Progesterone: Difference between revisions

Progesterone
Clinical data
Trade names	Utrogestan, Prometrium, Endometrin, Crinone
Other names	4-pregnene-3,20-dione
AHFS/Drugs.com	Monograph
MedlinePlus	a604017
Pregnancy; category	B (USA);
Routes of; administration	Oral, transdermal, vaginal, rectal, intramuscular or subcutaneous injection, implant
ATC code	G03DA04 (WHO) ;
Legal status
Legal status	US: WARNING;
Pharmacokinetic data
Bioavailability	10–15% (oral)
Protein binding	96%–99%
Metabolism	Hepatic (CYP2C19, CYP3A4, CYP2C9)
Elimination half-life	16–18 hours (oral)
Excretion	Renal
Identifiers
	IUPAC name Pregn-4-ene-3,20-dione;
CAS Number	57-83-0 ;
PubChem CID	5994;
IUPHAR/BPS	2377;
DrugBank	DB00396 ;
ChemSpider	5773 ;
UNII	4G7DS2Q64Y;
KEGG	C00410 ;
ChEBI	CHEBI:17026 ;
ChEMBL	ChEMBL103 ;
CompTox Dashboard (EPA)	DTXSID3022370 ;
ECHA InfoCard	100.000.318
Chemical and physical data
Formula	C21H30O2
Molar mass	314.46 g/mol g·mol−1
3D model (JSmol)	Interactive image;
Specific rotation	[α]D
Melting point	126 °C (259 °F)
	SMILES CC(=O)[C@H]1CC[C@@H]2[C@@]1(CC[C@H]3[C@H]2CCC4=CC(=O)CC[C@]34C)C;
	InChI InChI=InChI=1S/C21H30O2/c1-13(22)17-6-7-18-16-5-4-14-12-15(23)8-10-20(14,2)19(16)9-11-21(17,18)3/h12,16-19H,4-11H2,1-3H3/t16-,17+,18-,19-,20-,21+/m0/s1 ; Key:RJKFOVLPORLFTN-LEKSSAKUSA-N ;
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Progesterone (abbreviated as P4), also known as pregn-4-ene-3,20-dione,^[6]^[7] is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species.^[8] It belongs to a group of steroid hormones called the progestogens,^[8] and is the major progestogen in the body. Progesterone is also a crucial metabolic intermediate in the production of other endogenous steroids, including the sex hormones and the corticosteroids, and plays an important role in brain function as a neurosteroid.^[9]

Chemistry

Progesterone was independently discovered by four research groups.^[10]^[11]^[12]^[13]

Willard Myron Allen co-discovered progesterone with his anatomy professor George Washington Corner at the University of Rochester Medical School in 1933. Allen first determined its melting point, molecular weight, and partial molecular structure. He also gave it the name Progesterone derived from Progestational Steroidal ketone.^[14]

Like other steroids, progesterone consists of four interconnected cyclic hydrocarbons. Progesterone contains ketone and oxygenated functional groups, as well as two methyl branches. Like all steroid hormones, it is hydrophobic.

Sources

Animal

Progesterone is produced in high amounts in the ovaries (by the corpus luteum) from the onset of puberty to menopause, and is also produced in smaller amounts by the adrenal glands after the onset of adrenarche in both males and females. To a lesser extent, progesterone is produced in nervous tissue, especially in the brain, and in adipose (fat) tissue, as well.

During human pregnancy, progesterone is produced in increasingly high amounts by the ovaries and placenta. At first, the source is the corpus luteum that has been "rescued" by the presence of human chorionic gonadotropin (hCG) from the conceptus. However, after the 8th week, production of progesterone shifts to the placenta. The placenta utilizes maternal cholesterol as the initial substrate, and most of the produced progesterone enters the maternal circulation, but some is picked up by the fetal circulation and used as substrate for fetal corticosteroids. At term the placenta produces about 250 mg progesterone per day.

An additional animal source of progesterone is milk products. After consumption of milk products the level of bioavailable progesterone goes up.^[15]

Plants

In at least one plant, Juglans regia, progesterone has been detected.^[16] In addition, progesterone-like steroids are found in Dioscorea mexicana. Dioscorea mexicana is a plant that is part of the yam family native to Mexico.^[17] It contains a steroid called diosgenin that is taken from the plant and is converted into progesterone.^[18] Diosgenin and progesterone are found in other Dioscorea species as well.

Another plant that contains substances readily convertible to progesterone is Dioscorea pseudojaponica native to Taiwan. Research has shown that the Taiwanese yam contains saponins — steroids that can be converted to diosgenin and thence to progesterone.^[19]

Many other Dioscorea species of the yam family contain steroidal substances from which progesterone can be produced. Among the more notable of these are Dioscorea villosa and Dioscorea polygonoides. One study showed that the Dioscorea villosa contains 3.5% diosgenin.^[20] Dioscorea polygonoides has been found to contain 2.64% diosgenin as shown by gas chromatography-mass spectrometry.^[21] Many of the Dioscorea species that originate from the yam family grow in countries that have tropical and subtropical climates.^[22]

Metabolism

Biosynthesis

In mammals, progesterone (6), like all other steroid hormones, is synthesized from pregnenolone (3), which in turn is derived from cholesterol (1) (see the upper half of the figure to the right).

Cholesterol (1) undergoes double oxidation to produce 20,22-dihydroxycholesterol (2). This vicinal diol is then further oxidized with loss of the side chain starting at position C-22 to produce pregnenolone (3). This reaction is catalyzed by cytochrome P450scc.

The conversion of pregnenolone to progesterone takes place in two steps. First, the 3-hydroxyl group is oxidized to a keto group (4) and second, the double bond is moved to C-4, from C-5 through a keto/enol tautomerization reaction.^[23] This reaction is catalyzed by 3beta-hydroxysteroid dehydrogenase/delta(5)-delta(4)isomerase.

Progesterone in turn (see lower half of figure to the right) is the precursor of the mineralocorticoid aldosterone, and after conversion to 17α-hydroxyprogesterone (another natural progestogen) of cortisol and androstenedione. Androstenedione can be converted to testosterone, estrone and estradiol.

Pregnenolone and progesterone can also be synthesized by yeast.^[24]

Clearance

Progesterone is metabolized mainly in the liver.^[25] It is reduced to a variety of active and inactive metabolites, including pregnanediol, pregnanetriol, and pregnanolone (pregnanedione).^[25] These metabolites are subsequently conjugated into glucuronide and sulfate forms.^[25] In urine, pregnanediol glucuronide is the major metabolite of progesterone.^[26] It has been found to constitute about 30% of an injection of progesterone.^[26]

Progesterone is reduced to its much less potent progestogen metabolite 20α-hydroxyprogesterone by the 20α-hydroxysteroid dehydrogenases AKR1C1 and AKR1C3.^[27] In addition, progesterone is converted into its active progestogen and neurosteroid metabolite 5α-dihydroprogesterone by 5α-reductase, which in turn can be converted into the non-progestogen but even more potent neurosteroid allopregnanolone by 3α-hydroxysteroid dehydrogenase.^[28] Progesterone is converted into 17α-hydroxyprogesterone and deoxycorticosterone by 17α-hydroxylase and 21-hydroxylase, respectively. 17α-Hydroxyprogesterone serves as a precursor for the androgens and estrogens, and deoxycorticosterone is a corticosteroid and a precursor for other corticosteroids as well.

Levels

In women, progesterone levels are relatively low during the preovulatory phase of the menstrual cycle, rise after ovulation, and are elevated during the luteal phase, as shown in diagram below. Progesterone levels tend to be < 2 ng/ml prior to ovulation, and > 5 ng/ml after ovulation. If pregnancy occurs, human chorionic gonadotropin is released maintaining the corpus luteum allowing it to maintain levels of progesterone. Between 7–9 weeks the placenta begins to produce progesterone in place of the corpus luteum, this process is named the luteal-placental shift.^[29] After the luteal-placental shift progesterone levels start to rise further and may reach 100-200 ng/ml at term. Whether a decrease in progesterone levels is critical for the initiation of labor has been argued and may be species-specific. After delivery of the placenta and during lactation, progesterone levels are very low.

Progesterone levels are relatively low in children and postmenopausal women.^[30] Adult males have levels similar to those in women during the follicular phase of the menstrual cycle.

