Estradiol valerate/norethisterone enantate

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Estradiol valerate /
norethisterone enantate
Estradiol valerate.svg
Norethindrone enanthate.svg
Estradiol valerate (top) and
norethisterone enantate (bottom)
Combination of
Estradiol valerate Estrogen
Norethisterone enantate Progestogen
Clinical data
Trade names Mesigyna, others
Other namesEV/NETE; HRP-102
Routes of
administration 		Intramuscular injection
Identifiers
CAS Number
PubChem CID
UNII

Estradiol valerate/norethisterone enantate (EV/NETE), sold under the brand name Mesigyna among others, is a form of combined injectable birth control which is used to prevent pregnancy in women. [1] [2] [3] [4] It contains estradiol valerate (EV), an estrogen, and norethisterone enantate (NETE), a progestin. [1] [2] [3] The medication is given once a month by injection into muscle. [1] [2] [3]

Contents

EV/NETE is approved for use in at least 36 countries, and is the most widely used combined injectable contraceptive. [5] [3] It is available widely throughout Latin America, in a few Asian and African countries, and in Turkey. [6] [7] [8]

Medical uses

EV/NETE is used as a combined injectable contraceptive to prevent pregnancy in women. [1] [2] [3] It is given by intramuscular injection once a month. [1] [2] [3]

Available forms

EV/NETE is available in the form of an oil solution containing 5 mg estradiol valerate (EV) and 50 mg norethisterone enantate (NETE). [5] [1] [2] [3]

Pharmacology

Pharmacodynamics

Hormone levels following a single intramuscular injection of EV/NETE (5 mg/50 mg) in healthy young men. Testosterone levels were maximally suppressed by about 94%, to ~30 ng/dL, when measured at day 7. Hormone levels in men with a single intramuscular injection of 5 mg estradiol valerate and 50 mg norethisterone enanthate in oil.png
Hormone levels following a single intramuscular injection of EV/NETE (5 mg/50 mg) in healthy young men. Testosterone levels were maximally suppressed by about 94%, to ~30 ng/dL, when measured at day 7.

EV/NETE is a combination of EV, an estrogen, and NETE, a progestogen with weak androgenic activity.

Through its progestogenic activity, NETE has potent antigonadotropic effects and can inhibit fertility and suppress sex hormone levels. A single intramuscular injection of EV/NETE has been found to strongly suppress testosterone levels in men. [9] Levels of testosterone decreased from ~503 ng/dL at baseline to ~30 ng/dL at the lowest point (–94%) which occurred at day 7 post-injection. [9]

Pharmacokinetics

Peak levels of estradiol after an intramuscular injection of EV/NETE (5 mg/50 mg) are reached within 2 days and range from 232 to 428 pg/mL. [4] [1]

History

EV/NETE, along with estradiol cypionate/medroxyprogesterone acetate (EC/MPA; code name HRP-112), was developed by the World Health Organization. [5] [10] Both EV/NETE and EC/MPA became available in 1993. [11]

Society and culture

Generic names

EV/NETE is also known by its former developmental code name HRP-102. [12]

Brand names

EV/NETE has been marketed under a variety of brand names including Chinese Injectable No. 3, Effectimes, Ginediol, Mesigyna, Mesilar, Meslart, Mesocept, Mesygest, Nofertyl, Nofertyl Lafrancol, Noregyna, Norestrin, Norifam, Norigynon, Nostidyn, Sexseg, and Solouna. [6] [7] [8] [13] [3] [14] [10] [1] [15]

Availability

EV/NETE has been marketed in at least 36 countries, including Argentina, the Bahamas, Barbados, Bolivia, Brazil, Chile, Colombia, Costa Rica, the Dominican Republic, Ecuador, Egypt, El Salvador, Ghana, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Kenya, Mexico, Nicaragua, Panama, Paraguay, Peru, St. Lucia, Turkey, Uruguay, Venezuela, and Zimbabwe. [6] [7] [8] [13] [3] [14] [10] [1] [15] At least 15 of the countries in which EV/NETE is registered are Caribbean states. [5] EV/NETE is the most widely used combined injectable contraceptive. [5] [3]

See also

Related Research Articles

<span class="mw-page-title-main">Estradiol valerate</span> Chemical compound

Estradiol valerate (EV), sold for use by mouth under the brand name Progynova and Primiwal E4 and for use by injection under the brand names Delestrogen and Progynon Depot among others, is an estrogen medication. In women, it is used in hormone therapy for menopausal symptoms and low estrogen levels, hormone therapy for transgender people, and in hormonal birth control. It is also used in the treatment of prostate cancer in men. The medication is taken by mouth or by injection into muscle or fat once every 1 to 4 weeks.

