Adverse Drug Reaction Classification System

Pharmaceutical Information
Drug Name Estradiol acetate
Drug ID BADD_D00822
Description Estradiol acetate is a pro-drug ester of [DB00783], a naturally occurring hormone that circulates endogenously within the human body. Estradiol is the most potent form of all mammalian estrogenic steroids and acts as the major female sex hormone. As a pro-drug of estradiol, estradiol acetate therefore has the same downstream effects within the body through binding to the Estrogen Receptor (ER) including ERα and ERβ subtypes, which are located in various tissues including in the breasts, uterus, ovaries, skin, prostate, bone, fat, and brain. [DB00783] is commonly produced with an ester side-chain as endogenous estradiol has very low oral bioavailability on its own (2-10%). First-pass metabolism by the gut and the liver quickly degrades the estradiol molecule before it gets a chance to enter systemic circulation and exert its estrogenic effects [A12102]. Esterification of estradiol aims to improves absorption and bioavailability after oral administration (such as with Estradiol valerate) or to sustain release from depot intramuscular injections (such as with Estradiol Cypionate) through improved lipophilicity. Following absorption, the esters are cleaved, resulting in the release of endogenous estradiol, or 17β-estradiol. Ester pro-drugs of estradiol are therefore considered to be bioidentical forms of estrogen [T84]. Estradiol acetate is commercially available as Femring, a vaginal ring used for the treatment of moderate to severe vasomotor symptoms and vulvovaginal atrophy due to menopause. The primary source of estrogen in normally cycling adult women is the ovarian follicle, which secretes 70 to 500 mcg of estradiol daily, depending on the phase of the menstrual cycle. However, after menopause, most endogenous estrogen is produced by conversion of androstenedione, secreted by the adrenal cortex, to estrone by peripheral tissues. Thus, estrone and the sulfate conjugated form, estrone sulfate, are the most abundant circulating estrogens in postmenopausal women [FDA Label]. Although circulating estrogens exist in a dynamic equilibrium of metabolic interconversions, estradiol is the principal intracellular human estrogen and is substantially more potent than its metabolites, estrone and estriol at the receptor level. Because of the difference in potency between estradiol and estrone, menopause (and a change in primary hormone from estradiol to estrone) is associated with a number of symptoms associated with this reduction in potency and in estrogenic effects. These include hot flashes, vaginal dryness, mood changes, irregular menses, chills, and sleeping problems. Administration of synthetic and bioidentical forms of estrogen, such as estradiol acetate, has shown to improve these menopausal symptoms.
Indications and Usage Femring is indicated for the treatment of vasomotor and urogenital symptoms associated with menopause. Use of Femring (estradiol acetate) has been shown to improve symptoms caused by atrophy of the vagina (such as dryness, burning, pruritus and dyspareunia) and/or the lower urinary tract (urinary urgency and dysuria).
Marketing Status Prescription; Discontinued
ATC Code G03CA03
DrugBank ID DB13952
KEGG ID D04061
MeSH ID D004958
PubChem ID 9818306
TTD Drug ID D0T7ZQ
NDC Product Code 72495-201; 72495-202; 64918-0105
Synonyms Estradiol | Estradiol-17 beta | Estradiol 17 beta | Estradiol Anhydrous | Oestradiol | Estradiol-17beta | Estradiol 17beta | 17 beta-Estradiol | 17 beta Estradiol | 17 beta-Oestradiol | 17 beta Oestradiol | Progynova | Estradiol, (9 beta,17 alpha)-Isomer | Estradiol, (9 beta,17 beta)-Isomer | Estradiol, Monosodium Salt | Estradiol, Sodium Salt | Vivelle | Aerodiol | Estrace | Estraderm TTS | Estradiol Hemihydrate | Estradiol Hemihydrate, (17 alpha)-Isomer | Estradiol Monohydrate | Estradiol, (+-)-Isomer | Estradiol, (-)-Isomer | Estradiol, (16 alpha,17 alpha)-Isomer | Estradiol, (16 alpha,17 beta)-Isomer | Estradiol, (8 alpha,17 beta)-(+-)-Isomer | Estradiol, (8 alpha,17 beta)-Isomer | Estradiol Valerate | Estradiol Valeriante | Progynon-Depot | Progynon Depot | Delestrogen | Estradiol-17 alpha | Estradiol 17 alpha | Estradiol, (17-alpha)-Isomer | Ovocyclin
Chemical Information
Molecular Formula C20H26O3
CAS Registry Number 4245-41-4
SMILES CC(=O)OC1=CC2=C(C=C1)C3CCC4(C(C3CC2)CCC4O)C
Chemical Structure
ADR Related Proteins Induced by Drug
ADR Term Protein Name UniProt AC TTD Target ID PMID
AdhesionVinculinP18206Not AvailableNot Available
Blood luteinising hormone increasedAngiotensinogenP01019T64485Not Available
Blood luteinising hormone increasedLutropin-choriogonadotropic hormone receptorP22888T79473Not Available
Blood luteinising hormone increasedProgonadoliberin-1P01148T18950Not Available
Endometrial cancerFibroblast growth factor 2P09038T31621Not Available
Endometrial cancerVascular endothelial growth factor AP15692T20761Not Available
High density lipoprotein decreasedEstrogen receptorP03372T89534Not Available
KyphosisNociceptin receptorP35370Not AvailableNot Available
KyphosisPrepronociceptinQ62923Not AvailableNot Available
Lipid metabolism disorder3-hydroxy-3-methylglutaryl-coenzyme A reductaseP04035T53585Not Available
ProstatitisStromelysin-2P09238T40488Not Available
Tumour necrosisEstrogen receptorP03372T89534Not Available
Tumour necrosisProtransforming growth factor alphaP01135T00033Not Available
ADRs Induced by Drug
ADR Term ADReCS ID ADR Frequency (FAERS) ADR Severity Grade (FAERS) ADR Severity Grade (CTCAE)
Abdominal distension07.01.04.001--
Abdominal pain07.01.05.002--
Alopecia23.02.02.001--
Amenorrhoea21.01.02.001; 05.05.01.002--
Anaphylactic reaction24.06.03.006; 10.01.07.001--
Angioedema23.04.01.001; 10.01.05.009--Not Available
Arthralgia15.01.02.001--
Asthma22.03.01.002; 10.01.03.010--Not Available
Back pain15.03.04.005--
Blood pressure increased13.14.03.005--Not Available
Blood triglycerides increased13.12.03.001--Not Available
Breast cancer21.05.01.003; 16.10.01.001--Not Available
Breast discharge21.05.05.001--Not Available
Breast enlargement21.05.04.001--Not Available
Breast tenderness21.05.05.004--Not Available
Bronchitis22.07.01.001; 11.01.09.001--
Carbohydrate tolerance decreased13.02.02.003--Not Available
Cerebrovascular accident24.03.05.001; 17.08.01.007--
Chloasma23.05.01.001; 18.08.02.002--Not Available
Chorea17.01.01.001--Not Available
Corneal oedema06.04.02.001--Not Available
Dementia17.03.01.001; 19.20.02.001--Not Available
Depression19.15.01.001--
Dizziness02.01.02.004; 24.06.02.007; 17.02.05.003--
Dysmenorrhoea21.01.01.002--
Ectropion of cervix21.06.01.004--Not Available
Endometrial cancer21.07.02.002; 16.12.02.001--Not Available
Endometrial hyperplasia21.07.01.002--Not Available
Epilepsy17.12.03.002--Not Available
Erythema multiforme23.03.01.003; 10.01.03.015--
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