Blood test results should always be interpreted using the reference ranges provided by the laboratory that performed the results. Example reference ranges are listed below.

Person type	Reference range for blood test
Person type	Lower limit	Upper limit	Unit
Female - menstrual cycle	(see diagram below)
Female - postmenopausal	<0.2^[31]	1^[31]	ng/mL
Female - postmenopausal	<0.6^[32]	3^[32]	nmol/L
Female on oral contraceptives	0.34^[31]	0.92^[31]	ng/mL
Female on oral contraceptives	1.1^[32]	2.9^[32]	nmol/L
Males ≥16 years	0.27^[31]	0.9^[31]	ng/mL
Males ≥16 years	0.86^[32]	2.9^[32]	nmol/L
Female or male 1–9 years	0.1^[31]	4.1^[31] or 4.5^[31]	ng/mL
Female or male 1–9 years	0.3^[32]	13^[32]	nmol/L

Function

Activity profile

Progesterone is the most important progestogen in the body, the result of its action as a potent agonist of the nuclear progesterone receptor (nPR) (with an affinity of K_D = 1 nM^[26]).^[8] In addition, progesterone is an agonist of the more recently discovered membrane progesterone receptors (mPRs),^[33] as well as a ligand of the PGRMC1 (progesterone receptor membrane component 1; formerly known as the σ₂ receptor).^[34] Moreover, progesterone is also known to be an antagonist of the σ₁ receptor,^[35]^[36] a negative allosteric modulator of the nACh receptors,^[9] and a potent antagonist of the mineralocorticoid receptor (MR).^[37] Progesterone prevents MR activation by binding to this receptor with an affinity exceeding even those of aldosterone and glucocorticoids such as cortisol and corticosterone.^[37] In addition, progesterone binds to and behaves as an agonist of the glucocorticoid receptor (GR), albeit very weakly.^[38]^[39]

Progesterone, through its neurosteroid active metabolites such as 5α-dihydroprogesterone and allopregnanolone, acts indirectly as a positive allosteric modulator of the GABA_A receptor.^[40]

Progesterone and some of its metabolites, such as 5β-dihydroprogesterone, are agonists of the pregnane X receptor (PXR),^[41] albeit weakly so (EC₅₀ >10 µM).^[42] In accordance, progesterone induces several hepatic cytochrome P450 enzymes,^[43] such as CYP3A4,^[44]^[45] especially during pregnancy when concentrations are much higher than usual.^[46] Premenopausal women have been found to have greater CYP3A4 activity relative to men and postmenopausal women, and it has been inferred that this may be due to the higher progesterone levels present in premenopausal women.^[44]

Progesterone modulates the activity of CatSper (cation channels of sperm) voltage-gated Ca²⁺ channels. Since eggs release progesterone, sperm may use progesterone as a homing signal to swim toward eggs (chemotaxis). As a result, it has been suggested that substances that block the progesterone binding site on CatSper channels could potentially be used in male contraception.^[47]^[48]

Progesterone binds extensively to plasma proteins, including albumin (50–54%) and transcortin (43–48%).^[25] It has similar affinity for albumin relative to the PR.^[26]

Interactions with other steroid hormones

Progesterone has a number of physiological effects that are amplified in the presence of estrogens. Estrogens through estrogen receptors (ERs) induce or upregulate the expression of the PR.^[49] One example of this is in breast tissue, where estrogens allow progesterone to mediate lobuloalveolar development.^[50]^[51]^[52]

Elevated levels of progesterone potently reduce the sodium-retaining activity of aldosterone, resulting in natriuresis and a reduction in extracellular fluid volume. Progesterone withdrawal, on the other hand, is associated with a temporary increase in sodium retention (reduced natriuresis, with an increase in extracellular fluid volume) due to the compensatory increase in aldosterone production, which combats the blockade of the mineralocorticoid receptor by the previously elevated level of progesterone.^[53]

Reproductive system

Progesterone has key effects via non-genomic signalling on human sperm as they migrate through the female tract before fertilization occurs, though the receptor(s) as yet remain unidentified.^[54] Detailed characterisation of the events occurring in sperm in response to progesterone has elucidated certain events including intracellular calcium transients and maintained changes,^[55] slow calcium oscillations,^[56] now thought to possibly regulate motility.^[57] Interestingly, progesterone has also been shown to demonstrate effects on octopus spermatozoa.^[58]

Progesterone is sometimes called the "hormone of pregnancy",^[59] and it has many roles relating to the development of the fetus:

Progesterone converts the endometrium to its secretory stage to prepare the uterus for implantation. At the same time progesterone affects the vaginal epithelium and cervical mucus, making it thick and impenetrable to sperm. Progesterone is anti-mitogenic in endometrial epithelial cells, and as such, mitigates the tropic effects of estrogen.^[60] If pregnancy does not occur, progesterone levels will decrease, leading, in the human, to menstruation. Normal menstrual bleeding is progesterone-withdrawal bleeding. If ovulation does not occur and the corpus luteum does not develop, levels of progesterone may be low, leading to anovulatory dysfunctional uterine bleeding.
During implantation and gestation, progesterone appears to decrease the maternal immune response to allow for the acceptance of the pregnancy.
Progesterone decreases contractility of the uterine smooth muscle.^[59]
In addition progesterone inhibits lactation during pregnancy. The fall in progesterone levels following delivery is one of the triggers for milk production.
A drop in progesterone levels is possibly one step that facilitates the onset of labor.

The fetus metabolizes placental progesterone in the production of adrenal steroids.

Breasts

Progesterone plays an important role in mammary gland development in females. In conjunction with prolactin, it mediates lobuloalveolar maturation of the breasts during pregnancy to allow for milk production, and thus lactation and breastfeeding after childbirth.^[61] Estrogen is required for progesterone to mediate lobuloalveolar maturation, as it induces expression of the PR in breast tissue.^[50]^[51]^[52] Moreover, it has been found that RANKL is a critical downstream mediator of progesterone-mediated lobuloalveolar development.^[62] Knockout mice of RANKL show an almost identical mammary phenotype relative to PR knockout mice, including normal mammary ductal development but complete failure of the development of lobuloalveolar structures.^[62]

Though to a far lesser extent than estrogen, which is the major mediator of breast ductal development (via ERα, specifically),^[63]^[64] progesterone has been found to be involved in ductal development as well.^[65] PR knockout mice or mice treated with the PR antagonist mifepristone show delayed but otherwise normal ductal development at puberty.^[65] In addition, mice modified to have overexpression of PRA display ductal hyperplasia,^[62] and progesterone induces ductal growth in mouse mammary gland.^[65] Progesterone mediates ductal development mainly via the induction of amphiregulin, the same growth factor that estrogen primarily induces to mediate ductal development.^[65] These findings suggest that, while not essential for full ductal development, progesterone seems to play a potentiating or accelerating role in estrogen-mediated ductal development, at least in mice.^[65]

Progesterone also appears to be involved in the pathophysiology of breast cancer, though its role, and whether it is a promoter or inhibitor of breast cancer risk, has not been fully elucidated.^[66] In any case, while certain synthetic progestins with androgenic effects such as medroxyprogesterone acetate and 19-nortestosterone derivatives including norethisterone acetate, norgestrel, and levonorgestrel have been found to significantly increase the risk of breast cancer in postmenopausal women in combination with estrogen as a component of hormone replacement therapy, the combination of natural progesterone or the pure, non-androgenic progestin dydrogesterone with estrogen has been found not to do so.^[67]^[68] In fact, progesterone or dydrogesterone added to estrogen appear to decrease the risk of breast cancer relative to estrogen alone.^[67]

Sexuality

Sex drive

Progesterone and its neurosteroid active metabolite allopregnanolone appear to be importantly involved in sex drive in females.^[69]

Homosexuality

Dr. Diana Fleischman, of the University of Portsmouth, and colleagues examined the relationship between progesterone and sexual attitudes. Their research was published in the Archives of Sexual Behavior.^[70] They found that heterosexual women who have higher levels of progesterone are more likely to be open to the idea of engaging in sexual behaviour with other women.^[71] Similarly, when heterosexual men are subtly reminded of the importance of having male friends and allies, they report more positive attitudes toward engaging in sexual behaviour with other men. This pattern is particularly dramatic in men who have high levels of progesterone.^[72]

Nervous system

Progesterone, like pregnenolone and dehydroepiandrosterone (DHEA), belongs to an important group of endogenous steroids called neurosteroids. It can be synthesized within the central nervous system and also serves as a precursor to another major neurosteroid, allopregnanolone.

