) and their 95% confidential intervals (CIs) were calculated and adjusted for potential confounding factors. Previous use of LNG-EC was not correlated with the EP. Compared to women who did not use contraceptives, current use of LNG-EC reduced the risk for intrauterine pregnancy (Adjusted OR [AOR] = 0.20, 95%CI: 0.14-0.27), but did not increase the risk for EP (AOR2 = 1.04, 95%CI: 0.76-1.42). Furthermore, compared to women who did not have further act of intercourse, women with unprotected further act of intercourse were at a higher risk of EP (AOR1 = 2.35, 95%CI: 1.17-4.71), and women with repeated use of LNG-EC for further intercourse during the same cycle was also associated with a higher risk for EP (AOR1 = 3.08, 95%CI: 1.09-8.71; AOR2 = 2.49, 95%CI: 1.00-6.19). A better understanding of the risk of EP following LNG-EC failure can optimize LNG-EC use and thus reduce the risk of EP.
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Affiliation(s)
- Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Cheng Li
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Wei-Hong Zhao
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Xiaowei Xi
- Department of Obstetrics and Gynecology, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
| | - Shu-Jun Cao
- Department of Obstetrics and Gynecology, Songjiang Central Hospital, Shanghai 201600, China
| | - Hua Ping
- Department of Obstetrics and Gynecology, Songjiang Maternity and Child Health Hospital, Shanghai 201620, China
| | - Guo-Juan Qin
- Department of Obstetrics and Gynecology, Minhang Central Hospital, Shanghai 201100, China
| | - Linan Cheng
- Shanghai Institute of Planned Parenthood Research, Shanghai 200030, China
| | - He-Feng Huang
- Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
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Shohel M, Rahman MM, Zaman A, Uddin MMN, Al-Amin MM, Reza HM. A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception. BMC Womens Health 2014; 14:54. [PMID: 24708837 PMCID: PMC3977662 DOI: 10.1186/1472-6874-14-54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 03/30/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Unintended pregnancy is a complex phenomenon which raise to take an emergency decision. Low contraceptive prevalence and high user failure rates are the leading causes of this unexpected situation. High user failure rates suggest the vital role of emergency contraception to prevent unplanned pregnancy. Levonorgestrel - a commonly used progestin for emergency contraception. However, little is known about its pharmacokinetics and optimal dose for use. Hence, there is a need to conduct a systematic review of the available evidences. METHODS Randomized, double-blind trials were sought, evaluating healthy women with regular menstrual cycles, who requested emergency contraception within 72 h of unprotected coitus, to one of three regimens: 1.5 mg single dose levonorgestrel, two doses of 0.75 mg levonorgestrel given 12 h apart or two doses of 0.75 mg levonorgestrel given 24 h apart. The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation. RESULTS Every trial under consideration successfully established the contraceptive effectiveness of levonorgestrel for preventing unintended pregnancy. Moreover, a single dose of levonorgestrel 1.5 mg for emergency contraception supports its safety and efficacy profile. If two doses of levonorgestrel 0.75 mg are intended for administration, the second dose can positively be taken 12-24 h after the first dose without compromising its contraceptive efficacy. The main side effect was frequent menstrual irregularities. No serious adverse events were reported. CONCLUSIONS The review shows that, emergency contraceptive regimen of single-dose levonorgestrel is not inferior in efficacy to the two-dose regimen. All the regimens studied were very efficacious for emergency contraception and prevented a high proportion of pregnancies if taken within 72 h of unprotected coitus. Single levonorgestrel dose (1.5 mg) can substitute two 0.75 mg doses 12 or 24 h apart. With either regimen, the earlier the treatment is given, the more effective it seems to be.
