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Blue SW, Winchell AJ, Kaucher AV, Lieberman RA, Gilles CT, Pyra MN, Heffron R, Hou X, Coombs RW, Nanda K, Davis NL, Kourtis AP, Herbeck JT, Baeten JM, Lingappa JR, Erikson DW. Simultaneous quantitation of multiple contraceptive hormones in human serum by LC-MS/MS. Contraception 2018; 97:363-369. [PMID: 29407362 DOI: 10.1016/j.contraception.2018.01.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/13/2017] [Accepted: 01/24/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective was to develop a method to simultaneously quantify five commonly used hormonal contraceptives (HCs) and two endogenous sex steroids by liquid chromatography-tandem triple quadrupole mass spectrometry (LC-MS/MS) and apply this method to human serum samples. STUDY DESIGN We developed a method to simultaneously analyze ethinyl estradiol (EE2), etonogestrel (ENG), levonorgestrel (LNG), medroxyprogesterone acetate (MPA) and norethisterone (NET), along with estradiol (E2) and progesterone (P4), in human serum for a Shimadzu Nexera-LCMS-8050 LC-MS/MS platform. We analyzed serum collected from women self-reporting use of oral contraceptives, contraceptive implants or injectable contraceptives (n=14) and normally cycling women using no HC (n=15) as well as pooled samples from women administered various HCs (ENG, n=6; LNG, n=14; MPA, n=7; NET, n=5). RESULTS Limits of quantitation were 0.010ng/mL for E2, EE2 and P4; 0.020ng/mL for ENG, LNG and MPA; and 0.040ng/mL for NET. Precisions for all assays, as indicated by coefficient of variation, were less than or equal to 12.1%. Accuracies for all assays were in the range of 95%-108%. Endogenous hormone values obtained from analysis of human serum samples are in agreement with levels previously reported in the literature for normally cycling women as well as for women taking the appropriate HC. CONCLUSIONS We have developed a robust, accurate and sensitive method for simultaneously analyzing commonly used contraceptive steroids and endogenous sex steroids in human serum. IMPLICATIONS This analytical method can be used for quantitating contraceptive steroid levels in women for monitoring systemic exposure to determine drug interactions, nonadherence, misreporting and proper dosing.
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Affiliation(s)
- Steven W Blue
- Endocrine Technologies Support Core, Oregon National Primate Research Center, Beaverton, OR
| | - Andrea J Winchell
- Endocrine Technologies Support Core, Oregon National Primate Research Center, Beaverton, OR
| | - Amy V Kaucher
- Endocrine Technologies Support Core, Oregon National Primate Research Center, Beaverton, OR
| | | | | | - Maria N Pyra
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Renee Heffron
- Department of Epidemiology, University of Washington, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA
| | - Xuanlin Hou
- Department of Global Health, University of Washington, Seattle, WA
| | - Robert W Coombs
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Nicole L Davis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Athena P Kourtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joshua T Herbeck
- Department of Global Health, University of Washington, Seattle, WA
| | - Jared M Baeten
- Department of Epidemiology, University of Washington, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Jairam R Lingappa
- Department of Global Health, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA
| | - David W Erikson
- Endocrine Technologies Support Core, Oregon National Primate Research Center, Beaverton, OR.
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Stegeman BH, Vos HL, Helmerhorst FM, Rosendaal FR, Reitsma PH, van Hylckama Vlieg A. Genetic variation in the first-pass metabolism of ethinylestradiol, sex hormone binding globulin levels and venous thrombosis risk. Eur J Intern Med 2017; 42:54-60. [PMID: 28579309 DOI: 10.1016/j.ejim.2017.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Use of ethinylestradiol, one of the active ingredients in combined oral contraceptives, affects the incidence of venous thrombosis. To explain why some women develop thrombosis when using oral contraceptives and others do not, we hypothesized a role for the first-pass metabolism of ethinylestradiol in the liver. We set out to determine the association between genetic variation in the first-pass metabolism of ethinylestradiol, venous thrombosis risk and the effect on Sex-hormone-binding-globulin (SHBG) levels. METHODS Premenopausal women were included from two case-control studies: LETS (103 cases; 159 controls) and MEGA (397 cases; 796 controls). Haplotype-tagging SNPs were selected in 11 candidate genes; COMT, CYP1A2, CYP2C9, CYP3A4, CYP3A5, SULT1A1, SULT1E1, UGT1A1, UGT1A3, UGT1A9, UGT2B7. Venous thrombosis risk was expressed as odds ratios (OR) with 95% confidence intervals (CI). For SHBG levels, mean differences with 95%CI were estimated in combined oral contraceptive-using control subjects from the MEGA study. RESULTS Two copies of haplotype D in the UGT2B7 gene increased venous thrombosis risk (ORLETS: 3.78; ORMEGA: 2.61) as well as SHBG levels (mean difference 27.6nmol/L, 95%CI: -61.7 to 116.9 compared with no copies) in oral contraceptive users and not in non-users. In oral contraceptive users, haplotype A and B in the CYP3A4 gene were associated with venous thrombosis risk, but not in non-users; however, the effect on SHBG levels was not directional with the risk. None of the other haplotypes were associated with venous thrombosis. CONCLUSION Genetic variation in the UGT2B7 gene may, in part, explain venous thrombosis risk in combined oral contraceptive users.
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Affiliation(s)
- Bernardine H Stegeman
- Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Hans L Vos
- Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Frans M Helmerhorst
- Department of Gynaecology and Reproductive Medicine, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Pieter H Reitsma
- Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Astrid van Hylckama Vlieg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands.
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Guida M, Di Carlo C, Troisi J, Gallo A, Cibarelli F, Martini E, Tiranini L, Nappi RE. The sexuological impact of hormonal contraceptives based on their route of administration. Gynecol Endocrinol 2017; 33:218-222. [PMID: 27908210 DOI: 10.1080/09513590.2016.1249841] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Evidence on the effects of hormonal contraceptives on female sexuality is conflicting. We enrolled 556 women, divided into six groups: two composed of subjects using a combined hormonal contraceptive (COC) containing 0.020 ("COC20") and 0.030 ("COC30") mg of ethynyl estradiol (EE), "natural", using COC containing 1.5 mg of estradiol (E2), "ring", using a vaginal ring releasing each day 0.015 mg of EE + 0.120 of etonogestrel, "subcutaneous", using a progestin only subcutaneous contraceptive implant releasing etonogestrel and "controls", using no hormonal contraceptive methods. The subjects were required to answer to the McCoy female sexuality questionnaire and were subjected to a blood test for hormonal evaluation. An ultrasound evaluation of the dorsal clitoral artery was also performed. The higher McCoy sexological value were recorded in the subdermal group; significant differences were recorded among the groups in terms of hormone distribution, with the higher levels of androstenedione in subdermal and control groups. The ultrasound evaluation of dorsal clitoral artery shows a significative correlation between pulsatility and resistance indices and orgasm parameters of McCoy questionnaire. The recorded difference in the sexual and hormonal parameters among the studied hormonal contraceptives may guide toward the personalization of contraceptive choice.
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MESH Headings
- Adult
- Clitoris/blood supply
- Clitoris/diagnostic imaging
- Clitoris/drug effects
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/blood
- Contraceptive Agents, Female/pharmacokinetics
- Contraceptive Devices, Female/adverse effects
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/blood
- Contraceptives, Oral, Combined/pharmacokinetics
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/blood
- Contraceptives, Oral, Hormonal/pharmacokinetics
- Delayed-Action Preparations/administration & dosage
- Delayed-Action Preparations/adverse effects
- Desogestrel/administration & dosage
- Desogestrel/adverse effects
- Desogestrel/blood
- Desogestrel/pharmacokinetics
- Dose-Response Relationship, Drug
- Drug Implants
- Estrogens/administration & dosage
- Estrogens/adverse effects
- Estrogens/blood
- Estrogens/pharmacokinetics
- Female
- Humans
- Italy
- Megestrol/administration & dosage
- Megestrol/adverse effects
- Megestrol/blood
- Megestrol/pharmacokinetics
- Norpregnadienes/administration & dosage
- Norpregnadienes/adverse effects
- Norpregnadienes/blood
- Norpregnadienes/pharmacokinetics
- Orgasm/drug effects
- Progestins/administration & dosage
- Progestins/adverse effects
- Progestins/blood
- Progestins/pharmacokinetics
- Regional Blood Flow/drug effects
- Self Report
- Sexual Behavior/drug effects
- Ultrasonography, Doppler
- Young Adult
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Affiliation(s)
- Maurizio Guida
- a Department of Medicine "Scuola Medica Salernitana" , University of Salerno , Salerno , Italy
- b Theoreo srl - spin-off of the University of Salerno , Salerno , Italy
| | - Costantino Di Carlo
- c Department of Neurosciences and Reproductive Sciences , University of Naples Federico II , Naples , Italy , and
| | - Jacopo Troisi
- a Department of Medicine "Scuola Medica Salernitana" , University of Salerno , Salerno , Italy
- b Theoreo srl - spin-off of the University of Salerno , Salerno , Italy
| | - Alessandra Gallo
- a Department of Medicine "Scuola Medica Salernitana" , University of Salerno , Salerno , Italy
| | - Francesca Cibarelli
- a Department of Medicine "Scuola Medica Salernitana" , University of Salerno , Salerno , Italy
| | - Ellis Martini
- d Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause Unit, Dept of Obstetrics and Gynecology, IRCCS "S. Matteo Foundation", University of Pavia , Pavia , Italy
| | - Lara Tiranini
- d Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause Unit, Dept of Obstetrics and Gynecology, IRCCS "S. Matteo Foundation", University of Pavia , Pavia , Italy
| | - Rossella E Nappi
- d Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause Unit, Dept of Obstetrics and Gynecology, IRCCS "S. Matteo Foundation", University of Pavia , Pavia , Italy
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4
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Stocco B, Fumagalli HF, Franceschini SA, Martinez EZ, Marzocchi-Machado CM, de Sá MFS, Toloi MRT. Comparative study of the effects of combined oral contraceptives in hemostatic variables: an observational preliminary study. Medicine (Baltimore) 2015; 94:e385. [PMID: 25634167 PMCID: PMC4602984 DOI: 10.1097/md.0000000000000385] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Thrombotic risk is associated with the estrogen dose and type of progestin in combined oral contraceptives. Studies published since 1990 showed that third-generation progestins have larger risk to contribute to thrombosis development than the second-generation. However, there are conflicts in the literature regarding the thrombotic risk associated to the drospirenone progestin. So, this study aimed to evaluate the effects of 3 formulations of contraceptives containing ethinylestradiol (EE) (20 and 30 μg) combined with drospirenone versus levonorgestrel combined with EE (30 μg) in hemostatic parameters. This cross-sectional study included 70 healthy women between 18 and 30 years, BMI 19 to 30 kg/m², not pregnant, non-smokers, and users or non-users (control) of contraceptives for a minimum period of 6 months. The following parameters were assessed: prothrombin time (PT), Factor VII, activated partial thromboplastin time (aPTT), Factor XII, fibrinogen, Factor 1 + 2, Protein C, Protein S, antithrombin, D-dimers, and plasminogen activator inhibitor-1. Significant alterations were found in PT, aPTT, fibrinogen, D-dimers, and protein S, all favoring a state of hypercoagulation for contraceptive containing DRSP/20EE. Both contraceptives containing DRSP/30EE and LNG/30EE promoted changes that favor the hypercoagulability in the coagulant variable PT and in the anticoagulant variables Protein S and Protein C, respectively. We suggest that the progestin drospirenone can contribute to an inadequate balance among procoagulant, anticoagulant, and fibrinolytic factors, since that the contraceptive containing the lowest dose of estrogen and drospirenone (DRSP/20EE) caused a higher number of hemostatic changes.
