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{{Short description|Chemical compound}}
{{Drugbox
{{Drugbox
| Verifiedfields = verified
| Verifiedfields = verified
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| legal_status =
| legal_status =
| routes_of_administration = [[Intramuscular injection]]
| routes_of_administration = [[Intramuscular injection]]
| class = [[Progestin]], [[progestogen]], [[progestogen ester]]
| class = [[Progestogen (medication)|Progestogen]]; [[Progestin]]; [[Progestogen ester]]


<!--Pharmacokinetic data-->
<!--Pharmacokinetic data-->
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| metabolism =
| metabolism =
| elimination_half-life =
| elimination_half-life =
| excretion =
| excretion =


<!--Identifiers-->
<!--Identifiers-->
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| PubChem = 229295
| PubChem = 229295
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank =
| DrugBank = DB14678
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 34894
| ChEBI = 34894
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| UNII_Ref = {{fdacite|correct|FDA}}
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = HY3S2K0J0F
| UNII = HY3S2K0J0F
| KEGG = C14486
| synonyms = NETE; NET-EN; Norethindrone enanthate; SH-393; 17α-Ethynyl-19-nortestosterone 17β-enanthate; 17α-Ethynylestra-4-en-17β-ol-3-one 17β-enanthate
| synonyms = NETE; NET-EN; Norethindrone enanthate; SH-393; 17α-Ethynyl-19-nortestosterone 17β-enanthate; 17α-Ethynylestra-4-en-17β-ol-3-one 17β-enanthate


<!--Chemical data-->
<!--Chemical data-->
| C=27 | H=38 | O=3
| C=27 | H=38 | O=3
| molecular_weight = 410.598 g/mol
| SMILES = CCCCCCC(=O)O[C@]1(CC[C@@H]2[C@@]1(CC[C@H]3[C@H]2CCC4=CC(=O)CC[C@H]34)C)C#C
| SMILES = CCCCCCC(=O)O[C@]1(CC[C@@H]2[C@@]1(CC[C@H]3[C@H]2CCC4=CC(=O)CC[C@H]34)C)C#C
| StdInChI = 1S/C27H38O3/c1-4-6-7-8-9-25(29)30-27(5-2)17-15-24-23-12-10-19-18-20(28)11-13-21(19)22(23)14-16-26(24,27)3/h2,18,21-24H,4,6-17H2,1,3H3/t21-,22+,23+,24-,26-,27-/m0/s1
| StdInChI = 1S/C27H38O3/c1-4-6-7-8-9-25(29)30-27(5-2)17-15-24-23-12-10-19-18-20(28)11-13-21(19)22(23)14-16-26(24,27)3/h2,18,21-24H,4,6-17H2,1,3H3/t21-,22+,23+,24-,26-,27-/m0/s1
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}}
}}
<!-- Definition and medical uses -->
<!-- Definition and medical uses -->
'''Norethisterone enanthate''' ('''NETE'''), also known as '''norethindrone enanthate''', is a form of [[progestogen-only injectable contraceptive|progestogen-only injectable birth control]] which is used to prevent [[pregnancy]] in women.<ref name=UK2016/><ref name="Elks2014">{{cite book|author=J. Elks|title=The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies|url=https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA886|date=14 November 2014|publisher=Springer|isbn=978-1-4757-2085-3|pages=886–|deadurl=no|archiveurl=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA886|archivedate=5 November 2017|df=}}</ref><ref name="IndexNominum2000">{{cite book | title = Index Nominum 2000: International Drug Directory | url = https://books.google.com/books?id=5GpcTQD_L2oC&pg=PA750 | accessdate = 30 May 2012 | year = 2000 | publisher = Taylor & Francis US | isbn = 978-3-88763-075-1 | page = 750 | deadurl = no | archiveurl = https://web.archive.org/web/20130528233641/http://books.google.com/books?id=5GpcTQD_L2oC&pg=PA750 | archivedate = 28 May 2013 | df = }}</ref> It may be used following [[childbirth]], [[miscarriage]], or [[abortion]].<ref name=UK2016/> The failure rate per year in preventing pregnancy is 2 per 100 women.<ref name=Mas1990/> Each dose lasts two months with only up to two doses typically recommended.<ref name=WHO2008/><ref name=UK2016/>
'''Norethisterone enanthate''' ('''NETE'''), also known as '''norethindrone enanthate''', is a form of [[hormonal birth control]] which is used to prevent [[pregnancy]] in women.<ref name=UK2016/><ref name="Elks2014">{{cite book| vauthors = Elks J |title=The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies|url=https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA886|date=14 November 2014|publisher=Springer|isbn=978-1-4757-2085-3|pages=886–|url-status=live|archive-url=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA886|archive-date=5 November 2017}}</ref><ref name="IndexNominum2000B">{{cite book | title = Index Nominum 2000: International Drug Directory | url = https://books.google.com/books?id=5GpcTQD_L2oC&pg=PA750 | access-date = 30 May 2012 | year = 2000 | publisher = Taylor & Francis US | isbn = 978-3-88763-075-1 | page = 750 | url-status = live | archive-url = https://web.archive.org/web/20130528233641/http://books.google.com/books?id=5GpcTQD_L2oC&pg=PA750 | archive-date = 28 May 2013}}</ref> It is used both as a form of [[progestogen-only injectable contraceptive|progestogen-only injectable birth control]] and in [[combined injectable birth control]] formulations. It may be used following [[childbirth]], [[miscarriage]], or [[abortion]].<ref name=UK2016/> The failure rate per year in preventing pregnancy for the progestogen-only formulation is 2 per 100 women.<ref name=Mas1990/> Each dose of this form lasts two months with only up to two doses typically recommended.<ref name=WHO2008/><ref name=UK2016/>


