十一酸雌二醇
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臨床資料 | |
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讀音 | shí yī suān cí èr chún(漢語拼音) |
商品名 | Delestrec, Progynon Depot 100, 以及其他 |
其他名稱 | EU;E2U; 雌二醇十一酸酯;十一酸雌酮;十一烷酸雌二醇 (商品代號)RS-1047;SQ-9993 |
給藥途徑 | 肌注[1] |
藥物類別 | 雌二醇; 雌二醇酯 |
ATC碼 | |
法律規範狀態 | |
法律規範 |
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藥物動力學數據 | |
生物利用度 | 肌注(IM ):接近100%[2] 口服:同口服雌激素藥物,約為5%[3][4] |
血漿蛋白結合率 | Estradiol: ~98% (到白蛋白和SHBG)[2][5] |
藥物代謝 | 在肝臟、血液和組織中通過酯酶的裂解[6][4] |
代謝產物 | 雌二醇,十一酸,雌二醇代謝物[6][4] |
生物半衰期 | 不確定 |
作用時間 | 肌注(IM ): • 10–12.5 mg: 1–2 月[7][8] • 25–50 mg: 2–4 月[9] |
排泄途徑 | 尿液 |
識別資訊 | |
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CAS號 | 3571-53-7 ![]() |
PubChem CID | |
ChemSpider | |
UNII | |
KEGG | |
ChEMBL | |
CompTox Dashboard (EPA) | |
ECHA InfoCard | 100.020.616 |
化學資訊 | |
化學式 | C29H44O3 |
摩爾質量 | 440.67 g·mol−1 |
3D模型(JSmol) | |
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十一酸雌二醇(estradiol undecylate)縮寫EU或E2U,又稱十一酸雌酮,曾在Delestrec和Progynon Depot 100等品牌名下銷售,是一種雌激素藥物,曾用於治療男性攝護腺癌[10][11][12][13][1]。它還作為跨性別女性激素療法的一種方式[14][15][16]。儘管十一酸雌二醇過去曾經使用,但目前已停產[12][17]。該藥物通常攝入方式是每月一次的肌肉注射[1][18][13]。
十一酸雌二醇對男性的副作用可能包括乳房壓痛、乳房發育、女性化、性功能障礙、不孕不育、液體滯留和心血管問題[18]。十一烷基雌二醇是一種雌激素,因此,是雌激素受體的激動劑,而雌激素受體是雌激素的生物靶標,如雌二醇[6][19][20]。它是一種雌激素酯,是體內雌二醇的一種非常持久[6]的前體藥物[4]。正因為如此,它被認為是一種天然和生物相同的雌激素形式。注射十一酸雌二醇的持續時間約為1至4個月[8][9][7][21]。
十一酸雌二醇首次被描述是在1953年,並在1956年被引入醫學應用[8][22][9][23]。它一直在2000年代後期之前被使用,然後停產。十一酸雌二醇曾在歐洲市場上銷售,但似乎從未在美國上市[24][12][25]。多年來,它被用作治療男性攝護腺癌的肌注雌激素,儘管使用頻率不如聚磷酸雌二醇。有的跨性別女性會自行製作此種藥物以實施女性化激素療法。
醫療用途
十一酸雌二醇曾被用作高劑量雌激素療法的一種形式,用於治療前列腺(俗稱「高雌抗雄」),但後來在這個適應症上被新一代藥物取代,這些新藥物具有更少的不良效應(例如乳腺增生和心血管併發症),如GnRH類似物和非甾體抗雄激素[1][26]。它已在許多臨床研究中用於評估這個目的[27][28][29][30][31]。它以每3到4周(或每月一次)100毫克的劑量通過肌肉注射用於這個適應症[18][32]。
十一酸雌二醇有抗雄激素類似的效果,曾被用於抑制性犯罪者的性慾[33]。對此適應症,它的劑量為每3到4周一次,肌肉注射50到100毫克[33]。
十一酸雌二醇還曾用於治療女性的乳腺癌[34]。它也在更年期激素療法中使用,例如用於緩解潮熱和其他更年期症狀[9]。與雌二醇戊酸酯、雌二醇環戊酸酯和苯甲酸雌二醇一起,十一酸雌二醇已被用作肌肉注射雌激素,用於跨性別女性的激素療法[14][15][16],劑量為每月100毫克至800毫克不等[15][16][14][35][36][37]。