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Affiliation(s)
- Mohammad Shohel
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | | | - Asif Zaman
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | | | - Md Mamun Al-Amin
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | - Hasan Mahmud Reza
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
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7
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Sarkar NN. The emergency contraceptive drug, levonorgestrel: A review of post-coital oral and peri-coital vaginal administration for prevention of pregnancy. J OBSTET GYNAECOL 2011; 31:703-7. [DOI: 10.3109/01443615.2011.611917] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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8
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Menkhorst E, Zhang JG, Sims NA, Morgan PO, Soo P, Poulton IJ, Metcalf D, Alexandrou E, Gresle M, Salamonsen LA, Butzkueven H, Nicola NA, Dimitriadis E. Vaginally administered PEGylated LIF antagonist blocked embryo implantation and eliminated non-target effects on bone in mice. PLoS One 2011; 6:e19665. [PMID: 21611124 PMCID: PMC3097203 DOI: 10.1371/journal.pone.0019665] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 04/02/2011] [Indexed: 01/17/2023] Open
Abstract
Female-controlled contraception/HIV prevention is critical to address health issues associated with gender inequality. Therefore, a contraceptive which can be administered in tandem with a microbicide to inhibit sexually transmitted infections, is desirable. Uterine leukemia inhibitory factor (LIF) is obligatory for blastocyst implantation in mice and associated with infertility in women. We aimed to determine whether a PEGylated LIF inhibitor (PEGLA) was an effective contraceptive following vaginal delivery and to identify non-uterine targets of PEGLA in mice. Vaginally-applied 125I-PEGLA accumulated in blood more slowly (30 min vs 10 min) and showed reduced tissue and blood retention (24 h vs 96 h) compared to intraperitoneal injection in mice. Vaginally-applied PEGLA blocked implantation. PEGLA administered by intraperitoneal injection inhibited bone remodelling whereas vaginally-applied PEGLA had no effect on bone. Further, PEGLA had no effect in an animal model of multiple sclerosis, experimental auto-immune encephalomyelitis, suggesting PEGLA cannot target the central nervous system. Vaginally-administered PEGLA is a promising non-hormonal contraceptive, one which could be delivered alone, or in tandem with a microbicide. Vaginal application reduced the total dose of PEGLA required to block implantation and eliminated the systemic effect on bone, showing the vagina is a promising site of administration for larger drugs which target organs within the reproductive tract.
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Affiliation(s)
- Ellen Menkhorst
- Embryo Implantation, Prince Henry's Institute, Clayton, Australia.
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9
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New generation contraceptives: interleukin 11 family cytokines as non-steroidal contraceptive targets. J Reprod Immunol 2011; 88:233-9. [DOI: 10.1016/j.jri.2010.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/09/2010] [Accepted: 12/09/2010] [Indexed: 11/19/2022]
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10
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Kozinszky Z, Bakken RT, Lieng M. Ectopic pregnancy after levonorgestrel emergency contraception. Contraception 2010; 83:281-3. [PMID: 21310292 DOI: 10.1016/j.contraception.2010.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 08/07/2010] [Accepted: 08/16/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although the possibility of ectopic pregnancy after intake of levonorgestrel (LNG) as an emergency contraceptive (EE) pill is well-known, the causality has not been well established. CASE A 27-year-old nulliparous woman with regular menstrual periods took 1.5-mg LNG EE midcyclic 5 h after an unprotected intercourse. She had prolonged vaginal bleeding at the expected time. She consulted the general practitioner because of continuous vaginal bleeding for 4 weeks and lower abdominal pain. The pregnancy test was positive, and her symptoms and clinical findings suggested an ectopic pregnancy. At emergency surgery, she was found to have a left tubal pregnancy. CONCLUSION The possible role of 1.5-mg LNG EE in causing ectopic pregnancy is discussed. A high serum LNG concentration decreases ciliary activity and tube motility, but further epidemiological studies are necessary to establish the risk of ectopic pregnancy following intake of LNG EE.
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Affiliation(s)
- Zoltan Kozinszky
- Women and Children's Division, Department of Obstetrics and Gynecology, Oslo University Hospital, Norway.