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Affiliation(s)
- Bianca Stocco
- From the Department of Clinical, Toxicological and Bromatological Analysis, Faculty of Pharmaceutical, Sciences of Ribeirão Preto, (BS, HFF, CMM-M, MRTT); Department of Gynecology and Obstetrics (SAF,MFSDS); and Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil (EZM)
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5
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Stegeman BH, Raps M, Helmerhorst FM, Vos HL, van Vliet HAAM, Rosendaal FR, van Hylckama Vlieg A. Effect of ethinylestradiol dose and progestagen in combined oral contraceptives on plasma sex hormone-binding globulin levels in premenopausal women. J Thromb Haemost 2013; 11:203-5. [PMID: 23122048 DOI: 10.1111/jth.12054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
MESH Headings
- Adolescent
- Adult
- Biomarkers/blood
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/blood
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/blood
- Ethinyl Estradiol/administration & dosage
- Ethinyl Estradiol/adverse effects
- Ethinyl Estradiol/blood
- Female
- Humans
- Middle Aged
- Odds Ratio
- Premenopause/blood
- Progestins/administration & dosage
- Progestins/adverse effects
- Progestins/blood
- Risk Factors
- Sex Hormone-Binding Globulin/metabolism
- Venous Thrombosis/blood
- Venous Thrombosis/chemically induced
- Young Adult
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Affiliation(s)
- B H Stegeman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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6
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Divasta AD, Feldman HA, Giancaterino C, Rosen CJ, Leboff MS, Gordon CM. The effect of gonadal and adrenal steroid therapy on skeletal health in adolescents and young women with anorexia nervosa. Metabolism 2012; 61:1010-20. [PMID: 22257645 PMCID: PMC3465078 DOI: 10.1016/j.metabol.2011.11.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/29/2011] [Accepted: 11/30/2011] [Indexed: 12/20/2022]
Abstract
Anorexia nervosa (AN) is characterized by subnormal estrogen and dehydroepiandrosterone (DHEA) levels. We sought to determine whether the combination of DHEA + estrogen/progestin is superior to placebo in preserving skeletal health over 18 months in AN. Females with AN, aged 13 to 27 years, were recruited for participation in this double-blind, placebo-controlled, randomized trial. Ninety-four subjects were randomized, of whom 80 completed baseline assessments and received either study drug (oral micronized DHEA 50 mg + 20 µg ethinyl estradiol/0.1 mg levonorgestrel combined oral contraceptive pill [COC] daily; n = 43) or placebo (n = 37). Serial measurements of areal bone mineral density (aBMD), bone turnover markers, and serum hormone concentrations were obtained. Sixty subjects completed the 18-month trial. Spinal and whole-body aBMD z scores were preserved in the DHEA + COC group, but decreased in the placebo group (comparing trends, P = .008 and P = .001, respectively). Bone turnover markers initially declined in subjects receiving DHEA + COC and then returned to baseline. No differences in body composition, adverse effects of therapy, or alterations in biochemical safety parameters were observed. Combined therapy with DHEA + COC appears to be safe and effective for preventing bone loss in young women with AN, whereas placebo led to decreases in aBMD. Dehydroepiandrosterone + COC may be safely used to preserve bone mass as efforts to reverse the nutritional, psychological, and other hormonal components of AN are implemented.
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Affiliation(s)
- Amy D Divasta
- Division of Adolescent Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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7
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Stuart GS, Moses A, Corbett A, Phiri G, Kumwenda W, Mkandawire N, Chintedze J, Malunga G, Hosseinipour M, Cohen MS, Stanczyk FZ, Kashuba A. Combined oral contraceptives and antiretroviral PK/PD in Malawian women: pharmacokinetics and pharmacodynamics of a combined oral contraceptive and a generic combined formulation antiretroviral in Malawi. J Acquir Immune Defic Syndr 2011; 58:e40-3. [PMID: 21921726 PMCID: PMC3176587 DOI: 10.1097/qai.0b013e31822b8bf8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gretchen S. Stuart
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Amanda Corbett
- School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | | | | | | | | - Mina Hosseinipour
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Institute for Infectious Diseases and Global Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Myron S. Cohen
- Institute for Infectious Diseases and Global Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Frank Z. Stanczyk
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
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8
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Westhoff CL, Torgal AH, Mayeda ER, Pike MC, Stanczyk FZ. Pharmacokinetics of a combined oral contraceptive in obese and normal-weight women. Contraception 2010; 81:474-80. [PMID: 20472113 PMCID: PMC3522459 DOI: 10.1016/j.contraception.2010.01.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 01/07/2010] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study was conducted to compare oral contraceptive (OC) pharmacokinetics (PK) in normal-weight [body mass index (BMI) 19.0-24.9] and obese (BMI 30.0-39.9) women. STUDY DESIGN During the third week of the third cycle of OC use, we admitted 15 normal-weight and 15 obese women for collection of 12 venous specimens over 24 h. Using radioimmunoassay techniques, we measured levels of ethinyl estradiol (EE) and levonorgestrel (LNG). During the same cycle, women underwent twice-weekly sonography to assess ovarian follicular development and blood draws to measure endogenous estradiol (E2) and progesterone levels. RESULTS Obese women had a lower area under the curve (AUC; 1077.2 vs. 1413.7 pg*h/mL) and lower maximum values (85.7 vs. 129.5 pg/mL) for EE than normal-weight women (p=.04 and <0.01, respectively); EE trough levels were similar between BMI groups. The similar, but smaller, differences in their LNG levels for AUC and maximum values (C(max)) were not statistically significant. While peak values differed somewhat, the LNG trough levels were similar for obese and normal-weight women (2.6 and 2.5 ng/mL, respectively). Women with greater EE AUC had smaller follicular diameters (p=.05) and lower E2 levels (p=.04). While follicular diameters tended to be larger among obese women, these differences were not statistically significant. CONCLUSION OC hormone peak levels are lower among obese women compared to normal-weight women, but their trough levels are similar. In this small study, the observed PK differences did not translate into more ovarian follicular activity among obese OC users.
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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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9
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Roumen FJME. The contraceptive vaginal ring compared with the combined oral contraceptive pill: a comprehensive review of randomized controlled trials. Contraception 2007; 75:420-9. [PMID: 17519147 DOI: 10.1016/j.contraception.2007.01.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 01/18/2007] [Accepted: 01/19/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this review was to compare pharmacology, contraceptive efficacy, cycle control, side effects and acceptability with the combined contraceptive vaginal ring (CCVR) and combined oral contraceptives (COCs). STUDY DESIGN All randomized controlled trials (RCTs) between the CCVR and a COC up to and including December 2006 were analyzed. RESULTS Twelve RCTs comparing the CCVR and a COC were identified. Systemic exposure to ethinyl estradiol (EE) with the CCVR was half of that with a 30-microg EE-containing COC with less variation in serum levels. During CCVR use, sex hormone-binding globulin and cortisol-binding globulin concentrations were significantly less increased than during COC use. Both methods showed adequate ovarian suppression and equal contraceptive efficacy. Uterine concentrations of EE and etonogestrel were not elevated with the CCVR. Cycle control achieved with the CCVR was better than that of the COC. Compliance with both methods was high. Mean blood pressure and body weight did not change in either group. Incidence of adverse events such as breast tenderness, headache and nausea was comparable, but a higher incidence of local and ring-related events led to higher discontinuation rates in the CCVR group. Both contraceptives were highly acceptable and resulted in a global improvement of sexual function. Ring users were more likely to continue with their method after study completion than COC users. CONCLUSIONS The vaginal ring has the same contraceptive efficacy as COCs with lower systemic EE exposure, more consistent serum EE levels and better cycle control, but more local adverse events resulting in higher discontinuation rates.
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Affiliation(s)
- Frans J M E Roumen
- Department of Obstetrics and Gynecology, Atrium Medical Center Herlen, 6419 Heerlen, The Netherlands.
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10
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Trapnell CB, Connolly M, Pentikis H, Forbes WP, Bettenhausen DK. Absence of effect of oral rifaximin on the pharmacokinetics of ethinyl estradiol/norgestimate in healthy females. Ann Pharmacother 2007; 41:222-8. [PMID: 17284510 DOI: 10.1345/aph.1h395] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Rifaximin is an oral rifampin analog, and its activity is targeted within the gastrointestinal tract. Some analogs induce the cytochrome P450 family of oxidative enzymes. Ethinyl estradiol (EE), commonly found in oral contraceptives (OCs), is a known CYP3A4 substrate. OBJECTIVE To determine the potential effect of rifaximin on EE and norgestimate pharmacokinetics. METHODS In an open-label, crossover study, healthy females received a single dose of OC (EE 0.07 mg/norgestimate 0.50 mg). Following a 1 week washout period, individuals received rifaximin 200 mg every 8 hours for 3 days, with a single dose of OC administered with the ninth rifaximin dose. During both treatment periods, blood samples were collected periodically for up to 96 hours after each OC dose. Plasma concentration-time profiles and pharmacokinetic parameters were characterized for EE and 2 major metabolites of norgestimate, norgestrel (NG) and 17-deacetyl norgestimate (17-DNGM). A drug-drug interaction was confirmed if the 90% CI for the 2 treatment period comparison was outside the 80-125% limit. RESULTS Twenty-six of 28 women completed the study. No differences in pharmacokinetic parameters were observed for EE, NG, or 17-DNGM when a single dose of the OC was administered alone or with rifaximin. In addition, the 90% CI for the bioavailability contrasts (OC alone vs OC with rifaximin) for the maximum plasma concentration, area under the plasma concentration-time curve from zero to the last measurable plasma concentration or to infinity for EE, NG, and 17-DNGM all ranged from 86-118%. These intervals were within the predefined range for equivalence; therefore, no interaction was observed between OC and rifaximin. Rifaximin was well tolerated. CONCLUSIONS Administration of a 3 day dosing regimen of oral rifaximin was well tolerated and did not alter the pharmacokinetics of a commonly used combination OC containing EE and norgestimate.