<!-- Side effects and mechanism -->
<!-- Side effects and mechanism -->
Side effects include [[breast pain]], [[headache]]s, [[depression (mood)|depression]], [[irregular menstruation|irregular menstrual periods]], and [[injection site reaction|pain at the site of injection]].<ref name=WHO2008>{{cite book|title=WHO Model Formulary 2008|date=2009|publisher=World Health Organization|isbn=9789241547659|page=370|url=http://apps.who.int/medicinedocs/documents/s16879e/s16879e.pdf|accessdate=8 December 2016|deadurl=no|archiveurl=https://web.archive.org/web/20161213060118/http://apps.who.int/medicinedocs/documents/s16879e/s16879e.pdf|archivedate=13 December 2016|df=}}</ref> Use in those with [[liver disease]] is not recommended as is use during pregnancy due to risk of [[birth defect]]s.<ref name=UK2016/> Use appears to be okay during [[breastfeeding]].<ref name=UK2016/> It does not protect against [[sexually transmitted infections]].<ref name=UK2016>{{cite web|title=Noristerat 200mg, solution for intramuscular injection - Summary of Product Characteristics (SPC) - (eMC)|url=https://www.medicines.org.uk/emc/medicine/1835|website=www.medicines.org.uk|accessdate=31 December 2016|deadurl=no|archiveurl=https://web.archive.org/web/20161231170329/https://www.medicines.org.uk/emc/medicine/1835|archivedate=31 December 2016|df=}}</ref> NETE is an [[ester]] and [[prodrug]] of [[norethisterone]],<ref name=Wu2015>{{cite journal | vauthors = Wu L, Janagam DR, Mandrell TD, Johnson JR, Lowe TL | title = Long-acting injectable hormonal dosage forms for contraception | journal = Pharmaceutical Research | volume = 32 | issue = 7 | pages = 2180–91 | year = 2015 | pmid = 25899076 | doi = 10.1007/s11095-015-1686-2 | url = }}</ref> through which it works.<ref name=UK2016/> It works as a method of birth control by stopping [[ovulation]].<ref name=UK2016/>
Side effects include [[breast pain]], [[headache]]s, [[depression (mood)|depression]], [[irregular menstruation|irregular menstrual periods]], and [[injection site reaction|pain at the site of injection]].<ref name=WHO2008>{{cite book | title = WHO Model Formulary 2008 | year = 2009 | isbn = 9789241547659 | vauthors = ((World Health Organization)) | veditors = Stuart MC, Kouimtzi M, Hill SR | hdl = 10665/44053 | author-link = World Health Organization | publisher = World Health Organization | hdl-access=free | page=370}}</ref> Use in those with [[liver disease]] is not recommended as is use during pregnancy due to risk of [[birth defect]]s.<ref name=UK2016/> Use appears to be okay during [[breastfeeding]].<ref name=UK2016/> It does not protect against [[sexually transmitted infections]].<ref name=UK2016>{{cite web|title=Noristerat 200mg, solution for intramuscular injection - Summary of Product Characteristics (SPC) - (eMC)|url=https://www.medicines.org.uk/emc/medicine/1835|website=www.medicines.org.uk|access-date=31 December 2016|url-status=dead|archive-url=https://web.archive.org/web/20161231170329/https://www.medicines.org.uk/emc/medicine/1835|archive-date=31 December 2016}}</ref> NETE is an [[ester]] and [[prodrug]] of [[norethisterone]],<ref name=Wu2015>{{cite journal | vauthors = Wu L, Janagam DR, Mandrell TD, Johnson JR, Lowe TL | title = Long-acting injectable hormonal dosage forms for contraception | journal = Pharmaceutical Research | volume = 32 | issue = 7 | pages = 2180–91 | year = 2015 | pmid = 25899076 | doi = 10.1007/s11095-015-1686-2 | s2cid = 12856674}}</ref> through which it works.<ref name=UK2016/> It works as a method of birth control by stopping [[ovulation]].<ref name=UK2016/>


<!-- History, society, and culture -->
<!-- History, society, and culture -->
Norethisterone was [[patent]]ed in 1951 and came into medical use in 1957.<ref name=Fis2006>{{cite book|last1=Fischer|first1=Janos|last2=Ganellin|first2=C. Robin|title=Analogue-based Drug Discovery|date=2006|publisher=John Wiley & Sons|isbn=9783527607495|page=478|url=https://books.google.ca/books?id=FjKfqkaKkAAC&pg=PA478|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20161220144449/https://books.google.ca/books?id=FjKfqkaKkAAC&pg=PA478|archivedate=2016-12-20|df=}}</ref><ref name="Bullough2001" /> It is on the [[World Health Organization's List of Essential Medicines]], the most effective and safe medicines needed in a [[health system]].<ref name=WHO19th>{{cite web|title=WHO Model List of Essential Medicines (19th List)|url=http://www.who.int/medicines/publications/essentialmedicines/EML_2015_FINAL_amended_NOV2015.pdf?ua=1|work=World Health Organization|accessdate=8 December 2016|date=April 2015|deadurl=no|archiveurl=https://web.archive.org/web/20161213052708/http://www.who.int/medicines/publications/essentialmedicines/EML_2015_FINAL_amended_NOV2015.pdf?ua=1|archivedate=13 December 2016|df=}}</ref> The wholesale cost in the [[developing world]] is about US$1.04–7.99 per 200&nbsp;mg vial.<ref name=ERC2014>{{cite web|title=Norethisterone|url=http://mshpriceguide.org/en/single-drug-information/?DMFId=561&searchYear=2014|website=International Drug Price Indicator Guide|accessdate=8 December 2016}}</ref> It has been approved by itself in more than 60&nbsp;countries including the [[United Kingdom]] and some in [[Europe]], [[Central America]], and [[Africa]], and in combination with [[estradiol valerate]] in at least 36&nbsp;countries mainly in [[Latin America]].<ref name=Mas1990>{{cite book|editor1=Luigi Mastroianni|editor2=Peter J. Donaldson|editor3=Thomas T. Kane|author=Committee on Contraceptive Development (U.S.)|title=Developing New Contraceptives: Obstacles and Opportunities|url=https://books.google.com/books?id=x0QrAAAAYAAJ&pg=PA38|date=1 January 1990|publisher=National Academies|pages=38–|id=NAP:14119|deadurl=no|archiveurl=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=x0QrAAAAYAAJ&pg=PA38|archivedate=5 November 2017|df=}}</ref><ref name=Whit2014/><ref name="BagadePawar2014">{{cite journal | vauthors = Bagade O, Pawar V, Patel R, Patel B, Awasarkar V, Diwate S | title = Increasing use of long-acting reversible contraception: safe, reliable, and cost-effective birth control | journal = World J Pharm Pharm Sci | volume = 3 | issue = 10 | pages = 364–392 | year = 2014 | issn = 2278-4357 | doi = | url = http://www.wjpps.com/download/article/1412071798.pdf}}</ref><ref name="pmid12290848" /> It is not available in the [[United States]].<ref name=Whit2014>{{cite book|author1=Amy Whitaker|author2=Melissa Gilliam|title=Contraception for Adolescent and Young Adult Women|url=https://books.google.com/books?id=vMQkBAAAQBAJ&pg=PA96|date=27 June 2014|publisher=Springer|isbn=978-1-4614-6579-9|page=96|deadurl=no|archiveurl=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=vMQkBAAAQBAJ&pg=PA96|archivedate=5 November 2017|df=}}</ref>
Norethisterone was [[patent]]ed in 1951 and NETE came into medical use in 1957.<ref name=Fis2006>{{cite book| vauthors = Fischer J, Ganellin CR |title=Analogue-based Drug Discovery|date=2006|publisher=John Wiley & Sons|isbn=9783527607495|page=478|url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA478|language=en|url-status=live|archive-url=https://web.archive.org/web/20161220144449/https://books.google.ca/books?id=FjKfqkaKkAAC&pg=PA478|archive-date=2016-12-20}}</ref><ref name="Bullough2001" /> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO21st">{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 21st list 2019 | year = 2019 | hdl = 10665/325771 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO | hdl-access=free}}</ref> It has been approved by itself in more than 60&nbsp;countries including the [[United Kingdom]] and some in [[Europe]], [[Central America]], and [[Africa]], and in combination with [[estradiol valerate]] in at least 36&nbsp;countries mainly in [[Latin America]].<ref name=Mas1990>{{cite book| veditors = Mastroianni L, Donaldson PJ, Kane TT |author=Committee on Contraceptive Development (U.S.)|title=Developing New Contraceptives: Obstacles and Opportunities|url=https://archive.org/details/developingnewcon00mast|url-access=registration|date=1 January 1990|publisher=National Academies|pages=[https://archive.org/details/developingnewcon00mast/page/38 38]–|isbn=9780309041478|id=NAP:14119}}</ref><ref name=Whit2014/><ref name="BagadePawar2014">{{cite journal | vauthors = Bagade O, Pawar V, Patel R, Patel B, Awasarkar V, Diwate S | title = Increasing use of long-acting reversible contraception: safe, reliable, and cost-effective birth control | journal = World J Pharm Pharm Sci | volume = 3 | issue = 10 | pages = 364–392 | year = 2014 | issn = 2278-4357 | url = http://www.wjpps.com/download/article/1412071798.pdf | access-date = 2018-08-02 | archive-url = https://web.archive.org/web/20170810000242/http://www.wjpps.com/download/article/1412071798.pdf | archive-date = 2017-08-10 | url-status = dead }}</ref><ref name="pmid12290848" /> It is not available in the [[United States]].<ref name=Whit2014>{{cite book| vauthors = Whitaker A, Gilliam M |title=Contraception for Adolescent and Young Adult Women|url=https://books.google.com/books?id=vMQkBAAAQBAJ&pg=PA96|date=27 June 2014|publisher=Springer|isbn=978-1-4614-6579-9|page=96|url-status=live|archive-url=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=vMQkBAAAQBAJ&pg=PA96|archive-date=5 November 2017}}</ref>