Neurosteroids are neuromodulators, and are neuroprotective, neurogenic, and regulate neurotransmission and myelination.^[73] The effects of progesterone as a neurosteroid are mediated predominantly through its interactions with non-nuclear PRs, namely the mPRs and PGRMC1, as well as certain other receptors, such as the σ₁ and nACh receptors.

Aging

Since most progesterone in males is created during testicular production of testosterone, and most in females by the ovaries, the shutting down (whether by natural or chemical means), or removal, of those inevitably causes a considerable reduction in progesterone levels. Previous concentration upon the role of progestogens in female reproduction, when progesterone was simply considered a "female hormone", obscured the significance of progesterone elsewhere in both sexes.

The tendency for progesterone to have a regulatory effect, the presence of progesterone receptors in many types of body tissue, and the pattern of deterioration (or tumor formation) in many of those increasing in later years when progesterone levels have dropped, is prompting widespread research into the potential value of maintaining progesterone levels in both males and females.^{[citation needed]}

Brain damage

Studies as far back as 1987 show that female sex hormones have an effect on the recovery of traumatic brain injury.^[74] In these studies, it was first observed that pseudopregnant female rats had reduced edema after traumatic brain injury. Recent clinical trials have shown that among patients that have suffered moderate traumatic brain injury, those that have been treated with progesterone are more likely to have a better outcome than those who have not.^[75]

Previous studies have shown that progesterone supports the normal development of neurons in the brain, and that the hormone has a protective effect on damaged brain tissue. It has been observed in animal models that females have reduced susceptibility to traumatic brain injury and this protective effect has been hypothesized to be caused by increased circulating levels of estrogen and progesterone in females.^[76] A number of additional animal studies have confirmed that progesterone has neuroprotective effects when administered shortly after traumatic brain injury.^[77] Encouraging results have also been reported in human clinical trials.^[78]^[79]

Proposed mechanism

The mechanism of progesterone protective effects may be the reduction of inflammation that follows brain trauma.^[80]

Damage incurred by traumatic brain injury is believed to be caused in part by mass depolarization leading to excitotoxicity. One way in which progesterone helps to alleviate some of this excitotoxicity is by blocking the voltage-dependent calcium channels that trigger neurotransmitter release.^[81] It does so by manipulating the signaling pathways of transcription factors involved in this release. Another method for reducing the excitotoxicity is by up-regulating the GABA_A, a widespread inhibitory neurotransmitter receptor.^[82]

Progesterone has also been shown to prevent apoptosis in neurons, a common consequence of brain injury.^[74] It does so by inhibiting enzymes involved in the apoptosis pathway specifically concerning the mitochondria, such as activated caspase 3 and cytochrome c.

Not only does progesterone help prevent further damage, it has also been shown to aid in neuroregeneration. One of the serious effects of traumatic brain injury includes edema. Animal studies show that progesterone treatment leads to a decrease in edema levels by increasing the concentration of macrophages and microglia sent to the injured tissue.^[81]^[83] This was observed in the form of reduced leakage from the blood brain barrier in secondary recovery in progesterone treated rats. In addition, progesterone was observed to have antioxidant properties, reducing the concentration of oxygen free radicals faster than without.^[82] There is also evidence that the addition of progesterone can also help remyelinate damaged axons due to trauma, restoring some lost neural signal conduction.^[82] Another way progesterone aids in regeneration includes increasing the circulation of endothelial progenitor cells in the brain.^[84] This helps new vasculature to grow around scar tissue which helps repair the area of insult.

Combination treatments

Vitamin D and progesterone separately have neuroprotective effects after traumatic brain injury, but when combined their effects are synergistic.^[85] When used at their optimal respective concentrations, the two combined have been shown to reduce cell death more than when alone.

One study looks at a combination of progesterone with estrogen. Both progesterone and estrogen are known to have antioxidant-like qualities and are shown to reduce edema without injuring the blood-brain barrier. In this study, when the two hormones are administered alone it does reduce edema, but the combination of the two increases the water content, thereby increasing edema.^[86]

Clinical trials

The clinical trials for progesterone as a treatment for traumatic brain injury have only recently begun. ProTECT, a phase II trial conducted in Atlanta at Grady Memorial Hospital in 2007, the first to show that progesterone reduces edema in humans. Since then, trials have moved on to phase III. The National Institute of Health began conducting a nationwide phase III trial in 2011 led by Emory University.^[75] A global phase III initiative called SyNAPSe®, initiated in June 2010, is run by a U.S.-based private pharmaceutical company, BHR Pharma, and is being conducted in the United States, Argentina, Europe, Israel and Asia.^[87]^[88] Approximately 1,200 patients with severe (Glasgow Coma Scale scores of 3-8), closed-head TBI will be enrolled in the study at nearly 150 medical centers.

Addiction

Progesterone enhances the function of serotonin receptors in the brain, so an excess or deficit of progesterone has the potential to result in significant neurochemical issues. This provides an explanation for why some people resort to substances that enhance serotonin activity such as nicotine, alcohol, and cannabis when their progesterone levels fall below optimal levels.^[89]

To examine the effects of progesterone on nicotine addiction, participants in one study were either treated orally with a progesterone treatment, or treated with a placebo. When treated with progesterone, participants exhibited enhanced suppression of smoking urges, reported higher ratings of “bad effects” from IV nicotine, and reported lower ratings of “drug liking”. These results suggest that progesterone not only alters the subjective effects of nicotine, but reduces the urge to smoke cigarettes.^[90]
Sex differences in hormone levels may induce women to respond differently than men to nicotine. When women undergo cyclic changes or different hormonal transition phases (menopause, pregnancy, adolescence), there are changes in their progesterone levels.^[91] Therefore, females have an increased biological vulnerability to nicotine’s reinforcing effects compared to males and progesterone may be used to counter this enhanced vulnerability. This information supports the idea that progesterone can affect behavior.^[89]
Similar to nicotine, cocaine also increases the release of dopamine in the brain. The neurotransmitter is involved in the reward center and is one of the main neurotransmitters involved with substance abuse and reliance. In a study of cocaine users, it was reported that progesterone reduced craving and the feeling of being stimulated by cocaine. Thus, progesterone was suggested as an agent that decreases cocaine craving by reducing the dopaminergic properties of the drug.^[92]

Other effects

Progesterone raises epidermal growth factor-1 (EGF-1) levels, a factor often used to induce proliferation, and used to sustain cultures, of stem cells.^{[citation needed]}
Progesterone increases core temperature (thermogenic function) during ovulation.^[93]
Progesterone reduces spasm and relaxes smooth muscle. Bronchi are widened and mucus regulated. (PRs are widely present in submucosal tissue.)
Progesterone acts as an antiinflammatory agent and regulates the immune response.
Progesterone reduces gall-bladder activity.^[94]
Progesterone normalizes blood clotting and vascular tone, zinc and copper levels, cell oxygen levels, and use of fat stores for energy.
Progesterone may affect gum health, increasing risk of gingivitis (gum inflammation).^[95]
Progesterone appears to prevent endometrial cancer (involving the uterine lining) by regulating the effects of estrogen.
Progesterone plays an important role in the signaling of insulin release and pancreatic function, and may affect the susceptibility to diabetes or gestational diabetes.^[96]^[97]
Progesterone may play a role in male behavior, such as in male aggression towards infants.^[98]

Medical uses

The use of progesterone and its analogues have many medical applications, both to address acute situations and to address the long-term decline of natural progesterone levels. Because of the poor bioavailability of progesterone when taken orally, many synthetic progestins have been designed with improved oral bioavailability and have been used long before progesterone formulations became available.^[99] Progesterone was approved by the United States Food and Drug Administration as vaginal gel on July 31, 1997,^[100] an oral capsule on May 14, 1998^[101] in an injection form on April 25, 2001^[102] and as a vaginal insert on June 21, 2007.^[103] Progesterone is marketed under a large number of different brand names throughout the world.^[104]