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Affiliation(s)
- Carol Braun Trapnell
- Clinical Research and Development, ICON Development Solutions, Ellicott City, MD, USA
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11
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Sidhu J, Job S, Singh S, Philipson R. The pharmacokinetic and pharmacodynamic consequences of the co-administration of lamotrigine and a combined oral contraceptive in healthy female subjects. Br J Clin Pharmacol 2006; 61:191-9. [PMID: 16433873 PMCID: PMC1885007 DOI: 10.1111/j.1365-2125.2005.02539.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To assess the pharmacokinetic and pharmacodynamic effects of co-administration of a combined oral contraceptive (ethinyloestradiol plus levonorgestrel) and lamotrigine. METHODS Over a period of 130 days, healthy female subjects took lamotrigine (titrated up to 300 mg day(-1)) and the combined oral contraceptive, either individually or as co-therapy. Plasma ethinyloestradiol and levonorgestrel concentrations were measured in the presence and absence of lamotrigine, and serum lamotrigine concentrations were measured in the presence and absence of the combined oral contraceptive. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), progesterone, oestradiol and sex hormone binding globulin were also determined. RESULTS Of the 22 enrolled subjects, 16 had evaluable pharmacokinetic data. The mean (90% CI) ratios of lamotrigine area under the concentration-time curve from 0 to 24 h (AUC(0,24 h)) and maximum observed concentration (C(max)) of lamotrigine when it was given with the combined oral contraceptive and during monotherapy were 0.48 (0.44, 0.53) and 0.61 (0.57, 0.66), respectively. Ethinyloestradiol pharmacokinetics were unchanged by lamotrigine, the mean combined oral contraceptive + lamotrigine : combined oral contraceptive alone ratios (90% CI) of the AUC(0,24 h) and C(max) of levonorgestrel were 0.81 (0.76, 0.86) and 0.88 (0.82, 0.93), respectively. FSH and LH concentrations were increased (by 4.7-fold and 3.4-fold, respectively) in the presence of lamotrigine, but the low serum progesterone concentrations suggested that suppression of ovulation was maintained. Intermenstrual bleeding was reported by 7/22 (32%) of subjects during co-administration of lamotrigine and combined oral contraceptive. CONCLUSIONS A clinically relevant pharmacokinetic interaction was observed during co-administration of a combined oral contraceptive and lamotrigine. A dosage adjustment for lamotrigine may need to be considered when these agents are co-administered. A modest decrease in the plasma concentration of levonorgestrel was also observed but there was no corresponding hormonal evidence of ovulation.
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Roumen FJME, Dieben TOM. Comparison of uterine concentrations of ethinyl estradiol and etonogestrel after use of a contraceptive vaginal ring and an oral contraceptive. Fertil Steril 2006; 85:57-62. [PMID: 16412731 DOI: 10.1016/j.fertnstert.2005.06.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 06/28/2005] [Accepted: 06/28/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare uterine tissue concentrations of ethinyl estradiol (EE) and etonogestrel (ENG) after one cycle of use of a contraceptive vaginal ring (NuvaRing; NV Organon, Oss, The Netherlands) or a combined oral contraceptive (COC). DESIGN Randomized, open-label, pharmacokinetic study. SETTING Obstetrics and gynecology unit. PATIENT(S) Eight premenopausal women about to undergo hysterectomy but otherwise healthy. INTERVENTION(S) One cycle (17-21 days) of NuvaRing or COC treatment that ended with surgical hysterectomy. MAIN OUTCOME MEASURE(S) Tissue concentrations of EE and ENG in uterine tissue samples taken from the upper myometrium and mid-myometrium, the cervical region, and the endometrium. RESULT(S) In both groups, concentrations of EE and ENG were similar in uterine tissue taken from the upper myometrium and mid-myometrium and the cervical region. However, compared with the COC group, concentrations of both hormones were markedly lower in tissue samples from the endometrium of women who had been treated with NuvaRing. CONCLUSION(S) Vaginal administration of hormones with NuvaRing did not produce elevated uterine concentrations of EE and ENG, compared with an oral contraceptive.
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Affiliation(s)
- Frans J M E Roumen
- Department of Obstetrics and Gynecology, Atrium Medisch Centrum, Heerlen, The Netherlands
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13
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Sigridov I, Dikov I, Ivanov S. [Transdermal contraception--a new beginning]. Akush Ginekol (Sofiia) 2004; 43 Suppl 1:19-27. [PMID: 15323313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
MESH Headings
- Administration, Cutaneous
- Contraception/methods
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/blood
- Contraceptive Agents, Female/pharmacokinetics
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/blood
- Contraceptives, Oral, Combined/pharmacokinetics
- Drug Combinations
- Ethinyl Estradiol/administration & dosage
- Ethinyl Estradiol/blood
- Ethinyl Estradiol/pharmacokinetics
- Ethisterone/analogs & derivatives
- Female
- Humans
- Norgestrel/analogs & derivatives
- Oximes
- Skin Absorption
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Hall SD, Wang Z, Huang SM, Hamman MA, Vasavada N, Adigun AQ, Hilligoss JK, Miller M, Gorski JC. The interaction between St John's wort and an oral contraceptive. Clin Pharmacol Ther 2003; 74:525-35. [PMID: 14663455 DOI: 10.1016/j.clpt.2003.08.009] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The popular herbal remedy St John's wort is an inducer of cytochrome P450 (CYP) 3A enzymes and may reduce the efficacy of oral contraceptives. Therefore we evaluated the effect of St John's wort on the disposition and efficacy of Ortho-Novum 1/35 (Ortho-McNeil Pharmaceutical, Inc, Raritan, NJ), a popular combination oral contraceptive pill containing ethinyl estradiol (INN, ethinylestradiol) and norethindrone (INN, norethisterone). METHODS Twelve healthy premenopausal women who were using oral contraception (>3 months) received a combination oral contraceptive pill (Ortho-Novum 1/35) for 3 consecutive 28-day menstrual cycles. During the second and third cycles, the participants received 300 mg St John's wort 3 times a day. The serum concentrations of ethinyl estradiol (day 7), norethindrone (day 7), follicle-stimulating hormone (days 12-16), luteinizing hormone (days 12-16), progesterone (day 21), and intravenous and oral midazolam (days 22 and 23) were determined in serial blood samples. The incidence of breakthrough bleeding was quantified during the first and third cycles. RESULTS Concomitant use of St John's wort was associated with a significant (P <.05) increase in the oral clearance of norethindrone (8.2 +/- 2.7 L/h to 9.5 +/- 3.4 L/h, P =.042) and a significant reduction in the half-life of ethinyl estradiol (23.4 +/- 19.5 hours to 12.2 +/- 7.1 hours, P =.023). The oral clearance of midazolam was significantly increased (109.2 +/- 47.9 L/h to 166.7 +/- 81.3 L/h, P =.007) during St John's wort administration, but the systemic clearance of midazolam was unchanged (37.7 +/- 11.3 L/h to 39.0 +/- 10.3 L/h, P =.567). Serum concentrations of follicle-stimulating hormone, luteinizing hormone, and progesterone were not significantly affected by St John's wort dosing (P >.05). Breakthrough bleeding occurred in 2 of 12 women in the control phase compared with 7 of 12 women in the St John's wort phase. The oral clearance of midazolam after St John's wort dosing was greater in women who had breakthrough bleeding (215.9 +/- 66.5 L/h) than in those who did not (97.5 +/- 37.2 L/h) (P =.005). CONCLUSION St John's wort causes an induction of ethinyl estradiol-norethindrone metabolism consistent with increased CYP3A activity. Women taking oral contraceptive pills should be counseled to expect breakthrough bleeding and should consider adding a barrier method of contraception when consuming St Johns wort.
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MESH Headings
- Administration, Oral
- Adult
- Area Under Curve
- Aryl Hydrocarbon Hydroxylases/biosynthesis
- Aryl Hydrocarbon Hydroxylases/metabolism
- Contraceptives, Oral, Combined/blood
- Contraceptives, Oral, Combined/metabolism
- Contraceptives, Oral, Combined/pharmacokinetics
- Cytochrome P-450 CYP3A
- Drug Combinations
- Drug Interactions
- Enzyme Induction/drug effects
- Female
- Follicle Stimulating Hormone/blood
- Half-Life
- Humans
- Hypericum
- Hypnotics and Sedatives/pharmacokinetics
- Injections, Intravenous
- Menstrual Cycle/drug effects
- Mestranol/metabolism
- Mestranol/pharmacokinetics
- Metabolic Clearance Rate
- Midazolam/pharmacokinetics
- Norethindrone/metabolism
- Norethindrone/pharmacokinetics
- Oxidoreductases, N-Demethylating/biosynthesis
- Oxidoreductases, N-Demethylating/metabolism
- Plant Preparations/administration & dosage
- Plant Preparations/pharmacology
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Affiliation(s)
- Stephen D Hall
- Division of Clinical Pharmacology, Department of Medicine, Myers Building, W7123, Wishard Hospital, 1001 W 10th St, Indianapolis, IN 46202-2879, USA.
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15
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Hammond GL, Abrams LS, Creasy GW, Natarajan J, Allen JG, Siiteri PK. Serum distribution of the major metabolites of norgestimate in relation to its pharmacological properties. Contraception 2003; 67:93-9. [PMID: 12586319 DOI: 10.1016/s0010-7824(02)00473-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Norelgestromin (NGMN) and levonorgestrel (LNG) are the main active metabolites of norgestimate (NGM), but their relative contributions to the pharmacological effects of NGM are unclear. We have therefore determined the serum distribution of these NGM metabolites and assessed their steady-state concentrations in women following >or=3 cycles of oral contraceptive (OC) use. The administration of 250 microg NGM/35 microg ethinyl estradiol (EE) resulted in significantly higher sex hormone-binding globulin (SHBG) levels (p = 0.002), and 30% lower serum non-protein-bound (NPB) levels of testosterone, when compared to treatment with 150 microg LNG/30 microg EE. We also confirmed that NGMN does not bind to SHBG, and found that 97.2% of this metabolite is bound to albumin while only 2.8% is in the NPB fraction. In contrast, most of the LNG was bound to SHBG (92.5% and 87.2% after NGM/EE and LNG/EE treatment, respectively), and the NPB fraction of LNG (0.7%) during NGM/EE treatment was lower (p < 0.001) than during LNG/EE treatment (1.4%). Combining these serum distributions with the C(max) and AUC(0-24h) data obtained after NGM/EE treatment gave NPB and albumin-bound values of NGMN that were much greater than the corresponding LNG values. Furthermore, the C(max) and AUC(0-24h) values for NPB LNG during NGM/EE treatment were estimated to be lower than during LNG/EE treatment. Since LNG is primarily bound by SHBG, its access to target tissues is restricted. Moreover, because SHBG does not bind NGMN, it appears to be quantitatively the more important NGM metabolite available to target tissues, and probably accounts for a substantial proportion of the progestogenic activity of NGM/EE OCs. However, it is also possible that simultaneous exposure of NGMN and LNG after treatment with NGM/EE may provide clinical benefits not seen with LNG/EE combinations.