==Medical uses==
==Medical uses==
NETE is used on its own as a long-lasting [[progestogen-only injectable contraceptive]] in women.<ref name=UK2016/><ref name=WHO2008/> It is administered via [[intramuscular injection]] once every two months.<ref name=UK2016/><ref name=WHO2008/>
NETE is used on its own as a long-lasting [[progestogen-only injectable contraceptive]] in women.<ref name=UK2016/><ref name=WHO2008/> It is administered via [[intramuscular injection]] once every two months.<ref name=UK2016 /><ref name=WHO2008 />


==Contraindications==
==Contraindications==
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===Pharmacodynamics===
===Pharmacodynamics===
NETE is a [[prodrug]] of [[norethisterone]] in the body.<ref name="pmid15491776">{{cite journal | vauthors = Hapgood JP, Koubovec D, Louw A, Africander D | title = Not all progestins are the same: implications for usage | journal = Trends Pharmacol. Sci. | volume = 25 | issue = 11 | pages = 554–7 | date = November 2004 | pmid = 15491776 | doi = 10.1016/j.tips.2004.09.005 | url = }}</ref> Upon reaching circulation, it is rapidly converted into norethisterone by [[esterase]]s. Hence, as a prodrug of norethisterone, NETE has essentially the same effects as norethisterone, acting as a potent [[progestogen]] with additional weak [[androgen]]ic and [[estrogen (medication)|estrogen]]ic activity (the latter via its [[metabolite]] [[ethinylestradiol]]).<ref name="HumansOrganization2007">{{cite book|author1=IARC Working Group on the Evaluation of Carcinogenic Risks to Humans|author2=World Health Organization|author3=International Agency for Research on Cancer|title=Combined Estrogen-progestogen Contraceptives and Combined Estrogen-progestogen Menopausal Therapy|url=https://books.google.com/books?id=aGDU5xibtNgC&pg=PA417|year=2007|publisher=World Health Organization|isbn=978-92-832-1291-1|pages=417,432|quote=Norethisterone and its acetate and enanthate esters are progestogens that have weak estrogenic and androgenic properties.|deadurl=no|archiveurl=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=aGDU5xibtNgC&pg=PA417|archivedate=2017-11-05|df=}}</ref> NETA has some progestogenic activity of its own, but it is unclear if NETE does similarly.<ref name="pmid15491776" />
NETE is a [[prodrug]] of [[norethisterone]] in the body.<ref name="pmid15491776">{{cite journal | vauthors = Hapgood JP, Koubovec D, Louw A, Africander D | title = Not all progestins are the same: implications for usage | journal = Trends Pharmacol. Sci. | volume = 25 | issue = 11 | pages = 554–7 | date = November 2004 | pmid = 15491776 | doi = 10.1016/j.tips.2004.09.005}}</ref> Upon reaching circulation, it is rapidly converted into norethisterone by [[esterase]]s. Hence, as a prodrug of norethisterone, NETE has essentially the same effects as norethisterone, acting as a potent [[progestogen (medication)|progestogen]] with additional weak [[androgen]]ic and [[estrogen (medication)|estrogen]]ic activity (the latter via its [[metabolite]] [[ethinylestradiol]]).<ref name="HumansOrganization2007">{{cite book|author1=IARC Working Group on the Evaluation of Carcinogenic Risks to Humans|author2=World Health Organization|author3=International Agency for Research on Cancer|title=Combined Estrogen-progestogen Contraceptives and Combined Estrogen-progestogen Menopausal Therapy|url=https://books.google.com/books?id=aGDU5xibtNgC&pg=PA417|year=2007|publisher=World Health Organization|isbn=978-92-832-1291-1|pages=417, 432|quote=Norethisterone and its acetate and enanthate esters are progestogens that have weak estrogenic and androgenic properties.|url-status=live|archive-url=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=aGDU5xibtNgC&pg=PA417|archive-date=2017-11-05}}</ref> NETA has some progestogenic activity of its own, but it is unclear if NETE does similarly.<ref name="pmid15491776" />


NETE is of about 38% higher [[molecular weight]] than norethisterone due to the presence of its C17β [[enanthic acid|enanthate]] [[ester]].<ref name="Elks2014" />
NETE is of about 38% higher [[molecular weight]] than norethisterone due to the presence of its C17β [[enanthic acid|enanthate]] [[ester]].<ref name="Elks2014" />
Line 94: Line 95:


{{Parenteral potencies and durations of progestogens}}
{{Parenteral potencies and durations of progestogens}}

[[File:Hormone levels in men with a single intramuscular injection of 5 mg estradiol valerate and 50 mg norethisterone enanthate in oil.png|thumb|right|450px|Hormone levels following a single intramuscular injection of [[estradiol valerate/norethisterone enanthate]] (5&nbsp;mg/50&nbsp;mg) (Mesigyna) in healthy young men.<ref name="ValleAlvarez2011" /> Testosterone levels were maximally suppressed by about 94%, to ~30&nbsp;ng/dL, when measured at day 7 post-injection.<ref name="ValleAlvarez2011" />]]

A single intramuscular injection of [[estradiol valerate/norethisterone enanthate]] (5&nbsp;mg/50&nbsp;mg) (Mesigyna) has been found to strongly suppress [[testosterone]] levels in men.<ref name="ValleAlvarez2011">{{cite thesis | type = MSc | vauthors = del Cisne Valle Alvarez D | title = Efecto de una Dosis de 50 mg de Enantato de Noretisterona y 5 mg de Valerato de Estradiol en los Niveles de Testosterona Total en Hombres Mexicanos Sanos | trans-title = Effect of a Dose of 50 mg of Norethisterone Enanthate and 5 mg of Estradiol Valerate on Total Testosterone Levels in Healthy Mexican Men | date = 11 May 2011 | publisher = National Polytechnic Institute of Mexico | url = http://repositoriodigital.ipn.mx/handle/123456789/12490}}</ref> Levels of testosterone decreased from ~503&nbsp;ng/dL at baseline to ~30&nbsp;ng/dL at the lowest point (–94%).<ref name="ValleAlvarez2011" />


