Ormeloxifene

Ormeloxifene
Systematic (IUPAC) name
1-[2-[4-[(3S,4R)-7-methoxy-2,2- dimethyl-3-phenyl-chroman-4-yl] phenoxy] ethyl] pyrrolidine
Clinical data
Trade names Centron, Novex-DS, Saheli, Sevista
Routes of
administration		 Oral
Pharmacokinetic data
Biological half-life 7 days
Identifiers
CAS Number 78994-24-8 N
ATC code G03XC04 (WHO)
PubChem CID 154413
ChemSpider 32935 YesY
UNII 44AXY5VE90 YesY
KEGG D08301 YesY
ChEMBL CHEMBL301327 YesY
Synonyms Centchroman
Chemical data
Formula C30H35NO3
Molar mass 457.604 g/mol
 NYesY (what is this?)  (verify)
Ormeloxifene
Background
Birth control type Anti-estrogen
First use 1991
Failure rates (first year)
Perfect use 2%
Typical use 9%
Usage
Duration effect One week
Reversibility Immediate
User reminders Taken twice weekly for first 13 weeks
Clinic review Annually
Advantages and disadvantages
STD protection No
Periods May disrupt
Safe while breastfeeding Yes[1]
Weight No proven effect
Medical notes
Only approved as a contraceptive in India

Ormeloxifene (also known as centchroman) is one of the selective estrogen receptor modulators,[2] or SERMs, a class of medication which acts on the estrogen receptor. It is best known as a non-hormonal, non-steroidal oral contraceptive which is taken once per week. In India, ormeloxifene has been available as birth control since the early 1990s, and it is currently marketed there under the trade name Saheli.[3] Ormeloxifene has also been licensed under the trade names Novex-DS, Centron and Sevista.

Medical uses

Ormeloxifene is primarily used as a contraceptive but may also be effective for dysfunctional uterine bleeding and advanced breast cancer.[4]

Birth control

Ormeloxifene may be used as a weekly oral contraceptive.[4] The weekly schedule is an advantage for women who prefer an oral contraceptive, but find it difficult or impractical to adhere to a daily schedule required by other oral contraceptives.

For the first twelve weeks of use, it is advised to take the ormeloxifene pill twice per week.[4] From the thirteenth week on, it is taken once per week.[4][5] The consensus is that backup protection in the first month is a cautious but sensible choice. A standard dose is 30 mg weekly, but 60 mg loading doses can reduce pregnancy rates by 38%.[6]

It has a failure rate of about 1-2% with ideal use which is slightly less effective than found for combined oral contraceptive pills.[7]

Other indications

Adverse effects

There are concerns that ormeloxifene may cause delayed menstruation.[10]

Method of action

Ormeloxifene is a SERM, or selective estrogen receptor modulator. In some parts of the body, its action is estrogenic (e.g., bones), in other parts of the body, its action is anti-estrogenic (e.g., uterus, breasts.[11][12]) It causes an asynchrony in the menstrual cycle between ovulation and the development of the uterine lining, although its exact mode of action is not well defined. In clinical trials, it caused ovulation to occur later than it normally would in some women,[7] but did not affect ovulation in the majority of women, while causing the lining of the uterus to build more slowly. It speeds the transport of any fertilized egg through the fallopian tubes more quickly than is normal.[7] Presumably, this combination of effects creates an environment such that if fertilization occurs, implantation will not be possible.[7]

Marketing

Ormeloxifene is only legally available in India as of 2009.[13]

Ormeloxifene has been tested and licensed as a form of birth control, as well as a treatment for dysfunctional uterine bleeding.

Synthesis

See also

References

  1. ↑ Gupta RC, Paliwal JK, Nityanand S, Asthana OP, Lal J (1995). "Centchroman: a new non-steroidal oral contraceptive in human milk". Contraception 52 (5): 301–5. doi:10.1016/0010-7824(95)00214-U. PMID 8585887.
  2. ↑ Makker, Annu; Tandon, Indu; Goel, Madhu Mati; Singh, Mastan; Singh, Man Mohan (2009). "Effect of ormeloxifene, a selective estrogen receptor modulator, on biomarkers of endometrial receptivity and pinopode development and its relation to fertility and infertility in Indian subjects". Fertility and Sterility 91 (6): 2298–307. doi:10.1016/j.fertnstert.2008.04.018. PMID 18675966.
  3. ↑ "HLL - Product Overview".
  4. 1 2 3 4 Lal, J (April 2010). "Clinical pharmacokinetics and interaction of centchroman--a mini review.". Contraception 81 (4): 275–80. doi:10.1016/j.contraception.2009.11.007. PMID 20227542.
  5. ↑ http://www.reproline.jhu.edu/english/1fp/1advances/old/1centch/ceorvw.htm[]
  6. ↑ Lal J, Nitynand S, Asthana OP, Nagaraja NV, Gupta RC (January 2001). "Optimization of contraceptive dosage regimen of Centchroman". Contraception 63 (1): 47–51. doi:10.1016/S0010-7824(00)00189-X. PMID 11257249.
  7. 1 2 3 4 Singh, M.M. (2001). "Centchroman, a selective estrogen receptor modulator, as a contraceptive and for the management of hormone-related clinical disorders". Medicinal Research Reviews 21 (4): 302–47. doi:10.1002/med.1011. PMID 11410933.
  8. ↑ Kriplani A, Kulshrestha V, Agarwal N (August 2009). "Efficacy and safety of ormeloxifene in management of menorrhagia: a pilot study". J. Obstet. Gynaecol. Res. 35 (4): 746–52. doi:10.1111/j.1447-0756.2008.00987.x. PMID 19751337.
  9. ↑ Dhar A, Srivastava A (June 2007). "Role of centchroman in regression of mastalgia and fibroadenoma". World J Surg 31 (6): 1178–84. doi:10.1007/s00268-007-9040-4. PMID 17431715.
  10. ↑ Shelly, W; Draper, MW; Krishnan, V; Wong, M; Jaffe, RB (March 2008). "Selective estrogen receptor modulators: an update on recent clinical findings.". Obstetrical & gynecological survey 63 (3): 163–81. doi:10.1097/OGX.0b013e31816400d7. PMID 18279543.
  11. ↑ Gara Rishi Kumar, Konwar Rituraj, Bid Hemant K and MM Singh. In-vitro anti-cancer breast activity of ormeloxifene is mediated via induction of apoptosis and autophagy. 37th annual conference of the endocrine society of India. 30 nov-2 dec, 2007. Abstract p35.
  12. ↑ Nigam, Manisha; Ranjan, Vishal; Srivastava, Swasti; Sharma, Ramesh; Balapure, Anil K. (2008). "Centchroman induces G0/G1 arrest and Caspase-dependent Apoptosis involving Mitochondrial Membrane Depolarization in MCF-7 and MDA MB-231 Human Breast Cancer Cells". Life Sciences 82 (11–12): 577–90. doi:10.1016/j.lfs.2007.11.028. PMID 18279897.
  13. ↑ Patil, Robin D. Tribhuwan & Benazir D. (2009). Body image : human reproduction and birth control : a tribal perspective. New Delhi: Discovery Pub. House. p. 20. ISBN 978-81-8356-388-8.

Further reading

External links

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