Progesterone, when taken orally, has very poor pharmacokinetics, including low bioavailability (only about 10–15% reaches the bloodstream)^[2] and a half-life of only about 5 minutes, unless it is micronized.^[3]^[8] As such, it is sold in the form of oil-filled capsules containing micronized progesterone for oral use (Utrogestan, Prometrium, Microgest), termed oral micronized progesterone (OMP).^[3]^[104] Progesterone is also available in the forms of vaginal or rectal suppositories or pessaries (Cyclogest),^[104] transdermally-administered gels or creams (Crinone, Endometrin, Progestogel, Prochieve),^[104]^[105] or via intramuscular or subcutaneous injection of a vegetable oil solution (Progesterone, Strone).^[3]^[25]^[104]

Transdermal products made with progesterone USP (i.e., "natural progesterone") do not require a prescription. Some of these products also contain "wild yam extract" derived from Dioscorea villosa, but there is no evidence that the human body can convert its active ingredient (diosgenin, the plant steroid that is chemically converted to produce progesterone industrially^[106]) into progesterone.^[107]^[108]

Pharmacokinetics

Oral route

The route of administration impacts the effects of progesterone. OMP has a wide inter-individual variability in absorption and bioavailability. In contrast, progestins are rapidly absorbed with a longer half-life than progesterone and maintain stable levels in the blood.^[109] The absorption and bioavailability of OMP is increased approximately two-fold when it is taken with food.^[110]

Progesterone has a relatively short half-life in the body. As such, OMP is usually prescribed for twice or thrice-daily administration or once-daily administration when taken by injection.^[3] Via the oral route, peak concentrations are seen about 2–3 hours after ingestion, and the half-life is about 16–18 hours.^[3] Significantly elevated serum levels of progesterone are maintained for about 12 hours, and levels do not return to baseline until at least 24 hours have passed.^[3]

OMP is prescribed in divided doses of 25–400 mg/daily,^[111] but in the range of 100–300 mg per day most commonly. Oral doses of 100–200 mg will result in serum progesterone levels greater than 10 ng/mL.^[112] Notably, a portion of progesterone is converted into 5α-dihydroprogesterone and allopregnanolone (a conversion that is catalyzed by the enzymes 5α-reductase and 3α-hydroxysteroid dehydrogenase (3α-HSD) and occurs in the liver, reproductive endocrine tissues, skin, and the brain),^[28] which are neurosteroids and potent potentiators of GABA_A receptors.^[112]^[113] It is for this reason that common reported side effects of progesterone include dizziness, drowsiness or sedation, sleepiness, and fatigue, especially at high doses.^[112]^[113] As a result, some physicians may instruct their patients to take their progesterone before bed.^[112] Both oral and intramuscularly injected progesterone produce sedative effects, indicating that first-pass metabolism in the liver is not essential for the conversion to take place.^[114]^[115]^[116] Moreover, the sedative effects occur in both men and women, indicating a lack of sex-specificity of the effects.^[114]

There are several notable drug interactions with progesterone. Selective serotonin reuptake inhibitors (SSRIs) may increase the GABA_A receptor-related central depressant effects of progesterone by enhancing its conversion into 5α-dihydroprogesterone and allopregnanolone via activation of 3α-HSD.^[117] Progesterone potentiates the sedative effects of benzodiazepines and ethanol.^[118] Notably, there is a case report of progesterone abuse alone with very high doses.^[119] 5α-Reductase inhibitors such as finasteride and dutasteride, as well as inhibitors of 3α-HSD such as medroxyprogesterone acetate, inhibit the conversion of progesterone into its inhibitory neurosteroid metabolites, and for this reason, may have the potential to block or reduce its sedative effects.^[120]^[121]^[122]

Progesterone is a weak but significant agonist of the PXR, and has been found to induce several hepatic cytochrome P450 enzymes, such as CYP3A4, especially when concentrations are high, such as with pregnancy range levels.^[43]^[44]^[45]^[46] As such, progesterone may have the potential to accelerate the clearance of various drugs, especially with oral administration (which results in supraphysiological levels of progesterone in the liver), as well as with the high concentrations achieved with sufficient injection dosages.

Progesterone, when taken orally, undergoes gastrointestinal (especially hepatic) metabolism to form hydroxylated metabolites, which in turn are metabolized into sulfate and glucuronide derivatives.^[123] Enzymes involved in the hepatic metabolism of progesterone include, particularly, CYP2C19 and CYP3A4, as well as CYP2C9.^[4]^[5]

Other routes

Equivalent doses of transdermal progesterone are about 5–7 times lower relative to oral administration.^[2] This is due to the fact transdermal administration bypasses first-pass metabolism.^[2] As such, 20–30 mg/day transdermal progesterone is equivalent to about 100–200 mg/day oral progesterone.^[2]

With vaginal and rectal administration, a 100 mg dose of progesterone results in peak levels at 4 hours and 8 hours after dosing, respectively, with the levels achieved being in the serum luteal phase range.^[124] Following peak serum concentrations, there is a gradual decline in plasma levels, and after 24 hours, serum levels typical of the follicular phase are reached.^[124]

With intramuscular injection of 10 mg progesterone suspended in vegetable oil, maximum plasma concentrations (Cmax) are reached at approximately 8 hours after administration, and serum levels remain above baseline for about 24 hours.^[25] Doses of 10 mg, 25 mg, and 50 mg via intramuscular injection result in mean maximum serum concentrations of 7 ng/mL, 28 ng/mL, and 50 ng/mL, respectively.^[25] With intramuscular injection, a dose of 25 mg results in normal luteal phase serum levels of progesterone within 8 hours, and a 100 mg dose produces mid-pregnancy levels.^[124] At these doses, serum levels of progesterone remain elevated above baseline for at least 48 hours.^[124]

Due to the high concentrations achieved, progesterone by intramuscular injection at the usual clinical dose range is able to suppress gonadotropin secretion from the pituitary gland, demonstrating antigonadotropic efficacy.^[25]

Progesterone can also be administered alternatively via subcutaneous injection, with the aqueous new formulation Prolutex being intended specifically for once-daily administration by this route.^[125]^[126] This formulation is rapidly absorbed and has been found to result in higher serum peak progesterone levels relative to intramuscular oil formulations.^[126] In addition, subcutaneous injection of progesterone is considered to be easier, safer (less risk of injection site reactions), and less painful relative to intramuscular injection.^[126]

For comparative purposes, mid-luteal serum levels of progesterone are above 5–9 ng/ml,^[124] plasma levels in the first 4 to 8 weeks of pregnancy are 25–75 ng/ml,^[26] and serum levels at term are typically around 200 ng/ml.^[26]

Prevention of preterm birth

Vaginally dosed progesterone is being investigated as potentially beneficial in preventing preterm birth in women at risk for preterm birth. The initial study by Fonseca suggested that vaginal progesterone could prevent preterm birth in women with a history of preterm birth.^[127] According to a recent study, women with a short cervix that received hormonal treatment with a progesterone gel had their risk of prematurely giving birth reduced. The hormone treatment was administered vaginally every day during the second half of a pregnancy.^[128] A subsequent and larger study showed that vaginal progesterone was no better than placebo in preventing recurrent preterm birth in women with a history of a previous preterm birth,^[129] but a planned secondary analysis of the data in this trial showed that women with a short cervix at baseline in the trial had benefit in two ways: a reduction in births less than 32 weeks and a reduction in both the frequency and the time their babies were in intensive care.^[130] In another trial, vaginal progesterone was shown to be better than placebo in reducing preterm birth prior to 34 weeks in women with an extremely short cervix at baseline.^[131] An editorial by Roberto Romero discusses the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment.^[132] A meta-analysis published in 2011 found that vaginal progesterone cut the risk of premature births by 42 percent in women with short cervixes.^[133] The meta-analysis, which pooled published results of five large clinical trials, also found that the treatment cut the rate of breathing problems and reduced the need for placing a baby on a ventilator.^[134]