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Palomino WA, Kohen P, Devoto L. A single midcycle dose of levonorgestrel similar to emergency contraceptive does not alter the expression of the L-selectin ligand or molecular markers of endometrial receptivity. Fertil Steril 2010; 94:1589-94. [DOI: 10.1016/j.fertnstert.2009.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 09/08/2009] [Accepted: 09/10/2009] [Indexed: 12/30/2022]
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12
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Palomino WA, Devoto L. Endometrial progesterone receptors and levonorgestrel as emergency contraceptive. Gynecol Endocrinol 2010; 26:317-8. [PMID: 20028197 DOI: 10.3109/09513590903507412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Liu F, Xu Y, Liu A, Xu F, Hu W, Guo Q. LC–Tandem-MS Validation for the Quantitative Analysis of Levonorgestrel in Human Plasma. Chromatographia 2008. [DOI: 10.1365/s10337-008-0773-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Emergency contraception (EC), also known as 'the morning after pill', or post-coital contraception, is a modality of preventing the establishment of a pregnancy after unprotected intercourse. Both a hormonal and an intrauterine form are available. Modern hormonal EC, with low side effects, was first proposed by Yuzpe in 1974. More recently, a new regimen, consisting of levonorgestrel administered alone, was introduced and found in clinical trials to be more effective (if taken as early as possible), and associated with less side effects than the Yuzpe regimen, which it has gradually replaced. The WHO developed another regimen based on the use of the selective progesterone receptor modulator (antiprogestin) mifepristone and conducted trials with different dosages. Intrauterine EC was first proposed by Lippes in 1976. It has the advantage of being applicable for almost a week and the disadvantage of a greater complexity. In addition, this modality is solely interceptive, acting by preventing implantation. Pregnancy rates reported following EC using an intrauterine device with more than 300 mm2 of copper are consistently low (0.1-0.2%).
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Affiliation(s)
- Carlo Bastianelli
- Department of Gynaecologic Sciences, Perinatology and Child Care, University la Sapienza, Rome, Italy.
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Devoto L, Espinoza A, Muñoz A, Fuentes A, von Hertzen H. Pharmacokinetics of a single oral dose of 1.5-mg levonorgestrel when administered as 750-μg tablets or as 30-μg minipills. Fertil Steril 2007; 88:976-7. [PMID: 17481615 DOI: 10.1016/j.fertnstert.2006.12.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 12/27/2006] [Accepted: 12/27/2006] [Indexed: 10/23/2022]
Abstract
We examined the pharmacokinetics of a single dose of 1.5 mg of levonorgestrel when administered orally in two different formulations: two tablets of 0.75 mg or 50 minipills of 30 microg of levonorgestrel. Bioavailability of levonorgestrel with minipills was comparable to that with levonorgestrel tablets. These findings suggest that levonorgestrel-containing minipills can be considered as an alternative to standard levonorgestrel tablets for use in emergency contraception.
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Affiliation(s)
- Luigi Devoto
- Instituto de Investigaciones Materno Infantil and Departamento de Obstetricia y Ginecologia, Universidad de Chile, Santiago, Chile.