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Affiliation(s)
- Geoffrey L Hammond
- Department of Obstetrics and Gynecology, University of Western Ontario,790 Commissioners Rd East, London, Ontario N6A 4L6, Canada.
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16
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Moore KHP, McNeal S, Britto MR, Bye C, Sale M, Richardson MS. The pharmacokinetics of sumatriptan when administered with norethindrone 1 mg/ethinyl estradiol 0.035 mg in healthy volunteers. Clin Ther 2002; 24:1887-901. [PMID: 12501881 DOI: 10.1016/s0149-2918(02)80086-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Because the majority of migraineurs are young women in their peak reproductive years, it is important to understand the possible effects on the pharmacokinetics of both medications when sumatriptan is coadministered with an oral contraceptive (OC). OBJECTIVES The primary objective of this study was to assess the effect of multiple dosing of the OC norethindrone 1 mg/ethinyl estradiol 0.035 mg (NE/EE) on the single-dose pharmacokinetics of sumatriptan in healthy volunteers. Secondary objectives were to determine the effect of a single dose of sumatriptan on the multiple-dose pharmacokinetics of NE and EE, and to assess the safety and tolerability of the combination. METHODS This was an open-label, 1-sequence, crossover study in healthy women who had been receiving NE/EE for at least 3 months. Subjects received 1 cycle of NE/EE, consisting of 21 days of OC and 7 days of placebo. They also received a single dose of sumatriptan 50 mg on the last day of the OC or placebo regimen. Blood samples for the determination of plasma sumatriptan concentrations were collected on days 21 and 28, and blood samples for the determination of plasma NE and EE concentrations were collected on days 20 and 21. Treatments were compared by analysis of variance. Equivalence between treatments was to be concluded if the 90% Cl for the ratio of reference to test means for log(e)-transformed parameters (area under the plasma concentration-time curve [AUCI and maximum measured plasma concentration [C(max)]) for each analyte fell within the interval 0.80 to 1.25. RESULTS Twenty-six women (mean age, 29.8 years; age range, 18-44 years; weight range, 52-82 kg) participated in the study. The 90% CI for the ratio of reference to test means for the AUC extrapolated to infinity (AUC(infinity)) of sumatriptan was 1.11 to 1.22, and the 90% CIs for the AUC over the dosing interval at steady state (AUC(tau)) of NE and EE were 0.96 to 1.00 and 0.91 to 0.97, respectively. The 90% CIs for the ratio of reference to test means for the C(max) of sumatriptan, NE, and EE were a respective 1.05 to 1.30, 0.76 to 0.88, and 0.88 to 1.04. Study treatments were well tolerated. Adverse events were mild or moderate, and there were no clinically significant changes in vital signs or laboratory values. CONCLUSIONS The extent of absorption (AUC) of sumatriptan, NE, and EE was similar after oral administration of sumatriptan and NE/EE, both alone and in combination. Thus, in the opinion of the study investigators, there were no clinically relevant changes in the AUC of any of the medications when sumatriptan and NE/EE were administered concomitantly compared with administration alone. The results of this study suggest that dose adjustment is not necessary when sumatriptan is administered concomitantly with NE/EE in healthy premenopausal women.
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Affiliation(s)
- Katy H P Moore
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline, Research Triangle Park, North Carolina 27709-3398, USA.
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17
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Sağsöz N, Akçay F, Bayram M. Effects of oral contraceptives with low-dose estrogen and desogestrel on leptin concentrations. J Reprod Med 2002; 47:545-8. [PMID: 12170530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To evaluate short-term leptin concentrations in women who use low-dose oral contraceptives. STUDY DESIGN From 15 women without medical problems, venous blood samples were taken: basal, between days 3 and 5 of menstruation, and in the third month. The Human Leptin Radioimmunassay Kit (Linco Research, Inc., St. Charles, Missouri) was used for leptin measurement. Statistical analysis was done with the Wilcoxon test. RESULTS The average patient age was 30.1 +/- 6.7 years. The basal leptin concentrations and leptin concentrations at the third month were 22.17 +/- 8.85 and 23.04 +/- 6.77 ng/mL, respectively. This increase was not statistically significant. CONCLUSION Oral contraceptives with low-dose estrogen and desogestrel do not affect leptin concentrations in a three-month period.
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Affiliation(s)
- Nevin Sağsöz
- Department of Obstetrics and Gynecology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey.
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18
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Abstract
OBJECTIVE The pharmacokinetics of norelgestromin, the primary active metabolite of norgestimate, plus ethinyl estradiol (EE), delivered by the once-weekly contraceptive patch (Ortho Evra/Evra), have been studied in eight trials. This overview summarizes the relevant pharmacokinetic data for the contraceptive patch. DESIGN Review article. RESULT(S) The amount of norelgestromin and EE absorbed from the patch is proportional to patch size: the 20-cm(2) patch (Ortho Evra) delivers norelgestromin, 150 microg/d, and EE, 20 microg/d, to the systemic circulation. After single and multiple applications of the contraceptive patch, daily serum concentrations (area under the serum concentration-versus-time curve) of norelgestromin and EE were within the ranges generally seen with oral norgestimate, 250 microg/EE 35 microg (Ortho-Cyclen/Cilest), but without the peaks and troughs characteristic of oral dosing. Moreover, the contraceptive patch maintains serum concentrations of norelgestromin and EE within these ranges for up to 10 days, suggesting that clinical efficacy would be maintained even if a scheduled change is missed for as long as two full days. Regardless of the location of patch application (abdomen, buttock, upper outer arm, or torso [excluding breasts]) and even under conditions of heat, humidity, exercise, and cool-water immersion, efficacious concentrations of norelgestromin and EE are achieved. Coadministration of the patch with tetracycline did not affect the pharmacokinetics of norelgestromin and EE. CONCLUSION(S) The contraceptive patch exhibits an excellent pharmacokinetic profile, maintaining efficacious serum hormone concentrations under varying conditions.
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Affiliation(s)
- Larry S Abrams
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, New Jersey 08869, USA.
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19
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Abrams LS, Skee DM, Natarajan J, Wong FA, Anderson GD. Pharmacokinetics of a contraceptive patch (Evra/Ortho Evra) containing norelgestromin and ethinyloestradiol at four application sites. Br J Clin Pharmacol 2002; 53:141-6. [PMID: 11851637 PMCID: PMC1874289 DOI: 10.1046/j.0306-5251.2001.01532.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2001] [Accepted: 09/24/2001] [Indexed: 11/20/2022] Open
Abstract
AIMS To determine the pharmacokinetic profile of norelgestromin (NGMN) and ethinyloestradiol (EE) following application of the contraceptive patch, Evra/Ortho Evra, at each of four anatomic sites (abdomen, buttock, arm, and torso). METHODS Thirty-seven healthy, nonpregnant women aged 20-45 years participated in this open-label, four-period crossover study. Subjects were randomized to one of four treatment (site of application) sequences. Each patch was worn for 7 days, with a 1 month washout between treatments. Blood samples were collected before and at various times up to 240 h after application of each patch. Serum samples were assayed for NGMN and EE by validated methods. RESULTS The serum concentration reference ranges for NGMN and EE are 0.6-1.2 ng ml-1 and 25-75 pg ml-1, respectively, based on studies of the mean Cave of oral norgestimate 250 microg and EE 35 microg. For all application sites, mean concentrations of NGMN and EE remained within these ranges during the 7 day wear period. Absorption of NGMN and EE during patch application on the buttock, arm, and torso was equivalent. Absorption of NGMN and EE during patch application on the abdomen was approximately 20% less than observed for the other three sites, although mean serum concentrations were still within reference ranges. A previous study demonstrated therapeutic equivalence of patches worn on the abdomen vs other sites. CONCLUSIONS Serum concentrations of NGMN and EE from the contraceptive patch remain within the reference ranges throughout the 7 day wear period, regardless of the site of application (abdomen, buttock, arm, or torso).
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Affiliation(s)
- Larry S Abrams
- The R.W. Johnson Pharmaceutical Research Institute, 920 Route 202, Raritan, NJ 08869, USA.
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20
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Abstract
This review summarizes the clinical studies involving the once-weekly Ortho Evra/Evra contraceptive patch. The patch delivers norelgestromin (NGMN), 150 microg, and ethinyl estradiol (EE), 20 microg, daily to the systemic circulation. The contraceptive patch provided ovulation suppression and cycle control similar to that of oral norgestimate 250 microg/EE 35 microg, significantly decreased mean maximum follicular diameter following a 3-day intentional delayed dosing phase when compared with oral levonorgestrel (LNG) 50/75/125 microg/EE 30/40/30 micorg and oral LNG 100 microg/EE 20 microg, and was as effective as oral LNG 50/75/125 microg/EE 30/40/30 microg and oral desogestrel 150 microg/EE 20 microg in altering cervical mucus composition (i.e., creating a scanty, viscous consistency). The contraceptive patch provided efficacy, cycle control, and safety comparable to that seen with oral LNG 50/75/125 microg/EE 30/40/30 microg, but women were able to correctly follow the weekly dosing regimen significantly more often than the daily oral contraceptive dosing regimen. Less than 2% of patches were replaced because of complete detachment in these trials. The patch was not associated with phototoxicity or photoallergy. The contraceptive patch, the only noninvasive, weekly birth control method that a woman can self-administer, will be a valuable addition to current contraceptive options.