Other uses

Progesterone is used for luteal support in Assisted Reproductive Technology (ART) cycles such as In-vitro Fertilization (IVF).
Progesterone is used to control persistent anovulatory bleeding. It is also used to prepare uterine lining in infertility therapy and to support early pregnancy. Patients with recurrent pregnancy loss due to inadequate progesterone production may receive progesterone.
Progesterone is also used in nonpregnant women with a delayed menstruation of one or more weeks, in order to allow the thickened endometrial lining to slough off. This process is termed a progesterone withdrawal bleed. The progesterone is taken orally for a short time (usually one week), after which the progesterone is discontinued and bleeding should occur.^{[citation needed]}
Progesterone can be used to treat catamenial epilepsy by supplementation during certain periods of the menstrual cycle.^[135]
Progesterone is being investigated as potentially beneficial in treating multiple sclerosis, since the characteristic deterioration of nerve myelin insulation halts during pregnancy, when progesterone levels are raised; deterioration commences again when the levels drop.
Progesterone also has a role in skin elasticity and bone strength, in respiration, in nerve tissue and in female sexuality, and the presence of progesterone receptors in certain muscle and fat tissue may hint at a role in sexually dimorphic proportions of those.^[136]^{[infringing link?]}
Antiprogestins and selective progesterone receptor modulators (SPRM)s, such as mifepristone, can be used to prevent conception or induce medical abortions (note that methods of hormonal contraception do not contain progesterone but a progestin).
Progesterone is starting to be used in the treatment of the skin condition hidradenitis suppurativa.^{[citation needed]}
Progesterone is sometimes employed as a component of hormone replacement therapy for trans women.^[137]

Chemical synthesis

Semisynthesis

An economical semisynthesis of progesterone from the plant steroid diosgenin isolated from yams was developed by Russell Marker in 1940 for the Parke-Davis pharmaceutical company.^[106] This synthesis is known as the Marker degradation. Additional semisyntheses of progesterone have also been reported starting from a variety of steroids. For the example, cortisone can be simultaneously deoxygenated at the C-17 and C-21 position by treatment with iodotrimethylsilane in chloroform to produce 11-keto-progesterone (ketogestin), which in turn can be reduced at position-11 to yield progesterone.^[138]

Progesterone can also be made from the stigmasterol found in soybean oil also. c.f. Percy Julian.

Total synthesis

A total synthesis of progesterone was reported in 1971 by W.S. Johnson.^[144] The synthesis begins with reacting the phosphonium salt 7 with phenyl lithium to produce the phosphonium ylide 8. The ylide 8 is reacted with an aldehyde to produce the alkene 9. The ketal protecting groups of 9 are hydrolyzed to produce the diketone 10, which in turn is cyclized to form the cyclopentenone 11. The ketone of 11 is reacted with methyl lithium to yield the tertiary alcohol 12, which in turn is treated with acid to produce the tertiary cation 13. The key step of the synthesis is the π-cation cyclization of 13 in which the B-, C-, and D-rings of the steroid are simultaneously formed to produce 14. This step resembles the cationic cyclization reaction used in the biosynthesis of steroids and hence is referred to as biomimetic. In the next step the enol orthoester is hydrolyzed to produce the ketone 15. The cyclopentene A-ring is then opened by oxidizing with ozone to produce 16. Finally, the diketone 17 undergoes an intramolecular aldol condensation by treating with aqueous potassium hydroxide to produce progesterone.^[144]

The last reaction shows an Oppenauer oxidation of pregnenolone to progesterone.

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^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1021/ja01610a036, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1021/ja01610a036 instead.

Additional images

Steroidogenesis, showing progesterone among the progestogens in yellow area.

External links

Progesterone MS Spectrum
Progesterone at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
Kimball JW (2007-05-27). "Progesterone". Kimball's Biology Pages. Retrieved 2008-06-18. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
"Progesterone Resource Center". PMS, Menopause, and Progesterone Resource Center. Oasis Advanced Wellness, Inc. Retrieved 2008-06-18. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
Progesterone - Lab Tests Online
How to identify low progesterone and raise low levels naturally - presenting the information in an easy-to-understand manner.

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[pmid17671254-131] Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH (2007). "Progesterone and the risk of preterm birth among women with a short cervix". N. Engl. J. Med. 357 (5): 462–9. doi:10.1056/NEJMoa067815. PMID 17671254.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[pmid17899585-132] Romero R (2007). "Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment". Ultrasound Obstet Gynecol. 30 (5): 675–86. doi:10.1002/uog.5174. PMID 17899585.

[pmid21472815-133] Hassan SS, Romero R, Vidyadhari D, Fusey S, Baxter JK, Khandelwal M, Vijayaraghavan J, Trivedi Y, Soma-Pillay P, Sambarey P, Dayal A, Potapov V, O'Brien J, Astakhov V, Yuzko O, Kinzler W, Dattel B, Sehdev H, Mazheika L, Manchulenko D, Gervasi MT, Sullivan L, Conde-Agudelo A, Phillips JA, Creasy GW (July 2011). "Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial". Ultrasound Obstet Gynecol. 38 (1): 18–31. doi:10.1002/uog.9017. PMC 3482512. PMID 21472815. {{cite journal}}: Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)CS1 maint: multiple names: authors list (link)

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[Heyl-139] Heyl FW (1950). "Progesterone from 3-Acetoxybisnor-5-cholenaldehyde and 3-Ketobisnor-4-cholenaldehyde". Journal of the American Chemical Society. 72 (6): 2617–2619. doi:10.1021/ja01162a076.

[140] Slomp G (1958). "Ozonolysis. II. 1 The Effect of Pyridine on the Ozonolysis of 4,22-Stigmastadien-3-one 2". Journal of the American Chemical Society. 80 (4): 915–921. doi:10.1021/ja01537a041.

[141] Sundararaman P (1977). "A convenient synthesis of progesterone from stigmasterol". The Journal of Organic Chemistry. 42 (22): 3633–3634. doi:10.1021/jo00442a044. PMID 915584.

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[pmid5131151-144] Johnson WS, Gravestock MB, McCarry BE (August 1971). "Acetylenic bond participation in biogenetic-like olefinic cyclizations. II. Synthesis of dl-progesterone". J. Am. Chem. Soc. 93 (17): 4332–4. doi:10.1021/ja00746a062. PMID 5131151.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[145] Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1002/recl.19370560206, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1002/recl.19370560206 instead.

[146] Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1021/ja01610a036, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1021/ja01610a036 instead.

