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 approved; investigational; vet_approved
ATC Code G03CA03
DrugBank ID DB13952
KEGG ID D04061
MeSH ID D004958
PubChem ID 9818306
TTD Drug ID D0T7ZQ
NDC Product Code 64918-0105; 72495-202; 72495-201
UNII 5R97F5H93P
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
ADRs Induced by Drug
*The priority for ADR severity classification is based on FAERS assessment, followed by the most severe level in CTCAE rating. If neither is available, it will be displayed as 'Not available'.
**The 'Not Available' level is hidden by default and can be restored by clicking on the legend twice.
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--
Amenorrhoea05.05.01.002; 21.01.02.001--
Anaphylactic reaction10.01.07.001; 24.06.03.006--
Angioedema10.01.05.009; 22.04.02.008; 23.04.01.001---
Arthralgia15.01.02.001--
Asthma10.01.03.010; 22.03.01.002---
Back pain15.03.04.005--
Blood pressure increased13.14.03.005---
Blood triglycerides increased13.12.03.001---
Breast cancer16.10.01.001; 21.05.01.003---
Breast discharge21.05.05.001---
Breast enlargement21.05.04.001---
Breast tenderness21.05.05.004---
Bronchitis11.01.09.001; 22.07.01.001--
Carbohydrate tolerance decreased13.02.02.003---
Cerebrovascular accident17.08.01.007; 24.03.05.001--
Chloasma18.08.02.002; 23.05.01.001---
Chorea17.01.01.001---
Corneal oedema06.04.02.001---
Dementia17.03.01.001; 19.20.02.001---
Depression19.15.01.001--
Diarrhoea07.02.01.0010.010272%
Discomfort08.01.08.0030.010272%-
Dizziness02.11.04.006; 17.02.05.003; 24.06.02.0070.010272%
Drug ineffective08.06.01.0060.092444%-
Dysmenorrhoea21.01.01.002--
Ectropion of cervix21.06.01.004---
Endometrial cancer16.12.02.001; 21.07.02.002---
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