Drospirenone
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| Systematic (IUPAC) name | |
| (6R,7R,8R,9S,10R,13S,14S,15S,16S,17S)- 1,3',4',6,6a,7,8,9,10,11,12,13,14,15,15a,16- hexadecahydro-10,13-dimethylspiro- [17H-dicyclopropa-6,7:15,16]cyclopenta [a]phenanthrene-17,2'(5H)-furan]-3,5'(2H)-dione) |
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| Clinical data | |
| Pregnancy cat. | X(US) |
| Legal status | ? |
| Routes | Oral |
| Pharmacokinetic data | |
| Bioavailability | 76% |
| Protein binding | 97% |
| Metabolism | Hepatic, minor (CYP3A4-mediated) |
| Half-life | 30 hours |
| Excretion | Renal and fecal |
| Identifiers | |
| CAS number | 67392-87-4  |
| ATC code | G03AA12 |
| PubChem | CID 68873 |
| DrugBank | DB01395 |
| ChemSpider | 62105 |
| UNII | N295J34A25 |
| KEGG | D03917 |
| ChEBI | CHEBI:50838 |
| ChEMBL | CHEMBL1509 |
| Chemical data | |
| Formula | C24H30O3 |
| Mol. mass | 366.493 g/mol |
| SMILES | eMolecules & PubChem |
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Drospirenone is an anti-androgenic synthetic progestin that is used in birth control.
Contents |
[edit] Medical uses
Drospirenone is part of some birth control pills and hormone replacement therapy. In combination with ethinyl estradiol it is used as contraception, to treat moderate acne, and for premenstrual dysphoric disorder.[1] In combination with estradiol it is used to treat menopausal symptoms and premenstrual dysphoric disorder.[2]
[edit] Adverse effects
Women who take contraceptive pills containing drospirenone have a six- to sevenfold risk of developing thromboembolism compared to women who do not take any contraceptive pill, and twice the risk of women who take a contraceptive pill containing levonorgestrel.[3]
Drospirenone can potentially cause hyperkalemia in high-risk patients, is comparable to a 25 mg dose of spironolactone.
The medication is contraindicated in people with hepatic dysfunction, renal insufficiency, adrenal insufficiency, or in whom the use of oral contraceptives is contraindicated, such as smokers and patients with a history of DVT, stroke, or other blood clots. Because of the anti-mineralocorticoid effects care needs to be exercised when other drugs that may increase potassium levels are taken. Such medications include ACE inhibitors, angiotensin-II receptor agonists, potassium-sparing diuretics, potassium supplementation, heparin, aldosterone antagonists, and NSAIDs.
Although there have been concerns raised regarding the safety of drospirenone containing oral contraceptives, the data is conflicting and it is unclear whether the increased risk of venous thrombembolic events seen in recent studies represents a true increase in this risk or whether flaws in the design of these studies are resulting in a false safety signal. Further study in this regard appears to be warranted.[4]
[edit] Mechanism of action
Drospirenone is taken orally with about 76% bioavailability. It is bound not by sex hormone-binding globulin or corticosteroid binding globulin, but by other serum proteins. Metabolites have not been shown to be biologically active, show up in urine and feces, and are essentially completely excreted within 10 days.
The compound differs from other synthetic progestins in that its pharmacological profile in preclinical studies shows it to be closer to the natural progesterone. As such it has anti-mineralocorticoid properties, counteracts the estrogen-stimulated activity of the renin-angiotensin-aldosterone system, and is not androgenic. The anti-aldosterone properties exhibited by drospirenone promote sodium excretion and prevent water retention.[5]
[edit] Chemistry
It is an analog to spironolactone, with a molecular weight of 366.5 and the molecular formula C24H30O3.
[edit] Formulations
The compound is part of certain newer oral contraceptive formulations:
- Yasmin contains 3 mg drospirenone and 30 mcg ethinylestradiol per tablet. It is indicated for the prevention of pregnancy in women who elect an oral contraceptive.
- Yasminelle contains 3 mg drospirenone and 20 mcg ethinylestradiol per tablet and is used for contraception.
- Yaz contains 3 mg drospirenone and 20 mcg ethinylestradiol per tablet and is given for 24/4 days with the same indications.
- Ocella contains 3 mg drospirenone and 30 mcg ethinylestradiol per tablet and is taken daily.
It has also been formulated in medication to manage menopausal symptoms using 0.5 mg drsp and 1 mg estradiol per day by oral application. This medication was introduced in the United States in 2007 as Angeliq.
[edit] Litigation
In 2008, a series of television commercials prompted the FDA to cite Bayer for overstating the approved uses of Yaz while failing to adequately address the risks of the drug. Bayer was required to dispel the inaccurate information contained in those ads by creating new ads that clarified the drug's approved uses.[6]
On October 8, 2009, Bayer disclosed that 129 lawsuits had been brought against them over the side effects and marketing of Yaz and Yasmin. The allegations include (but are not limited to):
- Glossing over risks associated with the products and overstating their approved uses in an effort to mislead users of Yaz and Yasmin into believing that the drugs were safe.[6][7]
- Failure to properly research the medication.
- Failing to recall the drug after post-marketing reports demonstrated that the risk of potentially life-threatening side effects of Yasmin and Yaz outweighed potential benefits that could be achieved via other available oral contraceptives.
In September 2009, the FDA cited Bayer for sending out potentially low-quality batches of drosperinone. Bayer justified the shipments by explaining that they monitor the "average" quality of all shipments, not the quality of each individual batch.
In October 2011 the CBC TV program Market Place ran a segment discussing issues involved with the usage of Yaz/Yasmin [8]
[edit] See also
- Progestins
- Combined oral contraceptive pill
- Oral contraceptive formulations
- Hormone replacement therapy
[edit] References
- ^ http://www.drugs.com/mtm/drospirenone-and-ethinyl-estradiol.html
- ^ http://www.drugs.com/mtm/drospirenone-and-estradiol.html
- ^ Lidegaard et al. (2011). "Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses". BMJ 343: 1–15.
- ^ Dunn, N (2011 Apr 21). "The risk of deep venous thrombosis with oral contraceptives containing drospirenone.". BMJ (Clinical research ed.) 342: d2519. PMID 21511807.
- ^ . 1. 2007. pp. 11–18.
- ^ a b http://www.courthousenews.com/2009/10/15/Yasmin_YAZ_Claims_Against_Bayer_Mount_Up.htm
- ^ "Nurse Charges Dangerous Yaz Birth Control Drug "Altered My Life"". Reuters. October 21, 2009. http://www.reuters.com/article/pressRelease/idUS204695+21-Oct-2009+BW20091021.
- ^ "VIDEO: Marketplace looks into alleged Yasmin risks". CBC News. January 20, 2011. http://www.cbc.ca/news/health/story/2011/01/20/yasmin-marketplace.html.
- Krattenmacher R (2000). "Drospirenone: pharmacology and pharmacokinetics of a unique progestogen". Contraception 62 (1): 29–38. doi:10.1016/S0010-7824(00)00133-5. PMID 11024226.
- Yasmin product information
- Yaz product information
- Angeliq product information
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