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Affiliation(s)
- G W Creasy
- The R.W. Johnson Pharmaceutical Research Institute, Raritan, New Jersey 08869, USA
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21
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Abrams LS, Skee DM, Wong FA, Anderson NJ, Leese PT. Pharmacokinetics of norelgestromin and ethinyl estradiol from two consecutive contraceptive patches. J Clin Pharmacol 2001; 41:1232-7. [PMID: 11697756 DOI: 10.1177/00912700122012788] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The primary objective of this open-label study was to determine the pharmacokinetics of norelgestromin (NGMN) and ethinyl estradiol (EE)following two consecutive applications of a contraceptive patch (ORTHO EVRA/EVRA). Twelve healthy women wore the first patch on their abdomen for 7 days and, after removal at 168 hours (day 7), wore a second patch for 10 days (i.e., 3 days beyond the intended 7-day wear period). Blood samples were collected before and at various times up to 456 hours (day 19) after application of the first patch for analysis of NGMN and EE. Mean serum concentrations of NGMN and EE remained within the reference ranges, 0.6 to 1.2 ng/ml and 25 to 75 pg/ml, respectively, during the entire 7-day wear period after application of the first patch and for 10 days after application of the second patch; reference ranges are based on studies with ORTHO-CYCLEN/ Cilest. No patch detached spontaneously. No subject discontinued or experienced a serious adverse event.
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Affiliation(s)
- L S Abrams
- The R. W Johnson Pharmaceutical Research Institute, Raritan, New Jersey 08869, USA
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Abstract
Ovulatory potential was studied during the use of two oral contraceptive pill preparations, after repeated mid-cycle administration of activated charcoal. Eleven women used monophasic pills containing gestodene, 75 microgram, plus ethinyl oestradiol, 30 microgram, or norethisterone acetate, 1 mg, plus ethinyl oestradiol, 30 microgram, for 4 months each, in randomized order. During both pill treatments the third cycle was a control cycle, and during the fourth cycle of both pill types, 5 g of activated charcoal was ingested four times a day, starting 3 h after pill intake, on cycle days 12, 13 and 14. Ovarian activity was monitored by intravaginal ultrasonography of follicles and by measurements of serum concentrations of LH, FSH, oestradiol and progesterone throughout the control and charcoal-treatment cycles of both pill treatments. None of the women ovulated. Follicular activity seen in two women did not correlate with charcoal administration. It is concluded that the possible enterohepatic recirculation of gestodene and norethisterone is not of clinical importance. Repeated charcoal treatment, when administered 3 h after but at least 12 h before pill intake, can be used to treat diarrhoea in women taking oral contraceptives.
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Affiliation(s)
- K Elomaa
- The Family Federation of Finland (Väestöliitto), FIN-00101 Helsinki, Finland
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Abstract
We tested the hypothesis that the shift in the cutaneous vasodilator response to hyperthermia seen with elevated female reproductive hormones is a prostaglandin-dependent resetting of thermoregulation to higher internal temperatures, similar to that seen in the febrile response to bacterial infection. Using water-perfused suits to control body temperature, we conducted heat stress experiments in resting women under conditions of low and high progesterone and estrogen and repeated these experiments after an acute dose of ibuprofen (800 mg). In six women the hormones were exogenous (oral contraceptives); three women had regular menstrual cycles and were tested in the early follicular and midluteal phases. Resting oral temperature (Tor) was significantly elevated with high hormone status (P < 0.05); this was not affected by ibuprofen treatment (P > 0.2). The Tor threshold for cutaneous vasodilation was significantly increased by high hormone status (+0.27 +/- 0.07 degrees C, P < 0. 02); the shift was not affected by ibuprofen treatment (with ibuprofen: +0.29 +/- 0.08 degrees C, P > 0.2 vs. control experiments). The Tor threshold for sweating was similarly increased by high hormone status (+0.22 +/- 0.05 degrees C, P < 0.05); this shift was not influenced by ibuprofen (with ibuprofen: +0.35 +/- 0. 05, P > 0.1 vs. control experiments). Thus the shift in thermoregulatory control of skin blood flow and sweating mediated by female reproductive steroids is not sensitive to ibuprofen; it therefore appears that this shift is independent of prostaglandins.
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Affiliation(s)
- N Charkoudian
- Department of Physiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-7756, USA
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Westwood M, Gibson JM, Pennells LA, White A. Modification of plasma insulin-like growth factors and binding proteins during oral contraceptive use and the normal menstrual cycle. Am J Obstet Gynecol 1999; 180:530-6. [PMID: 10076123 DOI: 10.1016/s0002-9378(99)70249-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Sex steroid regulation of the insulin-like growth factor axis is a subject of contention. We examined the effect of combined oral contraceptives and investigated the cyclic variations in the insulin-like growth factor axis. STUDY DESIGN Fasting blood samples were taken from 9 women receiving oral contraceptives, 10 women receiving no medication, and 10 male subjects. RESULTS In women receiving oral contraceptives, insulin-like growth factor binding protein 1 remained highly phosphorylated and levels were acutely increased by sex steroid treatment (305 +/- 110 microg/L on day 14 of the cycle [medication phase] vs 118 +/- 70 microg/L during the medication-free period, P <.03). In women receiving no medication, insulin-like growth factor binding protein 1 levels were significantly lower (69 +/- 50 microg/L on day 14 of the menstrual cycle, P <.001) and varied cyclically, with a rise in the late-secretory phase that coincided with the appearance of nonphosphorylated and less phosphorylated insulin-like growth factor binding protein 1 isoforms. Compared with those in untreated women and in men, insulin-like growth factor I levels were decreased in women receiving oral contraceptives (405 +/- 104 ng/mL in untreated women and 330 +/- 28 ng/mL in men vs 287 +/- 73 ng/mL in women receiving oral contraceptives, P <.004). Oral contraceptive use had no effect on insulin-like growth factor II levels, and neither insulin-like growth factor I nor insulin-like growth factor II showed cyclic variation. CONCLUSION The bioavailability of insulin-like growth factor I is reduced in users of oral contraceptives. This may contribute to the metabolic changes observed in such subjects.
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Affiliation(s)
- M Westwood
- Endocrine Sciences Research Group, Department of Medicine, and the School of Biological Sciences, University of Manchester, United Kingdom
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Bartoli A, Gatti G, Cipolla G, Barzaghi N, Veliz G, Fattore C, Mumford J, Perucca E. A double-blind, placebo-controlled study on the effect of vigabatrin on in vivo parameters of hepatic microsomal enzyme induction and on the kinetics of steroid oral contraceptives in healthy female volunteers. Epilepsia 1997; 38:702-7. [PMID: 9186253 DOI: 10.1111/j.1528-1157.1997.tb01240.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE This study was conducted to determine whether vigabatrin affects in vivo indices of hepatic microsomal enzyme activity and the pharmacokinetics of steroid oral contraceptives in healthy subjects. METHODS Under double-blind conditions, 13 female healthy volunteers received, in random order and with a washout interval of > or = 4 weeks, two oral 4-week treatments with vigabatrin (VGB) (maintenance dosage, 3,000 mg daily) and placebo, respectively. The clearance and half-life of antipyrine (a broad marker of drug oxidation capacity), the urinary excretion of 6-beta-hydroxycortisol (a selective marker of cytochrome CYP3A-mediated oxidation), and the activity of serum gamma-glutamyltransferase (a nonspecific index of microsomal enzyme activity) were determined after 3 weeks of each treatment. The single-dose kinetics of a combined oral contraceptive containing 30 micrograms ethinyl estradiol and 150 micrograms levonorgestrel were also determined after 3 weeks of treatment by specific radioimmunologic assays. RESULTS VGB treatment had no influence on antipyrine clearance (28 +/- 5.6 vs. 30 +/- 4.5 ml/h/kg on placebo), antipyrine half-life (15.5 +/- 3.5 vs. 14.1 +/- 2.1 h), urinary 6-beta-hydroxycortisol excretion (488 +/- 164 vs. 470 +/- 228 nmol/ day), 6-beta-hydroxycortisol-to-cortisol concentration ratio (6.8 +/- 3.1 vs. 6.1 +/- 3.1) and serum gamma-glutamyltransferase activity (12 +/- 3 vs. 11 +/- 3 IU/L). No difference in pharmacokinetic parameters between VGB and placebo sessions were found for ethinyl estradiol (half-life, 12.5 +/- 3.2 vs. 13.9 +/- 3.2 h; AUC, 874 +/- 301 vs. 939 +/- 272 ng/ L/h) and levonorgestrel (half-life, 17.7 +/- 5.2 vs. 23.1 +/- 9.8 h; AUC, 27.5 +/- 9.6 vs. 30.0 +/- 12.0 micrograms/L/h). Two subjects, however, showed a 50 and a 39% reduction in ethinyl estradiol AUC during VGB treatment. CONCLUSIONS At therapeutic dosages, VGB did not modify in vivo indices of hepatic microsomal enzyme activity and did not interfere significantly with the CYP3A-mediated metabolism of ethinyl estradiol and levonorgestrel. Based on these data, VGB is unlikely to affect consistently the efficacy of steroid oral contraceptives or interact pharmacokinetically with drugs that are eliminated mainly by oxidative pathways, particularly those involving cytochrome CYP3A.
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Affiliation(s)
- A Bartoli
- Clinical Pharmacology Unit, University of Pavia, Italy
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26
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Rosenfeld WE, Doose DR, Walker SA, Nayak RK. Effect of topiramate on the pharmacokinetics of an oral contraceptive containing norethindrone and ethinyl estradiol in patients with epilepsy. Epilepsia 1997; 38:317-23. [PMID: 9070594 DOI: 10.1111/j.1528-1157.1997.tb01123.x] [Citation(s) in RCA: 158] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Because enzyme-inducing antiepileptic drugs (AEDs) can affect pharmacokinetics of oral contraceptives and thereby cause contraceptive failure, the potential effect of topiramate, a new AED, on the pharmacokinetics of the combination oral contraceptive norethindrone/ethinyl estradiol was evaluated. METHODS Twelve women receiving stable valproic acid (VPA) monotherapy for epilepsy received a combination norethindrone 1.0 mg/ethinyl estradiol 35-microg tablet daily for 21 days followed by seven daily doses of inert tablets for four 28-day cycles. After a baseline cycle (cycle 1), topiramate 100, 200, and 400 mg every 12 h was administered in cycles 2 through 4, respectively. Serial blood samples were obtained on day 20 of each cycle and were analyzed for norethindrone, ethinyl estradiol, and progesterone by using validated radioimmunoassay methods. RESULTS Compared with cycle 1, none of the norethindrone pharmacokinetic parameters changed significantly in the presence of topiramate, 100-400 mg every 12 h. Individual patient serum progesterone concentrations measured during each cycle were at or close to the limit of quantification with no apparent differences among cycles. However, mean area under the concentration-versus-time curve over the 24-h period (AUC(0-24)) values for ethinyl estradiol were 18-30% lower in cycles 2 through 4 compared with cycle 1 (p < or = 0.05 for all pairs), whereas mean oral serum clearance (CL/F) values were 14.7-33.0% higher (p < or = 0.05 for cycles 2 and 4 vs. cycle 1). Mean time of peak concentration (T(max)) values determined during topiramate therapy were not significantly different from those at baseline. CONCLUSIONS When prescribing an oral contraceptive for patients receiving topiramate, clinicians should consider initial therapy with an agent containing > or = 35 microg of ethinyl estradiol.