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@@ Line 140: / Line 140: @@
 ===Activity profile===
 [[File:Endometrium ocp use3.jpg|thumb|right|[[Micrograph]] showing changes to the [[endometrium]] due to progesterone ([[decidualization]]) [[H&E stain]].]]
-Progesterone is the most important progestogen in the body, the result of its action as a potent [[agonist]] of the [[progesterone receptor|nuclear progesterone receptor]] (nPR) (with an [[affinity (pharmacology)|affinity]] of K<sub>D</sub> = 1 nM<ref name="Josimovich2013">{{cite book|author=J.B. Josimovich|title=Gynecologic Endocrinology|url=http://books.google.com/books?id=9vv2BwAAQBAJ&pg=PA25|date=11 November 2013|publisher=Springer Science & Business Media|isbn=978-1-4613-2157-6|pages=25–29}}</ref>).<ref name="KingBrucker2010" /> In addition, progesterone is an agonist of the more recently discovered [[membrane progesterone receptor]]s (mPRs),<ref name="pmid22687885">{{cite journal | author = Thomas P, Pang Y | title = Membrane progesterone receptors: evidence for neuroprotective, neurosteroid signaling and neuroendocrine functions in neuronal cells | journal = Neuroendocrinology | volume = 96 | issue = 2 | pages = 162–71 | year = 2012 | pmid = 22687885 | pmc = 3489003 | doi = 10.1159/000339822 | url =  }}</ref> as well as a ligand of the [[PGRMC1]] (progesterone receptor membrane component 1; formerly known as the [[sigma-2 receptor|σ<sub>2</sub> receptor]]).<ref name="pmid9516722">{{cite journal | author = Meyer C, Schmid R, Schmieding K, Falkenstein E, Wehling M | title = Characterization of high affinity progesterone-binding membrane proteins by anti-peptide antiserum | journal = Steroids | volume = 63 | issue = 2 | pages = 111–6 | date = February 1998 | pmid = 9516722 | doi = 10.1016/s0039-128x(97)00143-8 | url =  }}</ref> Moreover, progesterone is also known to be an antagonist of the [[sigma-1 receptor|σ<sub>1</sub> receptor]],<ref name="pmid11744080">{{cite journal | author = Maurice T, Urani A, Phan VL, Romieu P | title = The interaction between neuroactive steroids and the sigma1 receptor function: behavioral consequences and therapeutic opportunities | journal = Brain Res. Brain Res. Rev. | volume = 37 | issue = 1-3 | pages = 116–32 | date = November 2001 | pmid = 11744080 | doi = 10.1016/s0165-0173(01)00112-6 | url =  }}</ref><ref name="pmid21084640">{{cite journal | author = Johannessen M, Fontanilla D, Mavlyutov T, Ruoho AE, Jackson MB | title = Antagonist action of progesterone at σ-receptors in the modulation of voltage-gated sodium channels | journal = Am. J. Physiol., Cell Physiol. | volume = 300 | issue = 2 | pages = C328–37 | date = February 2011 | pmid = 21084640 | pmc = 3043630 | doi = 10.1152/ajpcell.00383.2010 | url =  }}</ref> a [[negative allosteric modulator]] of the [[nicotinic acetylcholine receptor|nACh receptor]]s,<ref name="pmid11108866" /> and a potent antagonist of the [[mineralocorticoid receptor]] (MR).<ref name="pmid8282004">{{cite journal | author = Rupprecht R, Reul JM, van Steensel B, Spengler D, Söder M, Berning B, Holsboer F, Damm K | title = Pharmacological and functional characterization of human mineralocorticoid and glucocorticoid receptor ligands | journal = Eur J Pharmacol | volume = 247 | issue = 2 | pages = 145–54 | year = 1993 | pmid = 8282004 | doi = 10.1016/0922-4106(93)90072-H }}</ref> Progesterone prevents MR activation by binding to this receptor with an affinity exceeding even those of [[aldosterone]] and [[glucocorticoid]]s such as [[cortisol]] and [[corticosterone]].<ref name="pmid8282004" />
+Progesterone is the most important progestogen in the body, the result of its action as a potent [[agonist]] of the [[progesterone receptor|nuclear progesterone receptor]] (nPR) (with an [[affinity (pharmacology)|affinity]] of K<sub>D</sub> = 1 nM<ref name="Josimovich2013">{{cite book|author=J.B. Josimovich|title=Gynecologic Endocrinology|url=http://books.google.com/books?id=9vv2BwAAQBAJ&pg=PA25|date=11 November 2013|publisher=Springer Science & Business Media|isbn=978-1-4613-2157-6|pages=25–29}}</ref>).<ref name="KingBrucker2010" /> In addition, progesterone is an agonist of the more recently discovered [[membrane progesterone receptor]]s (mPRs),<ref name="pmid22687885">{{cite journal | author = Thomas P, Pang Y | title = Membrane progesterone receptors: evidence for neuroprotective, neurosteroid signaling and neuroendocrine functions in neuronal cells | journal = Neuroendocrinology | volume = 96 | issue = 2 | pages = 162–71 | year = 2012 | pmid = 22687885 | pmc = 3489003 | doi = 10.1159/000339822 | url =  }}</ref> as well as a ligand of the [[PGRMC1]] (progesterone receptor membrane component 1; formerly known as the [[sigma-2 receptor|σ<sub>2</sub> receptor]]).<ref name="pmid9516722">{{cite journal | author = Meyer C, Schmid R, Schmieding K, Falkenstein E, Wehling M | title = Characterization of high affinity progesterone-binding membrane proteins by anti-peptide antiserum | journal = Steroids | volume = 63 | issue = 2 | pages = 111–6 | date = February 1998 | pmid = 9516722 | doi = 10.1016/s0039-128x(97)00143-8 | url =  }}</ref> Moreover, progesterone is also known to be an antagonist of the [[sigma-1 receptor|σ<sub>1</sub> receptor]],<ref name="pmid11744080">{{cite journal | author = Maurice T, Urani A, Phan VL, Romieu P | title = The interaction between neuroactive steroids and the sigma1 receptor function: behavioral consequences and therapeutic opportunities | journal = Brain Res. Brain Res. Rev. | volume = 37 | issue = 1-3 | pages = 116–32 | date = November 2001 | pmid = 11744080 | doi = 10.1016/s0165-0173(01)00112-6 | url =  }}</ref><ref name="pmid21084640">{{cite journal | author = Johannessen M, Fontanilla D, Mavlyutov T, Ruoho AE, Jackson MB | title = Antagonist action of progesterone at σ-receptors in the modulation of voltage-gated sodium channels | journal = Am. J. Physiol., Cell Physiol. | volume = 300 | issue = 2 | pages = C328–37 | date = February 2011 | pmid = 21084640 | pmc = 3043630 | doi = 10.1152/ajpcell.00383.2010 | url =  }}</ref> a [[negative allosteric modulator]] of the [[nicotinic acetylcholine receptor|nACh receptor]]s,<ref name="pmid11108866" /> and a potent antagonist of the [[mineralocorticoid receptor]] (MR).<ref name="pmid8282004">{{cite journal | author = Rupprecht R, Reul JM, van Steensel B, Spengler D, Söder M, Berning B, Holsboer F, Damm K | title = Pharmacological and functional characterization of human mineralocorticoid and glucocorticoid receptor ligands | journal = Eur J Pharmacol | volume = 247 | issue = 2 | pages = 145–54 | year = 1993 | pmid = 8282004 | doi = 10.1016/0922-4106(93)90072-H }}</ref> Progesterone prevents MR activation by binding to this receptor with an affinity exceeding even those of [[aldosterone]] and [[glucocorticoid]]s such as [[cortisol]] and [[corticosterone]].<ref name="pmid8282004" /> In addition, progesterone binds to and behaves as an agonist of the [[glucocorticoid receptor]] (GR), albeit very weakly.<ref name="pmid18060946">{{vcite2 journal | vauthors = Attardi BJ, Zeleznik A, Simhan H, Chiao JP, Mattison DR, Caritis SN | title = Comparison of progesterone and glucocorticoid receptor binding and stimulation of gene expression by progesterone, 17-alpha hydroxyprogesterone caproate, and related progestins | journal = Am. J. Obstet. Gynecol. | volume = 197 | issue = 6 | pages = 599.e1–7 | year = 2007 | pmid = 18060946 | pmc = 2278032 | doi = 10.1016/j.ajog.2007.05.024 | url = }}</ref><ref name="SunLei2012">{{cite journal|last1=Sun|first1=Kang|last2=Lei|first2=Kaiyu|last3=Chen|first3=Li|last4=Georgiou|first4=Ektoras X.|last5=Sooranna|first5=Suren R.|last6=Khanjani|first6=Shirin|last7=Brosens|first7=Jan J.|last8=Bennett|first8=Phillip R.|last9=Johnson|first9=Mark R.|title=Progesterone Acts via the Nuclear Glucocorticoid Receptor to Suppress IL-1β-Induced COX-2 Expression in Human Term Myometrial Cells|journal=PLoS ONE|volume=7|issue=11|year=2012|pages=e50167|issn=1932-6203|doi=10.1371/journal.pone.0050167}}</ref>
 Progesterone, through its [[neurosteroid]] [[active metabolite]]s such as [[5α-dihydroprogesterone]] and [[allopregnanolone]], acts indirectly as a [[positive allosteric modulator]] of the [[GABAA receptor|GABA<sub>A</sub> receptor]].<ref name="pmid1347506">{{cite journal | vauthors = Paul SM, Purdy RH | title = Neuroactive steroids | journal = FASEB J. | volume = 6 | issue = 6 | pages = 2311–22 | year = 1992 | pmid = 1347506 | doi = | url = }}</ref>
@@ Line 334: / Line 334: @@
 {{Progestogens}}
 {{GABAAR PAMs}}
+{{Glucocorticoidics}}
+{{Mineralocorticoidics}}
 {{Progestogenics}}
 {{Sigmaergics}}
@@ Line 341: / Line 343: @@
 [[Category:Antigonadotropins]]
 [[Category:GABAA receptor positive allosteric modulators]]
+[[Category:Glucocorticoids]]
 [[Category:Glycine receptor antagonists]]
 [[Category:Neuroprotective agents]]