<span class="mw-page-title-main">Norethisterone acetate</span> Chemical compound

Norethisterone acetate (NETA), also known as norethindrone acetate and sold under the brand name Primolut-Nor among others, is a progestin medication which is used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. The medication available in low-dose and high-dose formulations and is used alone or in combination with an estrogen. It is ingested orally.

<span class="mw-page-title-main">Norethisterone</span> Progestin medication

Norethisterone, also known as norethindrone and sold under many brand names, is a progestin medication used in birth control pills, menopausal hormone therapy, and for the treatment of gynecological disorders. The medication is available in both low-dose and high-dose formulations and both alone and in combination with an estrogen. It is used by mouth or, as norethisterone enanthate, by injection into muscle.

Combined injectable contraceptives (CICs) are a form of hormonal birth control for women. They consist of monthly injections of combined formulations containing an estrogen and a progestin to prevent pregnancy.

Algestone acetophenide Chemical compound

Algestone acetophenide, also known more commonly as dihydroxyprogesterone acetophenide (DHPA) and sold under the brand names Perlutal and Topasel among others, is a progestin medication which is used in combination with an estrogen as a form of long-lasting injectable birth control. It has also been used alone, but is no longer available as a standalone medication. DHPA is not active by mouth and is given once a month by injection into muscle.

Estradiol cypionate

Estradiol cypionate (EC), sold under the brand name Depo-Estradiol among others, is an estrogen medication which is used in hormone therapy for menopausal symptoms and low estrogen levels in cis women, in hormone therapy for trans women, and in hormonal birth control for cis women. It is given by injection into muscle once every 1 to 4 weeks.

<span class="mw-page-title-main">Norethisterone enanthate</span> Chemical compound

Norethisterone enanthate (NETE), also known as norethindrone enanthate, is a form of hormonal birth control which is used to prevent pregnancy in women. It is used both as a form of progestogen-only injectable birth control and in combined injectable birth control formulations. It may be used following childbirth, miscarriage, or abortion. The failure rate per year in preventing pregnancy for the progestogen-only formulation is 2 per 100 women. Each dose of this form lasts two months with only up to two doses typically recommended.

<span class="mw-page-title-main">Estradiol enantate</span>

Estradiol enantate, also spelled estradiol enanthate and sold under the brand names Perlutal and Topasel among others, is an estrogen medication which is used in hormonal birth control for women. It is formulated in combination with dihydroxyprogesterone acetophenide, a progestin, and is used specifically as a combined injectable contraceptive. Estradiol enantate is not available for medical use alone. The medication, in combination with DHPA, is given by injection into muscle once a month.

An estrogen ester is an ester of an estrogen, most typically of estradiol but also of other estrogens such as estrone, estriol, and even nonsteroidal estrogens like diethylstilbestrol. Esterification renders estradiol into a prodrug of estradiol with increased resistance to first-pass metabolism, slightly improving its oral bioavailability. In addition, estrogen esters have increased lipophilicity, which results in a longer duration when given by intramuscular or subcutaneous injection due to the formation of a long-lasting local depot in muscle and fat. Conversely, this is not the case with intravenous injection or oral administration. Estrogen esters are rapidly hydrolyzed into their parent estrogen by esterases once they have been released from the depot. Because estradiol esters are prodrugs of estradiol, they are considered to be natural and bioidentical forms of estrogen.

<span class="mw-page-title-main">Estradiol hexahydrobenzoate</span>

Estradiol hexahydrobenzoate (EHHB), sold under a number of brand names including Benzo-Ginoestril A.P., BenzoGynoestryl Retard, Ginestryl-15-Depot, Menodin, and Tardoginestryl, is an estrogen medication which was previously used for indications such as menopausal hormone therapy and gynecological disorders. EHHB is given by injection into muscle at regular intervals, for instance once every few weeks.

Estradiol benzoate butyrate

Estradiol benzoate butyrate (EBB), sold under the brand names Neolutin N, Redimen, Soluna, and Unijab and formerly known under the developmental code name Unimens, is an estrogen medication which is used in hormonal birth control for women. It is formulated in combination with dihydroxyprogesterone acetophenide, a progestin, and is used specifically as a combined injectable contraceptive. EBB is not available for medical use alone. The medication, in combination with DHPA, is given by injection into muscle once a month.