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Affiliation(s)
- W E Rosenfeld
- The Comprehensive Epilepsy Care Center for Children and Adults at St. Luke's Hospital, St. Louis, Missouri 63017, USA
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27
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Saano V, Glue P, Banfield CR, Reidenberg P, Colucci RD, Meehan JW, Haring P, Radwanski E, Nomeir A, Lin CC. Effects of felbamate on the pharmacokinetics of a low-dose combination oral contraceptive. Clin Pharmacol Ther 1995; 58:523-31. [PMID: 7586946 DOI: 10.1016/0009-9236(95)90172-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effects of felbamate on the pharmacokinetics of a low-dose combination oral contraceptive containing 30 micrograms ethinyl estradiol and 75 micrograms gestodene were assessed in a randomized, double-blind, placebo-controlled parallel-group study in healthy premenopausal female volunteers established in a regimen of oral contraceptive use. They received either placebo or 2400 mg/day felbamate from midcycle (day 15) to midcycle (day 14) of two consecutive oral contraceptive cycles (months 1 and 2). Pharmacokinetic assessments of ethinyl estradiol and gestodene were performed on day 14 of both cycles. To determine whether ovulation occurred, plasma progesterone and urinary luteinizing hormone levels were measured, and diaries recording vaginal bleeding were kept. Felbamate treatment resulted in a significant 42% decrease in gestodene area under the plasma concentration-time curve (0 to 24 hours) (p = 0.018) compared with baseline, whereas a minor but not clinically relevant effect was observed on the pharmacokinetic parameters of ethinyl estradiol. There were no changes in the pharmacokinetics of ethinyl estradiol or gestodene after placebo treatment. No volunteer showed hormonal evidence of ovulation; however, one volunteer reported the onset of intermenstrual bleeding during felbamate treatment. Because of the effect of felbamate on the pharmacokinetics of gestodene and the report of intermenstrual bleeding, it is possible that the contraceptive efficacy of low-dose combination oral contraceptives may be adversely affected during felbamate treatment.
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Affiliation(s)
- V Saano
- Department of Pharmacology, University of Kuopio
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28
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Abstract
1. The effects of tenidap sodium and placebo on the pharmacokinetics of a combined oral contraceptive (Microgynon 30) were evaluated in 18 healthy premenopausal women in a double-blind, cross-over study lasting two menstrual cycles. 2. Tenidap (120 mg day-1) or placebo was given for 11 days, starting within 4 days of menstruation and Microgynon 30, containing levonorgestrel (150 micrograms) and ethinyloestradiol (30 micrograms), was administered on day 10 of tenidap therapy. 3. The mean maximum plasma levonorgestrel concentrations (Cmax), time to Cmax (tmax) and area under the plasma time-concentration curves (AUC(0,t)) did not differ between subjects given tenidap or placebo. The Cmax, tmax and AUC(0,t) values for ethinyloestradiol did not differ between tenidap and placebo recipients. Only the ethinyloestradiol Cmax showed a significant difference (P = 0.02) between menstrual cycles 1 and 2 (252.9 pg ml-1 and 271.3 pg ml-1, respectively). 4. Co-administration of tenidap and Microgynon 30 was well tolerated and no subject withdrew from the study because of side-effects. There were no side-effects considered to be related to tenidap and no clinically significant laboratory abnormalities were considered to be related to treatment. 5. The results of the study suggest that the pharmacokinetics of the oestrogen and progestin components of the oral contraceptive Microgynon 30 are unlikely to be affected by concomitant administration of tenidap.
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Affiliation(s)
- P E Coates
- Early Clinical Research Group, Pfizer Central Research, Sandwich, Kent, UK
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29
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Hümpel M, Täuber U, Kuhnz W, Pfeffer M, Brill K, Heithecker R, Louton T, Steinberg B, Seifert W, Schütt B. Protein binding of active ingredients and comparison of serum ethinyl estradiol, sex hormone-binding globulin, corticosteroid-binding globulin, and cortisol levels in women using a combination of gestodene/ethinyl estradiol (Femovan) or a combination of desogestrel/ethinyl estradiol (Marvelon) and single-dose ethinyl estradiol bioequivalence from both oral contraceptives. Am J Obstet Gynecol 1990; 163:329-33. [PMID: 2142574 DOI: 10.1016/0002-9378(90)90577-t] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Results from two clinical pharmacokinetic studies are given. The first study was an observational study in oral contraceptive users who took either a combination of gestodene and ethinyl estradiol (pill A, Femovan) or desogestrel and ethinyl estradiol (pill B, Marvelon). A total of 69 women (39 receiving pill A and 30 receiving pill B) were evaluated to determine serum ethinyl estradiol, sex hormone-binding globulin, corticosteroid-binding globulin, and cortisol levels. Samples were obtained on 1 day during the tenth to twenty-first days of pill intake. All women received the respective oral contraceptive for at least 3 months. The test power was such that an 80% difference of 1 standard deviation of each target variable would have been detected (alpha = 0.05; beta = 0.1). No statistically significant differences were found in sex hormone-binding globulin, corticosteroid-binding globulin, or cortisol serum levels between both groups. Time and height of maximum ethinyl estradiol levels were identical as was the area under the curves. Ex vivo protein-binding analysis of the progestins revealed a free portion of 0.6% for gestodene and 2.5% for 3-ketodesogestrel as the active metabolite of desogestrel. Sex hormone-binding globulin-bound portions were much higher for gestodene (75.3% +/- 9.1%) than for 3-ketodesogestrel (31.6% +/- 12%). The remaining fractions were bound to albumin. In a second study, ethinyl estradiol-bioequivalence from pills A and B was investigated in 18 women in a controlled, single-dose, randomized, crossover design. The area under the ethinyl estradiol serum levels were identical up to 4 hours after pill intake between both treatments. According to the relatively low variation in data in this group of women, a 10% difference in ethinyl estradiol-availability could have been detected. Both studies indicate that the pharmacokinetics of ethinyl estradiol were independent of the concomitantly administered progestin, that is, desogestel and gestodene.
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Affiliation(s)
- M Hümpel
- Research Laboratories of Schering AG, Berlin, West Germany
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30
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Pérez-López FR. Pituitary repetitive stimulation with GnRH/TRH in women treated with three different oral steroid contraceptives. Acta Endocrinol (Copenh) 1990; 122:163-7. [PMID: 2107650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Twelve untreated cycling women and 45 women using oral contraceptives were challenged iv with 50 micrograms of GnRH and 100 micrograms of TRH at 0, 90 and 180 min. The LH responses after the second and third pulses of GnRH/TRH were diminished in women treated with 30 micrograms of ethinylestradiol and levonorgestrel as compared with the control group, whereas the responses were severely blunted after each dose of GnRH/TRH in women treated with 50 micrograms of ethinylestradiol and levonorgestrel or lynestrenol as compared with both the control group and the women treated with 30 micrograms of ethinylestradiol and levonorgestrel. The FSH responses to GnRH/TRH in women treated with 30 micrograms of ethinylestradiol and levonorgestrel were similar to those in the control group, whereas there were reductions in the responses obtained in women treated with 50 micrograms of ehinylestradiol and progestin as compared with both the control group and the women under 30 micrograms of ethinylestradiol and levonorgestrel. In women treated with 30 micrograms of ethinylestradiol and levonorgestrel, the PRL peaks after the second and third pulses were higher than the first, and higher than the values obtained in the remaining three groups.
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MESH Headings
- Adult
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/blood
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Synthetic/administration & dosage
- Female
- Follicle Stimulating Hormone/blood
- Follicle Stimulating Hormone/metabolism
- Gonadotropin-Releasing Hormone/administration & dosage
- Gonadotropins, Pituitary/blood
- Gonadotropins, Pituitary/metabolism
- Humans
- Luteinizing Hormone/blood
- Luteinizing Hormone/metabolism
- Pituitary Gland/drug effects
- Pituitary Gland/physiology
- Thyrotropin-Releasing Hormone/administration & dosage
- Time Factors
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Affiliation(s)
- F R Pérez-López
- Department of Obstetrics and Gynecology, Hospital Clinico Universitario, University of Zaragoza Faculty of Medicine, Spain
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31
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Abstract
The metabolism of radiolabeled 125I-low density lipoprotein (LDL) was studied in cultured human aortic smooth muscle cells (SMC) to investigate potential mechanisms contributing to heart attack and stroke in young women taking oral contraceptive (OC) preparations. No consistent difference was discerned in the capacity of these cells to bind and internalize LDL following 24-hour exposure to pooled lipoprotein-poor (d greater than 1.25 gm/ml) serum from nonsmoking OC users and controls. However, significantly (p greater than 0.01) less soluble radioactive material was released into the media from dishes containing SMC incubated with OC serum, indicating that their capacity to degrade LDL was impaired. Increased amounts of both cholesterol and cholesterol ester and electron microscopic evidence of lipid accumulation were found in SMC grown for 12 days under standard culture conditions with 10% OC serum. This combination of in vitro findings suggests that OC use may accelerate the development of cardiovascular disease in some women by modifying the metabolism of LDL by cells of the arterial wall.
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MESH Headings
- Adolescent
- Adult
- Cells, Cultured
- Contraceptives, Oral, Combined/blood
- Contraceptives, Oral, Combined/pharmacokinetics
- Contraceptives, Oral, Combined/pharmacology
- Contraceptives, Oral, Synthetic/blood
- Contraceptives, Oral, Synthetic/pharmacokinetics
- Contraceptives, Oral, Synthetic/pharmacology
- Drug Combinations
- Female
- Humans
- Lipoproteins, LDL/metabolism
- Mestranol/blood
- Mestranol/pharmacokinetics
- Mestranol/pharmacology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/ultrastructure
- Norethindrone/blood
- Norethindrone/pharmacokinetics
- Norethindrone/pharmacology
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Affiliation(s)
- J D Bagdade
- Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612
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32
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Goebelsmann U, Hoffman D, Chiang S, Woutersz T. The relative bioavailability of levonorgestrel and ethinyl estradiol administered as a low-dose combination oral contraceptive. Contraception 1986; 34:341-51. [PMID: 3096634 DOI: 10.1016/0010-7824(86)90087-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The relative bioavailability of levonorgestrel (LNG) and ethinyl estradiol (EE) administered concomitantly both as an oral tablet and as a solution was assessed in a randomized two-period crossover study in 24 healthy women. Serum concentrations were monitored for 96 h after each administration. The relative bioavailability (Fr) of LNG in the tablet with respect to the solution was 107%; thus the two formulations were bioequivalent with respect to LNG. The relative bioavailability of EE, however, was significantly lower for the tablet (Fr 83%) compared to the solution. This difference may have been due to either decreased absorption or enhanced presystemic elimination of EE from the tablet formulation.