v t e GABA_A receptor positive modulators
Alcohols	Brometone Butanol Chloralodol Chlorobutanol (cloretone) Ethanol (alcohol) (alcoholic drink) Ethchlorvynol Isobutanol Isopropanol Menthol Methanol Methylpentynol Pentanol Petrichloral Propanol tert-Butanol (2M2P) tert-Pentanol (2M2B) Tribromoethanol Trichloroethanol Triclofos Trifluoroethanol
Barbiturates	(-)-DMBB Allobarbital Alphenal Amobarbital Aprobarbital Barbexaclone Barbital Benzobarbital Benzylbutylbarbiturate Brallobarbital Brophebarbital Butabarbital/Secbutabarbital Butalbital Buthalital Butobarbital Butallylonal Carbubarb Crotylbarbital Cyclobarbital Cyclopentobarbital Difebarbamate Enallylpropymal Ethallobarbital Eterobarb Febarbamate Heptabarb Heptobarbital Hexethal Hexobarbital Metharbital Methitural Methohexital Methylphenobarbital Narcobarbital Nealbarbital Pentobarbital Phenallymal Phenobarbital Phetharbital Primidone Probarbital Propallylonal Propylbarbital Proxibarbital Reposal Secobarbital Sigmodal Spirobarbital Talbutal Tetrabamate Tetrabarbital Thialbarbital Thiamylal Thiobarbital Thiobutabarbital Thiopental Thiotetrabarbital Valofane Vinbarbital Vinylbital
Benzodiazepines	2-Oxoquazepam 3-Hydroxyphenazepam Adinazolam Alprazolam Arfendazam Avizafone Bentazepam Bretazenil Bromazepam Bromazolam Brotizolam Camazepam Carburazepam Chlordiazepoxide Ciclotizolam Cinazepam Cinolazepam Clazolam Climazolam Clobazam Clonazepam Clonazolam Cloniprazepam Clorazepate Clotiazepam Cloxazolam CP-1414S Cyprazepam Delorazepam Demoxepam Diazepam Diclazepam Dimdazenil Doxefazepam Elfazepam Estazolam Ethyl carfluzepate Ethyl dirazepate Ethyl loflazepate Etizolam FG-8205 Fletazepam Flubromazepam Flubromazolam Fludiazepam Flunitrazepam Flunitrazolam Flurazepam Flutazolam Flutemazepam Flutoprazepam Fosazepam Gidazepam Halazepam Haloxazolam Iclazepam Imidazenil Irazepine Ketazolam Lofendazam Lopirazepam Loprazolam Lorazepam Lormetazepam Meclonazepam Medazepam Menitrazepam Metaclazepam Mexazolam Midazolam Motrazepam N-Desalkylflurazepam Nifoxipam Nimetazepam Nitrazepam Nitrazepate Nitrazolam Nordazepam Nortetrazepam Oxazepam Oxazolam Phenazepam Pinazepam Pivoxazepam Prazepam Premazepam Proflazepam Pyrazolam QH-II-66 Quazepam Reclazepam Remimazolam Rilmazafone Ripazepam Ro48-6791 Ro48-8684 SH-053-R-CH3-2′F Sulazepam Temazepam Tetrazepam Tolufazepam Triazolam Triflubazam Triflunordazepam (Ro5-2904) Tuclazepam Uldazepam Zapizolam Zolazepam Zomebazam
Carbamates	Carisbamate Carisoprodol Clocental Cyclarbamate Difebarbamate Emylcamate Ethinamate Febarbamate Felbamate Hexapropymate Hydroxyphenamate Lorbamate Mebutamate Meprobamate Nisobamate Pentabamate Phenprobamate Procymate Styramate Tetrabamate Tybamate
Flavonoids	6-Methylapigenin Ampelopsin (dihydromyricetin) Apigenin Baicalein Baicalin Catechin EGC EGCG Hispidulin Linarin Luteolin Rc-OMe Skullcap constituents (e.g., baicalin) Wogonin
Imidazoles	Etomidate Metomidate Propoxate
Kava constituents	10-Methoxyyangonin 11-Methoxyyangonin 11-Hydroxyyangonin Desmethoxyyangonin 11-Methoxy-12-hydroxydehydrokavain 7,8-Dihydroyangonin Kavain 5-Hydroxykavain 5,6-Dihydroyangonin 7,8-Dihydrokavain 5,6,7,8-Tetrahydroyangonin 5,6-Dehydromethysticin Methysticin 7,8-Dihydromethysticin Yangonin
Monoureides	Acecarbromal Apronal (apronalide) Bromisoval Carbromal Capuride Ectylurea
Neuroactive steroids	Acebrochol Allopregnanolone (brexanolone) Alfadolone Alfaxalone 3α-Androstanediol Androstenol Androsterone Certain anabolic-androgenic steroids Cholesterol DHDOC 3α-DHP 5α-DHP 5β-DHP DHT Etiocholanolone Ganaxolone Hydroxydione Minaxolone ORG-20599 ORG-21465 P1-185 Posovolone Pregnanolone (eltanolone) Progesterone Renanolone SAGE-105 SAGE-324 SAGE-516 SAGE-689 SAGE-872 Testosterone THDOC Zuranolone
Nonbenzodiazepines	Cyclopyrrolones: Eszopiclone Pagoclone Pazinaclone Suproclone Suriclone Zopiclone Imidazopyridines: Alpidem DS-1 Necopidem Saripidem Zolpidem Pyrazolopyrimidines: Divaplon Fasiplon Indiplon Lorediplon Ocinaplon Panadiplon Taniplon Zaleplon Others: Adipiplon CGS-8216 CGS-9896 CGS-13767 CGS-20625 CL-218,872 CP-615,003 CTP-354 ELB-139 GBLD-345 Imepitoin JM-1232 L-838,417 Lirequinil (Ro41-3696) NS-2664 NS-2710 NS-11394 Pipequaline ROD-188 RWJ-51204 SB-205,384 SX-3228 TGSC01AA TP-003 TPA-023 TP-13 U-89843A U-90042 Viqualine Y-23684
Phenols	Fospropofol Propofol Thymol
Piperidinediones	Glutethimide Methyprylon Piperidione Pyrithyldione
Pyrazolopyridines	Cartazolate Etazolate ICI-190,622 Tracazolate
Quinazolinones	Afloqualone Cloroqualone Diproqualone Etaqualone Mebroqualone Mecloqualone Methaqualone Methylmethaqualone Nitromethaqualone SL-164
Volatiles/gases	Acetone Acetophenone Acetylglycinamide chloral hydrate Aliflurane Benzene Butane Butylene Centalun Chloral Chloral betaine Chloral hydrate Chloroform Cryofluorane Desflurane Dichloralphenazone Dichloromethane Diethyl ether Enflurane Ethyl chloride Ethylene Fluroxene Gasoline Halopropane Halothane Isoflurane Kerosine Methoxyflurane Methoxypropane Nitric oxide Nitrogen Nitrous oxide Norflurane Paraldehyde Propane Propylene Roflurane Sevoflurane Synthane Teflurane Toluene Trichloroethane (methyl chloroform) Trichloroethylene Vinyl ether
Others/unsorted	3-Hydroxybutanal α-EMTBL AA-29504 Alogabat Avermectins (e.g., ivermectin) Bromide compounds (e.g., lithium bromide, potassium bromide, sodium bromide) Carbamazepine Chloralose Chlormezanone Clomethiazole Darigabat DEABL Deuterated etifoxine Dihydroergolines (e.g., dihydroergocryptine, dihydroergosine, dihydroergotamine, ergoloid (dihydroergotoxine)) DS2 Efavirenz Etazepine Etifoxine Fenamates (e.g., flufenamic acid, mefenamic acid, niflumic acid, tolfenamic acid) Fluoxetine Flupirtine Hopantenic acid KRM-II-81 Lanthanum Lavender oil Lignans (e.g., 4-O-methylhonokiol, honokiol, magnolol, obovatol) Loreclezole Menthyl isovalerate (validolum) Monastrol Niacin Niacinamide Org 25,435 Phenytoin Propanidid Retigabine (ezogabine) Safranal Seproxetine Stiripentol Sulfonylalkanes (e.g., sulfonmethane (sulfonal), tetronal, trional) Terpenoids (e.g., borneol) Topiramate Valerian constituents (e.g., isovaleric acid, isovaleramide, valerenic acid, valerenol) Unsorted benzodiazepine site positive modulators: α-Pinene MRK-409 (MK-0343) TCS-1105 TCS-1205
See also: Receptor/signaling modulators • GABA receptor modulators • GABA metabolism/transport modulators