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Brache V, Croxatto H, Sitruk-Ware R, Maguire R, Montero JC, Kumar N, Salvatierra AM, Tejada AS, Cochón L, Forcelledo ML, Lahteenmaki P, Alvarez F, Faundes A. Effect of a single vaginal administration of levonorgestrel in Carraguard® gel on the ovulatory process: a potential candidate for “dual protection” emergency contraception. Contraception 2007; 76:111-6. [PMID: 17656180 PMCID: PMC2077845 DOI: 10.1016/j.contraception.2007.04.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 04/18/2007] [Accepted: 04/22/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study was conducted to evaluate the effect of Carraguard vaginal gel containing 0.75 mg of levonorgestrel (CARRA/LNG gel) administered in a single dose at different stages of follicle development over subsequent follicle rupture and hormonal levels. METHOD Randomized, blinded, cross-over study comparing the effects of a single administration of CARRA/LNG gel or Carraguard (CARRA) gel. Twenty-four healthy women were enrolled in two centers. The gels were administered when the follicle had reached diameters of 12-14, 15-17 and > or =18 mm in eight women each. Volunteers were followed for one treatment, one washout cycle and a second treatment cycle. Follicle rupture or nonrupture was assessed by transvaginal ultrasound. Luteinizing hormone, estradiol and progesterone levels were measured daily for 5 days following treatment, and three times per week until menses. RESULTS No follicular rupture within the 5-day period following administration was observed in 74% and 30% of the CARRA/LNG and CARRA gel treatment cycles, respectively, while ovulation was documented in 4% and 61%, respectively. The overall proportion of cycles with lack of follicular rupture or ovulatory dysfunction (follicle rupture preceded by an inadequate LH surge) was 96% for CARRA/LNG and 39% in the CARRA gel cycles. CONCLUSION Single vaginal administration of 0.75 mg LNG in CARRA gel in the late follicular phase is effective for interfering with the ovulatory process.
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Affiliation(s)
- Vivian Brache
- PROFAMILIA, Biomedical Research Department, P.O. Box 1053, Santo Domingo 10401, Dominican Republic.
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do Nascimento JAA, Seppala M, Perdigão A, Espejo-Arce X, Munuce MJ, Hautala L, Koistinen R, Andrade L, Bahamondes L. In vivo assessment of the human sperm acrosome reaction and the expression of glycodelin-A in human endometrium after levonorgestrel-emergency contraceptive pill administration. Hum Reprod 2007; 22:2190-5. [PMID: 17537781 DOI: 10.1093/humrep/dem119] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The objectives were firstly to assess acrosome reaction (AR) status of spermatozoa following uterine flushing, secondly to measure levonorgestrel (LNG) levels in serum and in uterine flushing fluid and finally to measure endometrial glycodelin-A expression after administration of LNG as a form of emergency contraception (EC). METHODS Forty-eight experiments were conducted on 15 regularly menstruating women. Four groups were formed based on different intercourse to treatment interval and treatment to recovery of spermatozoa and the biopsies. RESULTS Twenty-four and forty-eight hours after treatment, there were 14.5 +/- 3.9 x 10(6) and 17.3 +/- 6.8 x 10(6) sperm recovered from the uterus, respectively. There were no differences between the AR rate and the endometrial glycodelin-A staining intensity in an LNG or placebo treated cycles. The LNG in uterine flushing medium represented 1.38% of the values observed in serum 24 h after the LNG intake. CONCLUSIONS Twenty-four and forty-eight hours after administration of EC, neither the proportion of AR sperm, nor the glycodelin-A level was influenced by 1.5 mg of LNG. LNG did not impair the cervical mucus either because viable spermatozoa were found in the genital tract 36-60 h after coitus and 24-48 h after LNG intake. The mechanism of action of LNG as EC remains unknown.