===Pharmacokinetics===
===Pharmacokinetics===
[[File:Norethisterone and ethinylestradiol levels after a single intramuscular injection of 200 mg norethisterone enanthate in premenopausal women.png|thumb|right|450px|Norethisterone and ethinylestradiol levels over 8 weeks after a single intramuscular injection of 200 mg NETE in premenopausal women.<ref name="pmid29522253" />]]
[[File:Norethisterone and ethinylestradiol levels after a single intramuscular injection of 200 mg norethisterone enanthate in premenopausal women.png|thumb|right|450px|Norethisterone and ethinylestradiol levels over 8 weeks after a single intramuscular injection of 200 mg NETE in premenopausal women.<ref name="pmid29522253" />]]


A single [[intramuscular injection]] of 50 to 200&nbsp;mg NETE in [[oil solution]] has been found to have a [[duration of action]] of 11 to 52&nbsp;days in terms of clinical [[biological effect]] in the [[uterus]] and on [[body temperature]] in women.<ref name="Ferin1972a">{{cite book | vauthors = Ferin J |chapter=Effects, Duration of Action and Metabolism in Man |pages=13–24 <!-- Tables on pages 17–19 --> | veditors = Tausk M |title=Pharmacology of the Endocrine System and Related Drugs: Progesterone, Progestational Drugs and Antifertility Agents |volume=II |url=https://books.google.com/books?id=Nv5sAAAAMAAJ |date=September 1972 |publisher=Pergamon Press |isbn=978-0080168128 |oclc=278011135}}</ref>
⚫
Similarly to oral norethisterone and [[norethisterone acetate]], intramuscular NETE has been found to form [[ethinylestradiol]] as an [[active metabolite]].<ref name="pmid29522253">{{cite journal | vauthors = Friedrich C, Berse M, Klein S, Rohde B, Höchel J | title = In Vivo Formation of Ethinylestradiol After Intramuscular Administration of Norethisterone Enantate | journal = J Clin Pharmacol | volume = | issue = | pages = | date = March 2018 | pmid = 29522253 | doi = 10.1002/jcph.1079 | url = }}</ref> With a single intramuscular injection of 200&nbsp;mg NETE in premenopausal women, the mean maximum concentration of ethinylestradiol was 32% of that of a combined oral contraceptive containing 30&nbsp;μg ethinylestradiol, the maximum equivalent oral dose of ethinylestradiol observed in the first few days of exposure was 20.3&nbsp;μg/day, and the mean equivalent oral dose of ethinylestradiol over 8&nbsp;weeks was 4.41&nbsp;μg/day.<ref name="pmid29522253" /> As such, the exposure to ethinylestradiol was described as markedly lower than that of an oral contraceptive containing 30&nbsp;μg ethinylestradiol.<ref name="pmid29522253" /> The estimated conversion rate of NETE into ethinylestradiol was 0.1%, which was much lower than that observed for oral norethisterone and norethisterone enanthate (0.2–1.0%), likely due to the lack of the [[first-pass metabolism|first-pass]] through the [[liver]] with [[parenteral]] administration.<ref name="pmid29522253" /> In accordance with the low levels of ethinylestradiol produced, no increase rates of [[thromboembolism]] or [[hepatic adenoma]] have been observed in [[postmarketing surveillance|post-authorization data]] of intramuscular NETE, and the medication does not resemble combined oral contraceptives containing ethinylestradiol in its [[drug safety|safety]] profile.<ref name="pmid29522253" />

⚫
Similarly to oral norethisterone and [[norethisterone acetate]], intramuscular NETE has been found to form [[ethinylestradiol]] as an [[active metabolite]].<ref name="pmid29522253">{{cite journal | vauthors = Friedrich C, Berse M, Klein S, Rohde B, Höchel J | title = In Vivo Formation of Ethinylestradiol After Intramuscular Administration of Norethisterone Enantate | journal = J Clin Pharmacol | volume = 58| issue = 6| pages = 781–789| date = March 2018 | pmid = 29522253 | doi = 10.1002/jcph.1079 | s2cid = 3813229}}</ref> With a single intramuscular injection of 200&nbsp;mg NETE in premenopausal women, the mean maximum concentration of ethinylestradiol was 32% of that of a combined oral contraceptive containing 30&nbsp;μg ethinylestradiol, the maximum equivalent oral dose of ethinylestradiol observed in the first few days of exposure was 20.3&nbsp;μg/day, and the mean equivalent oral dose of ethinylestradiol over 8&nbsp;weeks was 4.41&nbsp;μg/day.<ref name="pmid29522253" /> As such, the exposure to ethinylestradiol was described as markedly lower than that of an oral contraceptive containing 30&nbsp;μg ethinylestradiol.<ref name="pmid29522253" /> The estimated conversion rate of NETE into ethinylestradiol was 0.1%, which was much lower than that observed for oral norethisterone and norethisterone enanthate (0.2–1.0%), likely due to the lack of the [[first-pass metabolism|first pass]] through the [[liver]] with [[parenteral]] administration.<ref name="pmid29522253" /> In accordance with the low levels of ethinylestradiol produced, no increase rates of [[thromboembolism]] or [[hepatic adenoma]] have been observed in [[postmarketing surveillance|post-authorization data]] of intramuscular NETE, and the medication does not resemble combined oral contraceptives containing ethinylestradiol in its [[drug safety|safety]] profile.<ref name="pmid29522253" />


==Chemistry==
==Chemistry==
Line 106: Line 113:


==History==
==History==
NETE was introduced by [[Schering AG|Schering]] as Noristerat in 1957.<ref name="Bullough2001">{{cite book|author=Vern L. Bullough|title=Encyclopedia of Birth Control|url=https://books.google.com/books?id=XuX-MGTZnJoC&pg=PA145|year=2001|publisher=ABC-CLIO|isbn=978-1-57607-181-6|pages=145–|deadurl=no|archiveurl=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=XuX-MGTZnJoC&pg=PA145|archivedate=2017-11-05|df=}}</ref> It was the first progestogen-only injectable contraceptive, preceding [[medroxyprogesterone acetate]] (Depo-Provera).<ref name="Bullough2001"/>
NETE was introduced by [[Schering AG|Schering]] as Noristerat in 1957.<ref name="Bullough2001">{{cite book| vauthors = Bullough VL |title=Encyclopedia of Birth Control|url=https://books.google.com/books?id=XuX-MGTZnJoC&pg=PA145|year=2001|publisher=ABC-CLIO|isbn=978-1-57607-181-6|pages=145–|url-status=live|archive-url=https://web.archive.org/web/20171105201625/https://books.google.com/books?id=XuX-MGTZnJoC&pg=PA145|archive-date=2017-11-05}}</ref> It was the second long-acting progestogen to be used clinically, after [[hydroxyprogesterone caproate]].<ref name="pmid13583829">{{cite journal | vauthors = Boschann HW | title = Observations of the role of progestational agents in human gynecologic disorders and pregnancy complications | journal = Ann. N. Y. Acad. Sci. | volume = 71 | issue = 5 | pages = 727–52 | date = July 1958 | pmid = 13583829 | doi = 10.1111/j.1749-6632.1958.tb46803.x | bibcode = 1958NYASA..71..727B}}</ref> The medication was the first progestogen-only injectable contraceptive, preceding [[medroxyprogesterone acetate]] (Depo-Provera).<ref name="Bullough2001"/>