可用形式
十一酸雌二醇可作為肌肉注射的油溶液,一種規格是以100 mg/mL的藥物濃度的安瓿瓶。[38][39]
禁忌症
十一酸雌二醇作為一種雌激素,禁忌症包括凝血問題、心血管疾病、肝臟疾病以及某些激素敏感性癌症,例如乳腺癌和子宮內膜癌等。[40][41][42][43]
副作用
十一酸雌二醇及其副作用曾在由美因茨大學大學泌尿科Jacobi及其同事主持的III期國際多中心隨機對照試驗中進行評估,用於治療晚期前列腺癌[18][44][45][46][47][28][48]。該研究包括來自12個治療中心的191名患者,這些患者接受了為期6個月的肌肉注射,其中96名患者每月接受100毫克的十一酸雌二醇,另有95名患者每週接受300毫克的醋酸環丙孕酮[44][46][47][28][48][49][50]。該研究的一個分支首次於1978年和1980年報告了Mainz大學中心的42名患者[51][18][28][48]。
這些患者年齡在51到84歲之間(平均68歲),排除了有預先存在心血管疾病的患者[13][18][52]。對於十一酸雌二醇組報告了相當高的心血管併發症發生率(76%;21/16總發生率),其中心血管發病率為67%(21/14),心血管死亡率為9.5%(21/2)[13][18][52]。該組中的心血管發病包括外周水腫和表層靜脈炎(38%;21/8),冠心病(24%;21/5)和深靜脈血栓形成(4.8%;21/1)[18][52],而心血管死亡則包括心肌梗死(4.8%;21/1)和肺栓塞(4.8%;21/1)。
十一酸雌二醇組中的八例心血管併發症,包括兩例死亡,被認為是「嚴重的」[52][53]。相反,在環丙烯酸乙酯對照組中未發生心血管毒性(0%;21/0)[13][18][52]。十一酸雌二醇的其他副作用還包括乳腺增生(100%;21/21)和勃起功能障礙(90%;21/19)[18]。在這相對較小的研究中,十一酸雌二醇的心血管併發症與高劑量的聚磷酸雌二醇和經皮雌二醇治療前列腺癌的大規模和高質量的臨床研究形成對比,這些研究中觀察到最少或沒有心血管有害性[54][55][56][57][58]。
藥物過量
十一酸雌二醇曾在臨床上以每月高達800至2400毫克的大劑量通過肌肉注射使用,分為每週兩到三次注射[59][60][61][62][63],每次注射100至200毫克。作為比較,有報告指出,單次100毫克肌肉注射的十一酸雌二醇可導致約500pg/mL的雌二醇水平[64]。雌激素過量的症狀可能包括噁心、嘔吐、腹脹、體重增加、水腫、乳房疼痛、陰道分泌物增加、腿沉和腿部抽筋[65]。這些副作用可以通過降低攝入劑量來減輕[65]。
互動
藥理
藥效學
藥代動力學
化學性質
歷史
社會與文化
通用名
雌二醇十一酸酯(Estradiol undecylate)是該藥物的通用名稱、國際非專利藥品名稱(INN)和美國藥典通用名稱(USAN)。[66][67][68][69] 有些出版物中也將其拼寫為雌二醇十一酸酯,同時也被稱為雌二醇十一酸酯。[70][66][67][68][69] 在德國,它有多種拼寫,包括 estradiolundecylat、östradiolundecylat、östradiolundezylat、oestradiolundecylat、oestradiolundezylat 等。[71] 雌二醇十一酸酯還以其先前的開發代碼名稱 RS-1047 和 SQ-9993 而聞名。[66][67][68][69]
商品名
雌二醇十一酸酯的主要品牌名稱是 Progynon Depot 100。[66][67][68]除了 Progynon Depot 100 外,雌二醇十一酸酯還以其他品牌名稱上市,包括 Delestrec、Depogin、Estrolent、Oestradiol D、Oestradiol-Retard Theramex 和 Primogyn Depot [0.1 mg/ml] 等。[66][67][68][72][73]
可用性
雌二醇十一酸酯在歐洲(包括法國、德國、英國、摩納哥、荷蘭、瑞士)以及日本是可用的。[68][72][74][75][76] 然而,它已被停產,因此不再可獲得。[77][78]
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