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Affiliation(s)
- Josiane A A do Nascimento
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Sitruk-Ware R, Brache V, Maguire R, Croxatto H, Kumar N, Kumar S, Montero JC, Salvatierra AM, Phillips D, Faundes A. Pharmacokinetic study to compare the absorption and tolerability of two doses of levonorgestrel following single vaginal administration of levonorgestrel in Carraguard gel: a new formulation for "dual protection" contraception. Contraception 2007; 75:454-60. [PMID: 17519152 PMCID: PMC1995403 DOI: 10.1016/j.contraception.2007.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 01/30/2007] [Accepted: 02/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The study was conducted to assess levonorgestrel (LNG) serum levels achieved after a single administration of two different doses of Carraguard vaginal gel containing LNG (CARRA/LNG), designed for use as microbicide and contraceptive for potential dual protection. MATERIALS AND METHODS This was a randomized double-blind pharmacokinetic study conducted in 12 subjects enrolled at two centers. Each subject received a single vaginal administration of CARRA/LNG containing either 0.75 or 1.5 mg LNG per 4 mL of gel on Days 10-12 of the menstrual cycle. LNG serum levels were measured at 0, 1, 2, 4, 8 and 12 h after administration and for the following 7 days. LH and progesterone (for a preliminary evaluation of effect on the ovarian function) as well as SHBG were measured in the daily samples. RESULTS Serum LNG maximum concentrations (Cmax) were 14.1+/-2.1 and 11.7+/-2.7 nmol/L and Tmax was 12.0 and 6.0 h for the low and high dose, respectively, with large intersubject variability within the first 48 h. Mean levels at 96 h were 10% of Cmax. Differences in AUC between both doses were not statistically significant. SHBG levels decreased approximately 25% by Day 4 after administration. Luteal activity was observed in 3/6 and 5/6 of the subjects in the low- and high-dose group, respectively. CONCLUSION This study demonstrates that the CARRA/LNG gel can sustain elevated serum levels of the contraceptive steroid for up to 96 h after a single application. The serum levels attained with the 0.75-mg formulation are in the range expected to perturb the ovulatory process as observed in some subjects. The lack of correlation between the administered dose and serum concentrations of the steroid may be related to a rate-limiting absorption of LNG from the vaginal mucosa. The results reported here suggest that the CARRA/LNG formulation has good potential to become a dual-protection method, possibly preventing conception and sexually transmitted infections.
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MESH Headings
- Administration, Intravaginal
- Anti-Infective Agents/administration & dosage
- Anti-Infective Agents/blood
- Anti-Infective Agents/pharmacokinetics
- Area Under Curve
- Chemistry, Pharmaceutical
- Chile
- Contraceptives, Postcoital, Synthetic/administration & dosage
- Contraceptives, Postcoital, Synthetic/blood
- Contraceptives, Postcoital, Synthetic/pharmacokinetics
- Dominican Republic
- Double-Blind Method
- Female
- Humans
- Intestinal Absorption
- Levonorgestrel/administration & dosage
- Levonorgestrel/blood
- Levonorgestrel/pharmacokinetics
- Vaginal Creams, Foams, and Jellies
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Affiliation(s)
- Regine Sitruk-Ware
- Population Council, Center for Biomedical Research, New York, NY 10021, USA.
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Hansen LB, Saseen JJ, Teal SB. Levonorgestrel-Only Dosing Strategies for Emergency Contraception. Pharmacotherapy 2007; 27:278-84. [PMID: 17253917 DOI: 10.1592/phco.27.2.278] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The United States Food and Drug Administration-approved progestin-only dosing strategy for emergency contraception is levonorgestrel 0.75 mg taken as soon as possible within 72 hours of unprotected intercourse, with a second 0.75-mg dose taken 12 hours later. However, different dosing strategies have been studied and promoted by various organizations. The American College of Obstetricians and Gynecologists recommends a single dose of levonorgestrel 1.5 mg for emergency contraception as one option. As another option, they recommend two doses of levonorgestrel 0.75 mg may be effective when taken 12-24 hours apart. We performed a search of MEDLINE and International Pharmaceutical Abstracts from 1967-2006 to evaluate and describe the existing pharmacokinetic and patient outcome data regarding administration of levonorgestrel as a 1.5-mg single dose or two 0.75-mg doses taken 12 or 24 hours apart. Additional studies were identified from the bibliographies of the selected literature. Several pertinent articles were identified. All of the studies demonstrated that emergency contraception effectively prevented pregnancy. In addition, evidence supports the safety and efficacy of a single dose of levonorgestrel 1.5 mg for emergency contraception. Furthermore, when two doses of levonorgestrel 0.75 mg are administered, the second dose can confidently be taken 12-24 hours after the first without compromising efficacy. Understanding the evidence that supports the different emergency contraception dosing strategies is critical for clinicians, and especially pharmacists, who have interactive roles in dispensing emergency contraception.
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Affiliation(s)
- Laura B Hansen
- Department of Clinical Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80262-0238, USA
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