==Society and culture==
==Society and culture==


===Generic names===
===Generic names===
''Norethisterone enantate'' is the [[generic term|generic name]] of the drug and its {{abbrlink|INNM|International Nonproprietary Name}} and {{abbrlink|BANM|British Approved Name}}.<ref name="Elks2014" /><ref name="IndexNominum2000" /><ref name="MortonHall2012">{{cite book|author1=I.K. Morton|author2=Judith M. Hall|title=Concise Dictionary of Pharmacological Agents: Properties and Synonyms|url=https://books.google.com/books?id=tsjrCAAAQBAJ&pg=PA201|date=6 December 2012|publisher=Springer Science & Business Media|isbn=978-94-011-4439-1|pages=201–}}</ref><ref name="Drugs.com">https://www.drugs.com/international/norethisterone.html</ref><ref name="Martindale">{{cite book |editor=Sweetman, Sean C. |chapter=Sex hormones and their modulators |title=Martindale: The Complete Drug Reference |edition=36th |year=2009 |page=2082 |publisher=Pharmaceutical Press |location=London|isbn=978-0-85369-840-1|url=https://www.medicinescomplete.com/mc/martindale/}}</ref> It is also spelled as ''norethisterone enanthate'' and is also known as ''norethindrone enanthate'' (the {{abbrlink|USAN|United States Adopted Name}} of norethisterone being ''norethindrone'').<ref name="Elks2014" /><ref name="IndexNominum2000" /><ref name="MortonHall2012" /><ref name="Drugs.com" /><ref name="Martindale" /> NETE is known by its former developmental code name ''SH-393'' as well.<ref name="Elks2014" /><ref name="IndexNominum2000" /><ref name="MortonHall2012" /><ref name="Drugs.com" /><ref name="Martindale" />
''Norethisterone enantate'' is the [[generic term|generic name]] of the drug and its {{abbrlink|INNM|International Nonproprietary Name}} and {{abbrlink|BANM|British Approved Name}}.<ref name="Elks2014" /><ref name="IndexNominum2000" /><ref name="MortonHall2012">{{cite book| vauthors = Morton IK, Hall JM |title=Concise Dictionary of Pharmacological Agents: Properties and Synonyms|url=https://books.google.com/books?id=tsjrCAAAQBAJ&pg=PA201|date=6 December 2012|publisher=Springer Science & Business Media|isbn=978-94-011-4439-1|pages=201–}}</ref><ref name="Drugs.com">{{Cite web|url=https://www.drugs.com/international/norethisterone.html|title = Norethisterone}}</ref><ref name="Martindale">{{cite book | veditors = Sweetman SC |chapter=Sex hormones and their modulators |title=Martindale: The Complete Drug Reference |edition=36th |year=2009 |page=2082 |publisher=Pharmaceutical Press |location=London|isbn=978-0-85369-840-1|chapter-url=https://www.medicinescomplete.com/mc/martindale/}}</ref> It is also spelled as ''norethisterone enanthate'' and is also known as ''norethindrone enanthate'' (the {{abbrlink|USAN|United States Adopted Name}} of norethisterone being ''norethindrone'').<ref name="Elks2014" /><ref name="IndexNominum2000" /><ref name="MortonHall2012" /><ref name="Drugs.com" /><ref name="Martindale" /> NETE is known by its former developmental code name ''SH-393'' as well.<ref name="Elks2014" /><ref name="IndexNominum2000" /><ref name="MortonHall2012" /><ref name="Drugs.com" /><ref name="Martindale" />


===Brand names===
===Brand names===
NETE has been marketed alone as a [[progestogen-only injectable contraceptive]] under the brand names Depocon, Doryxas, NET-EN, Noristat, Noristerat, Norigest, and Nur-Isterate, and in combination with [[estradiol valerate]] as a [[combined injectable contraceptive]] under the brand names Chinese Injectable No. 3, Efectimes, Ginediol, Mesigyna, Mesilar, Meslart, Mesocept, Mesygest, Nofertyl, Nofertyl Lafrancol, Noregyna, Norestrin, Norifam, Norigynon, Nostidyn, Sexseg, and Solouna.<ref name="IndexNominum2000" /><ref name="Drugs.com" /><ref name="Martindale" /><ref name="Micromedex">https://www.micromedexsolutions.com/micromedex2/librarian/</ref>
NETE has been marketed alone as a [[progestogen-only injectable contraceptive]] under the brand names Depocon, Doryxas, NET-EN, Noristat, Noristerat, Norigest, and Nur-Isterate, and in combination with [[estradiol valerate]] as a [[combined injectable contraceptive]] under the brand names Chinese Injectable No. 3, {{not a typo|Efectimes}}, Ginediol, Mesigyna, Mesilar, Meslart, Mesocept, Mesygest, Nofertyl, Nofertyl Lafrancol, Noregyna, Norestrin, Norifam, Norigynon, Nostidyn, Sexseg, and Solouna.<ref name="IndexNominum2000" /><ref name="Drugs.com" /><ref name="Martindale" /><ref name="Micromedex">{{Cite web|url=https://www.micromedexsolutions.com/micromedex2/librarian/|title = Micromedex Products: Please Login}}</ref>


{{Formulations and brand names of norethisterone and esters}}
{{Formulations and brand names of norethisterone and esters}}
Line 121: Line 128:
NETE has been approved for use alone as a [[progestogen-only injectable contraceptive]] in more than 60&nbsp;countries throughout the world including in [[Europe]], [[Latin America]], [[Asia]], and [[Africa]].<ref name="Mas1990" /><ref name="Whit2014" /><ref name="BagadePawar2014" /> Specific countries in which NETE as a standalone medication is or has been available include [[Bangladesh]], [[France]], [[Germany]], [[India]], [[Italy]], [[Malaysia]], [[Mexico]], the [[Philippines]], [[Singapore]], [[South Africa]], [[Thailand]], and the [[United Kingdom]].<ref name="IndexNominum2000" /><ref name="Drugs.com" /><ref name="Martindale" /><ref name="Micromedex" />
NETE has been approved for use alone as a [[progestogen-only injectable contraceptive]] in more than 60&nbsp;countries throughout the world including in [[Europe]], [[Latin America]], [[Asia]], and [[Africa]].<ref name="Mas1990" /><ref name="Whit2014" /><ref name="BagadePawar2014" /> Specific countries in which NETE as a standalone medication is or has been available include [[Bangladesh]], [[France]], [[Germany]], [[India]], [[Italy]], [[Malaysia]], [[Mexico]], the [[Philippines]], [[Singapore]], [[South Africa]], [[Thailand]], and the [[United Kingdom]].<ref name="IndexNominum2000" /><ref name="Drugs.com" /><ref name="Martindale" /><ref name="Micromedex" />