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33
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Saperstein S, Edgren RA, Ellis DJ, Lee GJ, Kushinsky S, Olmsted A, Mroszczak E. Bioequivalence of norethindrone and ethinyl estradiol for two different weight tablets with the same hormonal content. Contraception 1986; 33:547-57. [PMID: 3769481 DOI: 10.1016/0010-7824(86)90043-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Two tablets of differing weights, 100 mg (A) and 50 mg (B), of an oral contraceptive drug (OC) were compared with each other and to a solution (C) of the same components. The composition of the OC consisted of 1 mg of norethindrone (NET) and 0.035 mg of ethinyl estradiol (EE2). Both tablets were shown to differ from the solution, which was more rapidly absorbed, but were not significantly different from each other. Formulation means for NET and EE2, for each of the two products, were similar. Application of an interval test for the ratio of computed parameters demonstrated equivalence of the two formulations with respect to 0-24 hr area under the curve (AUC24) and total area under the curve (AUC+o+) for both NET and EE2 and with respect to concentration maximum (Cmax) for EE2. The data support the hypothesis for bioequivalence of the two formulations with respect to total absorption.
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34
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el-Raghy I, Back DJ, Makeram M, Salem H, Osman F, Fathalla M, Orme ML. Pharmacokinetics of oral contraceptive steroids in Egyptian women: studies with Ovral, Nordette and Norminest. Contraception 1986; 33:379-84. [PMID: 3089683 DOI: 10.1016/0010-7824(86)90100-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Plasma concentration profiles and pharmacokinetic parameters have been obtained following single dose administration of three commonly used oral contraceptive steroid preparations, Ovral, Nordette and Norminest to Egyptian women. The constituents of the preparations are as follows: Ovral (50 micrograms ethinyloestradiol, EE2 and 500 micrograms levonorgestrel, LNG); Nordette (30 micrograms EE2 and 150 micrograms LNG); and Norminest (35 micrograms EE2 and 500 micrograms norethisterone, NOR). Peak plasma concentrations of EE2 ranged between 116-160 pg ml-1 for Ovral, 55-78 pg ml-1 for Norminest and 30-70 pg ml-1 for Nordette. There was no significant difference in half-life (t1/2), oral clearance (CL) or apparent volume of distribution (Vd). The relative values of the area under the plasma concentration-time curve (AUC) reflected well the different amounts of oestrogen in each preparation. There was no significant difference in t1/2, CL or Vd for LNG in the 2 preparations containing this progestogen. The mean AUC following Nordette (150 micrograms LNG) was 40% of that following Ovral (500 micrograms LNG; p less than 0.001). Comparing pharmacokinetic parameters for the same dose of LNG (Ovral) and NOR (Norminest) showed the AUC to be decreased and CL and Vd increased in the latter group. The study indicates that the kinetic profile of the OCS in healthy Egyptian women are similar to other ethnic populations.
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35
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Croxatto HB, Díaz S, Brandeis A, Pavez M, Johansson ED. Plasma levonorgestrel and progesterone levels in women treated with silastic covered rods containing levonorgestrel. Contraception 1985; 31:643-54. [PMID: 3930143 DOI: 10.1016/0010-7824(85)90064-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Levonorgestrel and progesterone plasma levels were measured in women bearing levonorgestrel subdermal implants. Two groups using four or six levonorgestrel covered rods and one group of non-hormonal contraceptors were compared. Blood samples were drawn twice a week for six consecutive weeks at different intervals after treatment administration. The mean levonorgestrel levels (mean +/- S.D.) observed in the four rods group was .49 +/- .13 ng/ml in the first year and decreased to .34 +/- .06 in the fifth year of treatment. The mean values observed in the six rods group were .70 +/- .15 ng/ml in the second year and .43 +/- .11 in the sixth year. The levonorgestrel plasma levels were slightly above those found with Norplantr implants in the four rods group and well above it in the six rod group. The highest plasma progesterone value found in each sampling period was above 9 nmol/l in 7 (14%) out of 50 subjects in the four rods group, in 2 (4.3%) out of 47 subjects in the six rods group and in all the 49 control women. In 4 out of the 7 subjects from the 4 rods group and in the two subjects from the 6 rods group, the highest progesterone value was preceded and followed by values lower than 6 nmol/l. It was concluded that the progesterone levels were seldom compatible with the occurrence of ovulation in women treated with four or six levonorgestrel covered rods which release an estimated daily dose of 70 and 105 micrograms, respectively.
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Cekan SZ, Jia M, Landgren BM, Diczfalusy E. The interaction between sex hormone binding globulin and levonorgestrel released from vaginal rings in women. Contraception 1985; 31:431-9. [PMID: 3924477 DOI: 10.1016/0010-7824(85)90009-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The levels of levonorgestrel (L-NOG), progesterone and estradiol were measured in plasma samples of 17 normally menstruating women during a control cycle and during a subsequent period (90 days) with a L-NOG-releasing vaginal ring. During days 38-66 after the insertion of the vaginal ring the concentrations of sex hormone binding globulin binding sites (hereafter: SHBG levels) were also assayed. Significant correlations were found not only between the corresponding levels of SHBG and L-NOG during exposure to the latter compound (r = 0.44; P less than 0.05), but also between the levels of SHBG in the control cycle and the levels of L-NOG measured during exposure (r = 0.60; P less than 0.01). Furthermore, the decrease in SHBG levels during the vaginal administration of L-NOG was directly proportional to the levels of SHBG in the pretreatment cycle (r = 0.64; P less than 0.01). A significant relationship was found between the levels of L-NOG (and, hence - indirectly - the levels of SHBG) and the degree of suppression of ovarian function. Thus the levels of L-NOG were lower (P less than 0.01) in the subjects (n = 8) with an apparently normal or partially suppressed ovulatory-like pattern of progesterone than in those subjects (n = 9) in whom progesterone levels were completely suppressed.
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37
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Nilsson LO, Victor A, Kral JG, Johansson ED, Kock NG. Absorption of an oral contraceptive gestagen in ulcerative colitis before and after proctocolectomy and construction of a continent ileostomy. Contraception 1985; 31:195-204. [PMID: 3921310 DOI: 10.1016/0010-7824(85)90034-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Plasma 1-norgestrel (1-Ng) levels after administration of a common oral contraceptive in fertile women (mean age 29 +/- 5 yrs) with mild ulcerative colitis before or after proctocolectomy with a conventional ileostomy or a continent ileostomy reservoir were determined and compared to those of a group of healthy volunteers serving as controls. Before operation, peak and 10-hour levels of 1-Ng were not statistically different from control. Levels in patients with either type of ileostomy were slightly lower than controls, but were only statistically significantly lower in patients with continent ileostomy (p less than 0.05). In a subgroup of patients studied both before and after proctocolectomy with construction of a continent ileostomy, there was a slight reduction in peak and 10-hour levels compared to control. After administration of the pill directly into the reservoir, significant levels of 1-Ng in plasma were found with peak and 10-hour levels approximately one-half of those achieved after oral administration. Although the material is small, it suggests that patients with mild ulcerative colitis and with small ileal resections (8.8 +/- 8 cm) can use combined contraceptive pills containing 1-norgestrel with confidence. Caution should be exercised, however, in prescribing "mini-pills" to patients after proctocolectomy and ileal resection.
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38
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Naqvi RH, Mitra SB, Lindberg MC. Effect of dose on the pharmacokinetics of levonorgestrel in the rat during the rapid elimination phase following subcutaneous administration. Contraception 1984; 30:599-605. [PMID: 6442230 DOI: 10.1016/0010-7824(84)90009-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Adult female rats were given a single, subcutaneous injection of 8, 16 or 32 micrograms of levonorgestrel (LNG). Blood samples were collected at various time intervals and serum concentrations of LNG were determined by radioimmunoassay. The patterns of temporal decline in LNG concentrations in the three dose groups indicated that the pharmacokinetics of LNG during the post-absorptive, rapid-elimination (beta) phase in the rat may be dose-dependent. Half-life, Co and AUC increased with the dose and -beta decreased as the dose increased. Mathematical relationships have been presented which can be used to predict the four parameters as well as concentrations of LNG at any given time after subcutaneous administration during the beta-phase for a given dose in the range of 8-32 micrograms. Significance of dose-dependent pharmacokinetic studies is discussed.
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39
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Shaaban MM, el-Nashar IM, Ghaneimah SA, Gomaa AA, Salah M, Abdel-Aleem AM. Hormonal changes during the first year of use of subdermal levonoregestrel implants, Norplant. Contraception 1984; 30:391-405. [PMID: 6440735 DOI: 10.1016/0010-7824(84)90031-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sixty-three women had NORPLANT implants inserted during the first eight days of the menstrual cycle. Blood specimens were withdrawn at the time of insertion and every three days during one of the following months of observation; the first, third, sixth, ninth and twelfth month after insertion. Ten subjects were sampled at multiple times during implant use. A total of 83 months of observation was available. The serum concentrations of levonorgestrel (LNG), FSH, LH, prolactin (PRL), estradiol (E2) and progesterone (prog) were measured in each specimen. LNG concentration rapidly declined during the first 15 days of use, the decline became more gradual during the subsequent two weeks, and an almost steady level was reached during the remainder of the year. There were no significant trends of change in the levels of FSH, LH, E2 and prog during the year. Frequent peaks in E2 concentration were observed and were generally associated with or followed by LH surges. PRL concentration showed a slight but significant rise during the second half of the year. Rises in prog concentration suggestive of ovulation occurred in 36 percent of the months of observation. However, in all these instances, there were evidences suggestive of deficient luteal phase. The bleeding episodes were usually, but not always, related to decline in E2 and prog concentrations.