Estradiol/progesterone

Estradiol/progesterone (E2/P4), sold under the brand names Bijuva and Juvenum, is a combined estrogen and progestogen medication which is used in the treatment of menopausal symptoms in postmenopausal women. It contains estradiol, an estrogen, and progesterone, a progestogen, and is available in both oral and intramuscular formulations. E2/P4 differs from other estrogen–progestogen formulations in that the sex-hormonal agents used are bioidentical.

Estradiol cypionate/medroxyprogesterone acetate

Estradiol cypionate/medroxyprogesterone acetate (EC/MPA), sold under the brand name Cyclofem among others, is a form of combined injectable birth control. It contains estradiol cypionate (EC), an estrogen, and medroxyprogesterone acetate (MPA), a progestin. It is recommended for short-term use and is given once a month by injection into a muscle.

Estradiol valerate/hydroxyprogesterone caproate

Estradiol valerate/hydroxyprogesterone caproate (EV/OHPC), sold under the brand names Gravibinon and Injectable No. 1 among others, is a combined estrogen and progestogen medication which is used in the treatment of threatened miscarriage and other indications and as a form of combined injectable birth control to prevent pregnancy. It contains estradiol valerate (EV), an estrogen, and hydroxyprogesterone caproate (OHPC), a progestin. The medication is given by injection into muscle once a day to once a month depending on the indication.

Estradiol enantate/algestone acetophenide

Estradiol enantate/algestone acetophenide, also known as estradiol enantate/dihydroxyprogesterone acetophenide (E2-EN/DHPA) and sold under the brand names Perlutal and Topasel among others, is a form of combined injectable birth control which is used to prevent pregnancy. It contains estradiol enantate (E2-EN), an estrogen, and algestone acetophenide, a progestin. The medication is given once a month by injection into muscle.

Estradiol benzoate butyrate/algestone acetophenide

Estradiol benzoate butyrate/algestone acetophenide, also known as estradiol benzoate butyrate/dihydroxyprogesterone acetophenide (EBB/DHPA) and sold under the brand names Neolutin N, Redimen, Soluna, and Unijab, is a form of combined injectable birth control which is used in Peru and Singapore. It contains estradiol benzoate butyrate (EBB), an estrogen, and algestone acetophenide, a progestin. The medication is given once per month by injection into muscle.

The Special Programme on Human Reproduction (HRP), also known as the Special Programme of Research, Development and Research Training in Human Reproduction, was a World Health Organization (WHO) endeavor.

Estradiol undecylate/norethisterone enanthate

Estradiol undecylate/norethisterone enanthate (EU/NETE) is a combination medication of estradiol undecylate (EU), an estrogen, and norethisterone enanthate (NETE), a progestin, which was developed by Schering for potential use as a combined injectable contraceptive in women but was ultimately never marketed. It contained 5 to 10 mg EU and 50 to 70 mg NETE in oil solution and was intended for use by intramuscular injection at regular intervals. Although never commercialized, EU/NETE was found to be effective and well tolerated.

Estradiol valerate/methenmadinone caproate

Estradiol valerate/methenmadinone caproate (EV/MMC), known by the tentative brand name Lutofollin, is a combination medication of estradiol valerate (EV), an estrogen, and methenmadinone caproate, a progestin, which was developed for potential use as a once-a-month combined injectable contraceptive but was never marketed. It contained 10 mg EV and 60 mg MMC in 1 mL oil solution and was intended for administration by intramuscular injection once every 4 weeks.

Estradiol valerate/megestrol acetate

Estradiol valerate/megestrol acetate (EV/MGA) is a combined injectable contraceptive which was developed in China in the 1980s but was never marketed. It is an aqueous suspension of microcapsules containing 5 mg estradiol valerate (EV) and 15 mg megestrol acetate (MGA). It was also studied at doses of EV ranging from 0.5 to 5 mg and at doses of MGA ranging from 15 to 25 mg.

References

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  6. 1 2 3 "Norethisterone".
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  14. 1 2 Pramilla Senanayake; Malcolm Potts (14 April 2008). Atlas of Contraception, Second Edition. CRC Press. pp. 50–. ISBN   978-0-203-34732-4.
  15. 1 2 IARC Working Group on the Evaluation of Carcinogenic Risks to Humans; World Health Organization; International Agency for Research on Cancer (2007). Combined Estrogen-progestogen Contraceptives and Combined Estrogen-progestogen Menopausal Therapy. World Health Organization. pp. 431–. ISBN   978-92-832-1291-1.
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