NETE has been approved for use in combination with [[estradiol valerate]] as a [[combined injectable contraceptive]] in at least 36&nbsp;countries, mostly in Latin America but also in Africa.<ref name="BagadePawar2014" /><ref name="pmid12290848">{{cite journal | vauthors = Newton JR, D'arcangues C, Hall PE | title = A review of "once-a-month" combined injectable contraceptives | journal = J Obstet Gynaecol (Lahore) | volume = 4 Suppl 1 | issue = | pages = S1–34 | year = 1994 | pmid = 12290848 | doi = 10.3109/01443619409027641| url = }}</ref> It is or has been available in combination with estradiol valerate in [[Argentina]], the [[Bahamas]], [[Barbados]], [[Bolivia]], [[Brazil]], [[Chile]], [[Colombia]], [[Costa Rica]], the [[Dominican Republic]], [[Ecuador]], [[Egypt]], [[El Salvador]], [[Ghana]], [[Grenada]], [[Guatemala]], [[Guyana]], [[Haiti]], [[Honduras]], [[Jamaica]], [[Kenya]], [[Mexico]], [[Nicaragua]], [[Panama]], [[Paraguay]], [[Peru]], [[St. Lucia]], [[Turkey]], [[Uruguay]], [[Venezuela]], and [[Zimbabwe]].<ref name="Drugs.com" /><ref name="Martindale" /><ref name="Micromedex" /><ref name="HumansOrganization2007" />
NETE has been approved for use in combination with [[estradiol valerate]] as a [[combined injectable contraceptive]] in at least 36&nbsp;countries, mostly in Latin America but also in Africa.<ref name="BagadePawar2014" /><ref name="pmid12290848">{{cite journal | vauthors = Newton JR, D'arcangues C, Hall PE | title = A review of "once-a-month" combined injectable contraceptives | journal = J Obstet Gynaecol (Lahore) | volume = 4 | issue = Suppl 1 | pages = S1–34 | year = 1994 | pmid = 12290848 | doi = 10.3109/01443619409027641}}</ref> It is or has been available in combination with estradiol valerate in [[Argentina]], the [[Bahamas]], [[Barbados]], [[Bolivia]], [[Brazil]], [[Chile]], [[Colombia]], [[Costa Rica]], the [[Dominican Republic]], [[Ecuador]], [[Egypt]], [[El Salvador]], [[Ghana]], [[Grenada]], [[Guatemala]], [[Guyana]], [[Haiti]], [[Honduras]], [[Jamaica]], [[Kenya]], [[Mexico]], [[Nicaragua]], [[Panama]], [[Paraguay]], [[Peru]], [[St. Lucia]], [[Turkey]], [[Uruguay]], [[Venezuela]], and [[Zimbabwe]].<ref name="Drugs.com" /><ref name="Martindale" /><ref name="Micromedex" /><ref name="HumansOrganization2007" />


NETE is not available in any form in the [[United States]].<ref name="Whit2014" />
NETE is not available in any form in the [[United States]].<ref name="Whit2014" />


==Research==
==Research==
NETE was studied by [[Schering AG|Schering]] for use as a [[progestogen-only injectable contraceptive]] at a dose of 25&nbsp;mg once a month but produced poor cycle control with this regimen and was not marketed.<ref name="pmid865726">{{cite journal | vauthors = Toppozada M | title = The clinical use of monthly injectable contraceptive preparations | journal = Obstet Gynecol Surv | volume = 32 | issue = 6 | pages = 335–47 | date = June 1977 | pmid = 865726 | doi = 10.1097/00006254-197706000-00001 | url = }}</ref>
NETE was studied by [[Schering AG|Schering]] for use as a [[progestogen-only injectable contraceptive]] at a dose of 25&nbsp;mg once a month but produced poor cycle control with this regimen and was not marketed.<ref name="pmid865726">{{cite journal | vauthors = Toppozada M | title = The clinical use of monthly injectable contraceptive preparations | journal = Obstet Gynecol Surv | volume = 32 | issue = 6 | pages = 335–47 | date = June 1977 | pmid = 865726 | doi = 10.1097/00006254-197706000-00001}}</ref>

⚫
NETE has been studied for use as a potential [[male contraceptive|male hormonal contraceptive]] in combination with [[testosterone (medication)|testosterone]] in men.<ref name="pmid20933120">{{cite journal | vauthors = Nieschlag E | title = Clinical trials in male hormonal contraception | journal = Contraception | volume = 82 | issue = 5 | pages = 457–70 | year = 2010 | pmid = 20933120 | doi = 10.1016/j.contraception.2010.03.020 | url = }}</ref>


⚫
NETE has been studied for use as a potential [[male contraceptive|male hormonal contraceptive]] in combination with [[testosterone (medication)|testosterone]] in men.<ref name="pmid20933120">{{cite journal | vauthors = Nieschlag E | title = Clinical trials in male hormonal contraception | journal = Contraception | volume = 82 | issue = 5 | pages = 457–70 | year = 2010 | pmid = 20933120 | doi =10.1016/j.contraception.2010.03.020 | url = http://www.kup.at/kup/pdf/10172.pdf}}</ref>
{{clear}}
==See also==
==See also==
* [[Estradiol valerate/norethisterone enanthate]]
* [[Estradiol valerate/norethisterone enantate]]
* [[Estradiol undecylate/norethisterone enanthate]]


==References==
==References==
{{Reflist}}
{{Reflist}}

== External links ==
* {{cite web | url = https://druginfo.nlm.nih.gov/drugportal/name/norethisterone%20enanthate | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Norethisterone Enanthate}}


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{{DEFAULTSORT:Norethisterone Enanthate}}
{{DEFAULTSORT:Norethisterone Enanthate}}

[[Category:1951 introductions]]
[[Category:1951 introductions]]
[[Category:Androgens and anabolic steroids]]
[[Category:Anabolic–androgenic steroids]]
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[[Category:Enanthate esters]]
[[Category:Estranes]]
[[Category:Estranes]]
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[[Category:Prodrugs]]
[[Category:Progestogen esters]]
[[Category:Progestogen esters]]
[[Category:Progestogens]]
[[Category:Progestogens]]
[[Category:RTT]]
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[[Category:Synthetic estrogens]]
[[Category:World Health Organization essential medicines]]
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{{portal bar|Pharmacy and pharmacology|Medicine}}

Latest revision as of 12:06, 2 November 2024

Norethisterone enanthate
Clinical data
Trade namesNoristerat, others
Other namesNETE; NET-EN; Norethindrone enanthate; SH-393; 17α-Ethynyl-19-nortestosterone 17β-enanthate; 17α-Ethynylestra-4-en-17β-ol-3-one 17β-enanthate
AHFS/Drugs.comInternational Drug Names
Routes of
administration		Intramuscular injection
Drug classProgestogen; Progestin; Progestogen ester
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
Identifiers
  • [(9S,10R,13S,14S,17R)-17-ethynyl-13-methyl-3-oxo-1,2,6,7,8,9,10,11,12,14,15,16-dodecahydrocyclopenta[a]phenanthren-17-yl] heptanoate
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.021.207 Edit this at Wikidata
Chemical and physical data
FormulaC27H38O3
Molar mass410.598 g·mol−1
3D model (JSmol)
  • CCCCCCC(=O)O[C@]1(CC[C@@H]2[C@@]1(CC[C@H]3[C@H]2CCC4=CC(=O)CC[C@H]34)C)C#C
  • InChI=1S/C27H38O3/c1-4-6-7-8-9-25(29)30-27(5-2)17-15-24-23-12-10-19-18-20(28)11-13-21(19)22(23)14-16-26(24,27)3/h2,18,21-24H,4,6-17H2,1,3H3/t21-,22+,23+,24-,26-,27-/m0/s1
  • Key:APTGJECXMIKIET-WOSSHHRXSA-N
  (verify)

Norethisterone enanthate (NETE), also known as norethindrone enanthate, is a form of hormonal birth control which is used to prevent pregnancy in women.[1][2][3] It is used both as a form of progestogen-only injectable birth control and in combined injectable birth control formulations. It may be used following childbirth, miscarriage, or abortion.[1] The failure rate per year in preventing pregnancy for the progestogen-only formulation is 2 per 100 women.[4] Each dose of this form lasts two months with only up to two doses typically recommended.[5][1]