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40
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Kurunmäki H, Toivonen J, Lähteenmäki PL, Luukkainen T. Immediate postabortal contraception with Norplant: levonorgestrel, gonadotropin, estradiol, and progesterone levels over two postabortal months and return of fertility after removal of Norplant capsules. Contraception 1984; 30:431-42. [PMID: 6440739 DOI: 10.1016/0010-7824(84)90035-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Six Silastic levonorgestrel-releasing capsules, Norplant, were introduced subcutaneously into the ventral aspect of the left forearm or upper arm of thirteen patients immediately after first trimester pregnancy termination. Blood samples were taken twice a week over two months after abortion and from one subject over one month after removal of Norplant capsules. Plasma concentrations of levonorgestrel were measured by radioimmunoassay and the effects of treatment on pituitary and ovarian function were determined by assaying plasma concentrations of LH, FSH, estradiol and progesterone. If removal of Norplant capsules took place because of planning pregnancy, the subjects were asked to inform us if they had become pregnant. During the first month after abortion the mean levonorgestrel concentration (489 pg/ml) was statistically significantly higher than during the second month (237 pg/ml). The mean estradiol values fell to prefollicular levels within four days, remaining a little suppressed. The mean progesterone concentrations were below 2 ng/ml three days after abortion. Three subjects had a transient increase in plasma progesterone concentrations nine days after abortion. Thereafter no ovulatory progesterone concentrations were seen. The LH concentrations ranged within normal values of the follicular phase and FSH values were just beneath the lower limit of follicular phase FSH values, apart from a few peaks, indicating mild suppression. After removal of Norplant capsules, progesterone concentrations increased to ovulatory levels fifteen days after removal. The Norplant capsules were removed from two subjects because of planning pregnancy and they delivered healthy babies 9.5 and 12.5 months after removal.
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Srivastava AK, Chandra G, Roy SK. Species differences in levonorgestrel binding to serum proteins of monkey, rabbit and rat blood. Exp Clin Endocrinol 1984; 84:218-22. [PMID: 6441726 DOI: 10.1055/s-0029-1210390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Levonorgestrel binding to serum proteins of monkey, rabbit and rat was studied. It showed high affinity binding to monkey and rabbit serum proteins but not to rat serum. Characterization by polyacrylamide gel electrophoresis revealed that the binding of levonorgestrel occurs to sex hormone binding globulin (SHBG) and albumin, but in rat it is confined to albumin only. These results suggest species differences in levonorgestrel binding to serum proteins and extrapolation of data from one animal model to another may not be directly feasible.
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Abstract
The progestin, levonorgestrel administered orally to fed female rats significantly lowers both plasma total and very low density lipoprotein triglycerides. In contrast, plasma total cholesterol and low density lipoprotein cholesterol rose significantly. Suspensions of isolated hepatocytes were used to study the effects of levonorgestrel on triglyceride synthesis by examining the incorporation of labelled precursors [( 9,10- 3H]palmitate and [U-14C]glycerol) into triglycerides. Levonorgestrel (10(-4) M) significantly inhibited the incorporation of both precursors into hepatocyte triglycerides and also reduced their incorporation into the triglycerides (nearly all in d less than 1.006) released into the medium. These results suggest that inhibition of hepatic triglyceride synthesis and release can account at least for part of the lowering of plasma VLDL which occurs during administration of levonorgestrel.
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44
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Back DJ, Breckenridge AM, Grimmer SF, Orme ML, Purba HS. Pharmacokinetics of oral contraceptive steroids following the administration of the antimalarial drugs primaquine and chloroquine. Contraception 1984; 30:289-95. [PMID: 6439467 DOI: 10.1016/0010-7824(84)90092-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The effects of a single dose of two antimalarial drugs chloroquine (CQ) and primaquine (PQ) on the pharmacokinetics of a combined oral contraceptive (O.C.) have been studied in volunteers. Each woman was studied on 3 separate occasions over 3 cycles and plasma concentrations of ethinyloestradiol (EE2) and levonorgestrel were measured by radioimmunoassay following administration of a single dose of O.C. (30 micrograms EE2 + 150 micrograms levonorgestrel) in the absence and presence of the antimalarial drugs (PQ, 45 mg; CQ, 300 mg). Neither CQ or PQ given 1 h before the O.C. had any significant effect on plasma concentrations of EE2 or levonorgestrel or on any pharmacokinetic parameter determined. There is therefore, no evidence that CQ or PQ interfere with the hepatic handling of O.C.'s. This is in contrast to previously reported inhibitory effects of PQ on the metabolism of antipyrine.
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Abstract
Levonorgestrel was administered intravenously as a bolus to adult female rats and blood samples were collected at various time intervals. Serum concentrations of levonorgestrel were measured by radioimmunoassay. Analysis of data for two- and three-compartment open models indicated that in the rat, as in the human and the rabbit, a tri-exponential equation provided a better fit of the data. The half-lives for the alpha, beta and gamma phases were 10.1 min, 42.7 min and 23.1 hours, respectively. These values were closer to those reported for women than were the half-lives reported for the rabbit. The alpha and the beta phases appeared to last for 51 min and 1.3 hours, respectively, and the gamma phase was longer than 45 hours.
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Gomaa AA, Osman FH, Salem HT, Abdel Wareth AA. A study of interaction between levonorgestrel and ethanol. Contraception 1984; 29:535-42. [PMID: 6432432 DOI: 10.1016/s0010-7824(84)80015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Female Wistar rats were pair-fed a diet containing either ethanol (5%) or isocaloric carbohydrate substituent. After 6 weeks, a single dose (5 micrograms/kg) of levonorgestrel was given to the animals in each group either orally, subcutaneously or intravenously. Plasma levels of levonorgestrel at different time intervals were measured by RIA. Chronic alcohol administration did not affect plasma levels of levonorgestrel after oral administration. When the drug was given subcutaneously, plasma levels and AUC were significantly decreased in the alcoholic compared to control group. Following intravenous administration, the elimination half-life of levonorgestrel was shorter while the metabolic clearance was higher in the alcohol-treated group rather than the control group.
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Abstract
The hormonal effects of the deliberate omission of a low-dose combined oral contraceptive pill (30 micrograms ethinyl estradiol + 150 micrograms levonorgestrel) during the first two days of three consecutive artificial cycles were studied in 10 women. The plasma levels of estradiol, progesterone, levonorgestrel and--whenever justified--of LH were measured three times weekly (Mondays, Wednesdays and Fridays) throughout a 90-day period, and the ovarian reaction to the prolongation of the pill-free period from 7 to 9 days was assessed. One subject (with a premature LH surge) showed a marked follicular and an inadequate luteal activity in 2 of 3 cycles. The remaining cycles were characterized by a varying degree of follicular activity associated with the absence of any luteal function. None of the subjects exhibited peripheral steroid levels indicating a normal ovulatory cycle. The results are interpreted as suggesting that repeated prolongation of the pill-free period from 7 to 9 days might result in a gradual increase in ovarian activity.
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48
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Düsterberg B, Beier S. Plasma levels and progestational activity of levonorgestrel after repeated intravenous and subcutaneous administration in the beagle bitch. Contraception 1984; 29:345-57. [PMID: 6430640 DOI: 10.1016/0010-7824(84)90068-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In pharmacological test models providing repeated daily administrations of steroid hormones, differing time courses of the drug level depending upon the pharmacokinetics can be observed often. The present study should make a contribution to the question whether the time course of the drug level can have an influence on the effectiveness of a given dose of a synthetic gestagen. On the basis of existing pharmacokinetic and pharmacodynamic data in the beagle dog, levonorgestrel (LN) was selected as progestogen. LN was administered daily in equal dosages (0.1 mg) over a period of 14 days subcutaneously (s.c.) and intravenously (i.v.). The gestagenic potency of LN was assessed in an established bioassay by the histological evaluation of the endometrial transformation. Whereas the s.c. administration resulted in a low, but almost constant, LN level, high peaks of short duration could be determined after i.v. administration. Following s.c. injection, LN was released only to a degree of 60% in the observation period compared with 100% after i.v. administration. Nevertheless, 0.1 mg LN given s.c. had stronger endometrial effects than 0.1 mg LN given as bolus i.v.
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Roy S, Mishell DR, Robertson DN, Krauss RM, Lacarra M, Duda MJ. Long-term reversible contraception with levonorgestrel-releasing Silastic rods. Am J Obstet Gynecol 1984; 148:1006-13. [PMID: 6424474 DOI: 10.1016/0002-9378(84)90544-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Subcutaneously placed Silastic capsules containing levonorgestrel are effective for 5 years and have a higher continuation rate than other methods of reversible contraception. Six 3 cm capsules are required to achieve satisfactory circulating levels of levonorgestrel. Two 4 cm covered Silastic rods containing levonorgestrel, which are easier to manufacture, insert, and remove than the capsules, produce similar in vitro release rates. This study compared clinical and metabolic effects as well as bleeding patterns in 23 women using either six capsules (n = 11) or two covered rods (n = 12). Serum levels of levonorgestrel, lipids, and lipoproteins as well as frequency of elevated progesterone levels were compared in serum samples obtained before treatment and 1, 6, 12, 18, and 24 months after insertion with the two systems. While bleeding patterns were similar for users of the two systems, rod users had slightly higher serum levels of levonorgestrel and a lower incidence of cycles with elevated progesterone levels. Therefore, rods could replace capsules as a long-term, reversible contraceptive method.
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Abstract
Twenty-six healthy, non-hirsute women had antecubital venous blood obtained before and during treatment with various contraceptive steroids for the measurement of dehydroepiandrosterone sulfate (DHEA-S). Six of the women were randomized to receive Ortho Novum 1/35 (O/N), 7 were assigned to Ovcon 35 (OV), and another five received Nordette (N). The 6 women ingesting O/N as well as the 7 receiving OV had significant decreases in serum concentrations of DHEA-S (p less than 0.05). The percentage of decrease in DHEA-S in the O/N group (39 +/- 6%) and in the OV group (30 +/- 5%) was not statistically different. The group receiving N showed no changes from baseline measurements. Serum samples from another 8 women who had received subcutaneous implants of levonorgestrel (1-Ng) were obtained. No significant changes occurred in serum DHEA-S between baseline and six-month samples. The data that 1-Ng alone and the combination of 1-Ng and ethinylestradiol did not change DHEA-S levels suggest that 1-Ng does not affect adrenal androgen secretion. Because N, O/N and OV contain similar quantities of ethinylestradiol, these results indicate that norethindrone, but not 1-Ng, has a major suppressive effect upon adrenal androgen secretion.
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MESH Headings
- Adolescent
- Adult
- Contraceptives, Oral/pharmacology
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/blood
- Contraceptives, Oral, Combined/pharmacology
- Contraceptives, Oral, Synthetic/pharmacology
- Dehydroepiandrosterone/analogs & derivatives
- Dehydroepiandrosterone/blood
- Dehydroepiandrosterone Sulfate
- Dose-Response Relationship, Drug
- Drug Combinations
- Drug Evaluation
- Ethinyl Estradiol/pharmacology
- Ethinyl Estradiol-Norgestrel Combination
- Female
- Humans
- Levonorgestrel
- Mestranol/pharmacology
- Norethindrone/pharmacology
- Norgestrel/administration & dosage
- Norgestrel/blood
- Norgestrel/pharmacology
- Random Allocation
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