v t e Sigma receptor modulators
σ₁	Agonists: 3-PPP 4-PPBP 5-MeO-DMT Alazocine (SKF-10047) Amantadine Arketamine BD-737 BD-1052 Blarcamesine Captodiame Citalopram CGRPTooltip Calcitonin gene-related peptide Cloperastine Cocaine Cutamesine (SA-4503) Cyclazocine Dehydroepiandrosterone (DHEA) (prasterone) Dehydroepiandrosterone sulfate (DHEA-S) (prasterone sulfate) Dextrallorphan Dextromethorphan (DXM) Dextrorphan (DXO) Dimemorfan Dimethyltryptamine (DMT) Ditolylguanidine (DTG) Donepezil Eliprodil Escitalopram Fabomotizole (afobazole) Fluoxetine Fluvoxamine Ifenprodil Igmesine (JO-1784) IPAB Ketamine L-687384 MDMA (midomafetamine) Memantine Methamphetamine Methoxetamine Methylphenidate Nepinalone Neuropeptide Y Noscapine OPC-14523 Opipramol Pentazocine Pentoxyverine (carbetapentane) PRE-084 Pregnenolone Pregnenolone sulfate Pridopidine Racemethorphan (methorphan) Racemorphan (morphanol) UMB-23 UMB-82 Antagonists: 3-PPP AC-927 BD-1008 BD-1031 BD-1047 BD-1060 BD-1063 BD-1067 BMY-14802 (BMS-181100) CM-156 Dup-734 E-5842 E-52862 (S1RA) Haloperidol LR-132 LR-172 MS-377 NE-100 NPC-16377 Panamesine (EMD-57455) PD-144418 Pentazocine Progesterone Rimcazole (BW-234U) Sertraline SR-31742A Allosteric modulators: Phenytoin; Positive: Methylphenylpiracetam SOMCL-668 Unknown/unsorted: 3-Methoxydextrallorphan 3-MeO-PCP 4C-T-2 4-IBP 4-IPBS 4-MeO-PCP 5-MeO-DALT 5-MeO-DiPT Amitriptyline Azidopamil Chlorpromazine Clemastine Clomipramine Clorgiline D-Deprenyl DiPTTooltip N,N-Diisopropyltryptamine DPTTooltip N,N-Dipropyltryptamine Ibogaine Imipramine KCR-12-83.1 Nemonapride Noribogaine RHL-033 RS-67,333 RTI-55 Saffron Safinamide Selegiline Spipethiane Trifluoperazine W-18 YKP10A
σ₂	Agonists: 3-PPP Arketamine BD-1047 BD1063 Ditolylguanidine (DTG) DKR-1005 DKR-1051 Haloperidol Ifenprodil Ketamine MDMA (midomafetamine) Methamphetamine OPC-14523 Opipramol PB-28 Phencyclidine Siramesine (Lu 28-179) UKH-1114 Antagonists: AC-927 BD-1008 BD-1067 CM-156 CT-1812 LR-172 MIN-101 Panamesine (EMD-57455) SAS-0132 Unknown/unsorted: 3-Methoxydextrallorphan 3-MeO-PCE 4-MeO-PCP 5-MeO-DALT 5-MeO-DiPT Clemastine DiPTTooltip N,N-Diisopropyltryptamine DPTTooltip N,N-Dipropyltryptamine Ibogaine Nemonapride Nepinalone Noribogaine Pentazocine RS-67,333 Safinamide TMATooltip 3,4,5-Trimethoxyamphetamine UMB-23 UMB-82 W-18
Unsorted	Agonists: Berberine Ethylketazocine Fourphit Metaphit Naluzotan Tapentadol Tenocyclidine Antagonists: AHD1 AZ66 Lamotrigine Naloxone SM-21 UMB-100 UMB-101 UMB-103 UMB-116 YZ-011 YZ-069 YZ-185 Allosteric modulators: SKF-83959 Unknown/unsorted: 18-Methoxycoronaridine BMY-13980 Butaclamol Caramiphen Carvotroline Chlorphenamine (chlorpheniramine) Chlorpromazine Cinnarizine Cinuperone Clocapramine Dezocine EMD-59983 Hypericin (St. John's wort) Fluphenazine Gevotroline (WY-47384) Mepyramine (pyrilamine) Molindone Perphenazine Pimozide Proadifen Promethazine Propranolol Quinidine Remoxipride SL 82.0715 SR-31747A Tiospirone (BMY-13859) Venlafaxine
See also: Receptor/signaling modulators

v t e Xenobiotic-sensing receptor modulators
CARTooltip Constitutive androstane receptor	Agonists: 6,7-Dimethylesculetin Amiodarone Artemisinin Benfuracarb Carbamazepine Carvedilol Chlorpromazine Chrysin CITCO Clotrimazole Cyclophosphamide Cypermethrin DHEA (prasterone) Efavirenz Ellagic acid Griseofulvin Methoxychlor Mifepristone Nefazodone Nevirapine Nicardipine Octicizer Permethrin Phenobarbital Phenytoin Pregnanedione (5β-dihydroprogesterone) Reserpine TCPOBOP Telmisartan Tolnaftate Troglitazone Valproic acid Antagonists: 3,17β-Estradiol 3α-Androstanol 3α-Androstenol 3β-Androstanol 17-Androstanol AITC Ethinylestradiol Meclizine Nigramide J Okadaic acid PK-11195 S-07662 T-0901317
PXRTooltip Pregnane X receptor	Agonists: 17α-Hydroxypregnenolone 17α-Hydroxyprogesterone Δ⁴-Androstenedione Δ⁵-Androstenediol Δ⁵-Androstenedione AA-861 Allopregnanediol Allopregnanedione (5α-dihydroprogesterone) Allopregnanolone (brexanolone) Alpha-Lipoic acid Ambrisentan AMI-193 Amlodipine besylate Antimycotics Artemisinin Aurothioglucose Bile acids Bithionol Bosentan Bumecaine Cafestol Cephaloridine Cephradine Chlorpromazine Ciglitazone Clindamycin Clofenvinfos Chloroxine Clotrimazole Colforsin Corticosterone Cyclophosphamide Cyproterone acetate Demecolcine Dexamethasone DHEA (prasterone) DHEA-S (prasterone sulfate) Dibunate sodium Diclazuril Dicloxacillin Dimercaprol Dinaline Docetaxel Docusate calcium Dodecylbenzenesulfonic acid Dronabinol Droxidopa Eburnamonine Ecopipam Enzacamene Epothilone B Erythromycin Famprofazone Febantel Felodipine Fenbendazole Fentanyl Flucloxacillin Fluorometholone Griseofulvin Guggulsterone Haloprogin Hetacillin potassium Hyperforin Hypericum perforatum (St John's wort) Indinavir sulfate Lasalocid sodium Levothyroxine Linolenic acid: α-Linolenic acid and γ-linolenic acid LOE-908 Loratadine Lovastatin Meclizine Metacycline Methylprednisolone Metyrapone Mevastatin Mifepristone Nafcillin Nicardipine Nicotine Nifedipine Nilvadipine Nisoldipine Norelgestromin Omeprazole Orlistat Oxatomide Paclitaxel Phenobarbital Piperine Plicamycin Prednisolone Pregnanediol Pregnanedione (5β-dihydroprogesterone) Pregnanolone Pregnenolone Pregnenolone 16α-carbonitrile Proadifen Progesterone Quingestrone Reserpine Reverse triiodothyronine Rifampicin Rifaximin Rimexolone Riodipine Ritonavir Simvastatin Sirolimus Spironolactone Spiroxatrine SR-12813 Suberoylanilide Sulfisoxazole Suramin Tacrolimus Tenylidone Terconazole Testosterone isocaproate Tetracycline Thiamylal sodium Thiothixene Thonzonium bromide Tianeptine Troglitazone Troleandomycin Tropanyl 3,5-dimethulbenzoate Zafirlukast Zeranol Antagonists: Ketoconazole Sesamin
See also Receptor/signaling modulators