Side effects include breast pain, headaches, depression, irregular menstrual periods, and pain at the site of injection.[5] Use in those with liver disease is not recommended as is use during pregnancy due to risk of birth defects.[1] Use appears to be okay during breastfeeding.[1] It does not protect against sexually transmitted infections.[1] NETE is an ester and prodrug of norethisterone,[6] through which it works.[1] It works as a method of birth control by stopping ovulation.[1]

Norethisterone was patented in 1951 and NETE came into medical use in 1957.[7][8] It is on the World Health Organization's List of Essential Medicines.[9] It has been approved by itself in more than 60 countries including the United Kingdom and some in Europe, Central America, and Africa, and in combination with estradiol valerate in at least 36 countries mainly in Latin America.[4][10][11][12] It is not available in the United States.[10]

Medical uses

[edit]

NETE is used on its own as a long-lasting progestogen-only injectable contraceptive in women.[1][5] It is administered via intramuscular injection once every two months.[1][5]

Contraindications

[edit]
See also: Norethisterone § Contraindications, and Progestin § Contraindications

Side effects

[edit]
See also: Norethisterone § Side effects, and Progestin § Side effects

Side effects of NETE may include breast pain, headaches, depression, irregular menstrual periods, and pain at the site of injection.[5] It can cause birth defects in the fetus if used during pregnancy.[1]

Overdose

[edit]
See also: Norethisterone § Overdose, and Progestin § Overdose

Interactions

[edit]
See also: Norethisterone § Interactions, and Progestin § Interactions

Pharmacology

[edit]
See also: Norethisterone § Pharmacology, and Norethisterone § Pharmacokinetics
Norethisterone, the active form of NETE.

Pharmacodynamics

[edit]

NETE is a prodrug of norethisterone in the body.[13] Upon reaching circulation, it is rapidly converted into norethisterone by esterases. Hence, as a prodrug of norethisterone, NETE has essentially the same effects as norethisterone, acting as a potent progestogen with additional weak androgenic and estrogenic activity (the latter via its metabolite ethinylestradiol).[14] NETA has some progestogenic activity of its own, but it is unclear if NETE does similarly.[13]

NETE is of about 38% higher molecular weight than norethisterone due to the presence of its C17β enanthate ester.[2]

Relative affinities (%) of norethisterone, metabolites, and prodrugs
Compound Typea PRTooltip Progesterone receptor ARTooltip Androgen receptor ERTooltip Estrogen receptor GRTooltip Glucocorticoid receptor MRTooltip Mineralocorticoid receptor SHBGTooltip Sex hormone-binding globulin CBGTooltip Corticosteroid binding globulin
Norethisterone – 67–75 15 0 0–1 0–3 16 0
5α-Dihydronorethisterone Metabolite 25 27 0 0 ? ? ?
3α,5α-Tetrahydronorethisterone Metabolite 1 0 0–1 0 ? ? ?
3α,5β-Tetrahydronorethisterone Metabolite ? 0 0 ? ? ? ?
3β,5α-Tetrahydronorethisterone Metabolite 1 0 0–8 0 ? ? ?
Ethinylestradiol Metabolite 15–25 1–3 112 1–3 0 0.18 0
Norethisterone acetate Prodrug 20 5 1 0 0 ? ?
Norethisterone enanthate Prodrug ? ? ? ? ? ? ?
Noretynodrel Prodrug 6 0 2 0 0 0 0
Etynodiol Prodrug 1 0 11–18 0 ? ? ?
Etynodiol diacetate Prodrug 1 0 0 0 0 ? ?
Lynestrenol Prodrug 1 1 3 0 0 ? ?
Notes: Values are percentages (%). Reference ligands (100%) were promegestone for the PRTooltip progesterone receptor, metribolone for the ARTooltip androgen receptor, estradiol for the ERTooltip estrogen receptor, dexamethasone for the GRTooltip glucocorticoid receptor, aldosterone for the MRTooltip mineralocorticoid receptor, dihydrotestosterone for SHBGTooltip sex hormone-binding globulin, and cortisol for CBGTooltip Corticosteroid-binding globulin. Footnotes: a = Active or inactive metabolite, prodrug, or neither of norethisterone. Sources: See template.
Parenteral potencies and durations of progestogens[a][b]
Compound Form Dose for specific uses (mg)[c] DOA[d]
TFD[e] POICD[f] CICD[g]
Algestone acetophenide Oil soln. – – 75–150 14–32 d
Gestonorone caproate Oil soln. 25–50 – – 8–13 d
Hydroxyprogest. acetate[h] Aq. susp. 350 – – 9–16 d
Hydroxyprogest. caproate Oil soln. 250–500[i] – 250–500 5–21 d
Medroxyprog. acetate Aq. susp. 50–100 150 25 14–50+ d
Megestrol acetate Aq. susp. – – 25 >14 d
Norethisterone enanthate Oil soln. 100–200 200 50 11–52 d
Progesterone Oil soln. 200[i] – – 2–6 d
Aq. soln. ? – – 1–2 d
Aq. susp. 50–200 – – 7–14 d
Notes and sources:
  1. ^ Sources: [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]
  2. ^ All given by intramuscular or subcutaneous injection.
  3. ^ Progesterone production during the luteal phase is ~25 (15–50) mg/day. The OIDTooltip ovulation-inhibiting dose of OHPC is 250 to 500 mg/month.
  4. ^ Duration of action in days.
  5. ^ Usually given for 14 days.
  6. ^ Usually dosed every two to three months.
  7. ^ Usually dosed once monthly.
  8. ^ Never marketed or approved by this route.
  9. ^ a b In divided doses (2 × 125 or 250 mg for OHPC, 10 × 20 mg for P4).
Hormone levels following a single intramuscular injection of estradiol valerate/norethisterone enanthate (5 mg/50 mg) (Mesigyna) in healthy young men.[34] Testosterone levels were maximally suppressed by about 94%, to ~30 ng/dL, when measured at day 7 post-injection.[34]

A single intramuscular injection of estradiol valerate/norethisterone enanthate (5 mg/50 mg) (Mesigyna) has been found to strongly suppress testosterone levels in men.[34] Levels of testosterone decreased from ~503 ng/dL at baseline to ~30 ng/dL at the lowest point (–94%).[34]

Pharmacokinetics

[edit]
Norethisterone and ethinylestradiol levels over 8 weeks after a single intramuscular injection of 200 mg NETE in premenopausal women.[35]

A single intramuscular injection of 50 to 200 mg NETE in oil solution has been found to have a duration of action of 11 to 52 days in terms of clinical biological effect in the uterus and on body temperature in women.[36]

Similarly to oral norethisterone and norethisterone acetate, intramuscular NETE has been found to form ethinylestradiol as an active metabolite.[35] With a single intramuscular injection of 200 mg NETE in premenopausal women, the mean maximum concentration of ethinylestradiol was 32% of that of a combined oral contraceptive containing 30 μg ethinylestradiol, the maximum equivalent oral dose of ethinylestradiol observed in the first few days of exposure was 20.3 μg/day, and the mean equivalent oral dose of ethinylestradiol over 8 weeks was 4.41 μg/day.[35] As such, the exposure to ethinylestradiol was described as markedly lower than that of an oral contraceptive containing 30 μg ethinylestradiol.[35] The estimated conversion rate of NETE into ethinylestradiol was 0.1%, which was much lower than that observed for oral norethisterone and norethisterone enanthate (0.2–1.0%), likely due to the lack of the first pass through the liver with parenteral administration.[35] In accordance with the low levels of ethinylestradiol produced, no increase rates of thromboembolism or hepatic adenoma have been observed in post-authorization data of intramuscular NETE, and the medication does not resemble combined oral contraceptives containing ethinylestradiol in its safety profile.[35]

Chemistry

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See also: List of progestogens, Progestogen ester, List of progestogen esters, and List of androgens/anabolic steroids

NETE, also known as norethinyltestosterone enanthate, as well as 17α-ethynyl-19-nortestosterone 17β-enanthate or 17α-ethynylestr-4-en-17β-ol-3-one 17β-enanthate, is a progestin, or synthetic progestogen, of the 19-nortestosterone group, and a synthetic estrane steroid.[2][37] It is the C17β enanthate ester of norethisterone.[2][37] NETE is a derivative of testosterone with an ethynyl group at the C17α position, the methyl group at the C19 position removed, and an enanthate ester attached at the C17β position.[2][37] In addition to testosterone, it is a combined derivative of nandrolone (19-nortestosterone) and ethisterone (17α-ethynyltestosterone).[2][37] Esters related to NETE include norethisterone acetate and levonorgestrel butanoate.[2][37]

History

[edit]

NETE was introduced by Schering as Noristerat in 1957.[8] It was the second long-acting progestogen to be used clinically, after hydroxyprogesterone caproate.[38] The medication was the first progestogen-only injectable contraceptive, preceding medroxyprogesterone acetate (Depo-Provera).[8]

Society and culture

[edit]

Generic names

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Norethisterone enantate is the generic name of the drug and its INNMTooltip International Nonproprietary Name and BANMTooltip British Approved Name.[2][37][39][40][41] It is also spelled as norethisterone enanthate and is also known as norethindrone enanthate (the USANTooltip United States Adopted Name of norethisterone being norethindrone).[2][37][39][40][41] NETE is known by its former developmental code name SH-393 as well.[2][37][39][40][41]

Brand names

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NETE has been marketed alone as a progestogen-only injectable contraceptive under the brand names Depocon, Doryxas, NET-EN, Noristat, Noristerat, Norigest, and Nur-Isterate, and in combination with estradiol valerate as a combined injectable contraceptive under the brand names Chinese Injectable No. 3, Efectimes, Ginediol, Mesigyna, Mesilar, Meslart, Mesocept, Mesygest, Nofertyl, Nofertyl Lafrancol, Noregyna, Norestrin, Norifam, Norigynon, Nostidyn, Sexseg, and Solouna.[37][40][41][42]

Formulations and brand names of norethisterone and esters
Composition Dose Brand names Use
NET only Low (e.g., 0.35 mg) Multiple[a] Progestogen-only oral contraceptive
NET or NETA only High (e.g., 5 mg, 10 mg) Multiple[b] Gynecological disorders and other uses
NETE only Injection (e.g., 200 mg) Multiple[c] Progestogen-only injectable contraceptive
NET or NETA with ethinylestradiol Low (e.g., 0.4 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg) Multiple[d] Combined oral contraceptive
NET with mestranol Low (e.g., 1 mg, 2 mg) Multiple[e] Combined oral contraceptive
NETA with estradiol Low (e.g., 0.1 mg, 0.5 mg) Multiple[f] Combined menopausal hormone therapy
NETE with estradiol valerate Injection (e.g., 50 mg) Multiple[g] Combined injectable contraceptive
Abbreviations: NET = Norethisterone. NETA = Norethisterone acetate. NETE = Norethisterone enanthate.
Sources: [43][44] [37][45]
Notes:
  1. ^ Camila, Errin, Heather, Jencycla, Jolivette, Locilan, Micro-Novum, Micronovum, Micronor, Nor-QD, Nora, Noriday, Ortho Micronor
  2. ^ Aygestin, Lupaneta Pack (combination pack with leuprorelin), Norcolut, Norlutate, Primolut N, Primolut Nor, SH-420, Utovlan
  3. ^ Depocon, Doryxas, NET-EN, Noristerat, Norigest, Nur-Isterate
  4. ^ Aranelle, Balziva, Binovum, Brevicon, Brevinor, Briellyn, Cyclafem, Dasetta, Estrostep, Femcon, Generess, Gildagia, Gildess, Jinteli, Junel, Larin, Leena, Lo Loestrin, Lo Minastrin, Loestrin, Lolo, Lomedia, Microgestin, Minastrin, Modicon, Nelova, Norimin, Norinyl, Nortrel, Ortho, Ortho-Novum, Ovcon, Ovysmen, Philith, Primella, Select, Synphase, Synphasic, Tilia, Tri-Legest, Tri-Norinyl, Trinovum, Vyfemla, Wera, Wymzya, Zenchent, Zeosa
  5. ^ Norethin, Noriday, Norinyl, Norquen, Ortho-Novum, Sophia
  6. ^ Activella, Activelle, Alyacen, Cliane, Climagest, Climesse, Cliovelle, CombiPatch, Elleste Duet, Estalis, Estropause, Eviana, Evorel, Kliane, Kliofem, Kliogest, Kliovance, Mesigyna, Mesygest, Mimvey, Necon, Novofem, Nuvelle, Sequidot, Systen, Trisequens
  7. ^ Chinese Injectable No. 3, Efectimes, Ginediol, Mesigyna, Mesilar, Meslart, Mesocept, Mesygest, Nofertyl, Nofertyl Lafrancol, Noregyna, Norestrin, Norifam, Norigynon, Nostidyn, Sexseg, Solouna

Availability

[edit]

NETE has been approved for use alone as a progestogen-only injectable contraceptive in more than 60 countries throughout the world including in Europe, Latin America, Asia, and Africa.[4][10][11] Specific countries in which NETE as a standalone medication is or has been available include Bangladesh, France, Germany, India, Italy, Malaysia, Mexico, the Philippines, Singapore, South Africa, Thailand, and the United Kingdom.[37][40][41][42]

NETE has been approved for use in combination with estradiol valerate as a combined injectable contraceptive in at least 36 countries, mostly in Latin America but also in Africa.[11][12] It is or has been available in combination with estradiol valerate in Argentina, the Bahamas, Barbados, Bolivia, Brazil, Chile, Colombia, Costa Rica, the Dominican Republic, Ecuador, Egypt, El Salvador, Ghana, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Kenya, Mexico, Nicaragua, Panama, Paraguay, Peru, St. Lucia, Turkey, Uruguay, Venezuela, and Zimbabwe.[40][41][42][14]

NETE is not available in any form in the United States.[10]

Research

[edit]

NETE was studied by Schering for use as a progestogen-only injectable contraceptive at a dose of 25 mg once a month but produced poor cycle control with this regimen and was not marketed.[46]

NETE has been studied for use as a potential male hormonal contraceptive in combination with testosterone in men.[47]

See also

[edit]

References

[edit]
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  2. ^ a b c d e f g h i j Elks J (14 November 2014). The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. Springer. pp. 886–. ISBN 978-1-4757-2085-3. Archived from the original on 5 November 2017.
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  4. ^ a b c Committee on Contraceptive Development (U.S.) (1 January 1990). Mastroianni L, Donaldson PJ, Kane TT (eds.). Developing New Contraceptives: Obstacles and Opportunities. National Academies. pp. 38–. ISBN 9780309041478. NAP:14119.
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  9. ^ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
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