LEVONORGESTREL ACETATE

Details

Stereochemistry	ABSOLUTE
Molecular Formula	C23H30O3
Molecular Weight	354.4825
Optical Activity	UNSPECIFIED
Defined Stereocenters	6 / 6
E/Z Centers	0
Charge	0

SHOW SMILES / InChI

Structure Search

SMILES

[H][C@@]12CC[C@@](OC(C)=O)(C#C)[C@@]1(CC)CC[C@]3([H])[C@@]4([H])CCC(=O)C=C4CC[C@@]23[H]

InChI

InChIKey=YDQDJLTYVZAOQX-GOMYTPFNSA-N

InChI=1S/C23H30O3/c1-4-22-12-10-19-18-9-7-17(25)14-16(18)6-8-20(19)21(22)11-13-23(22,5-2)26-15(3)24/h2,14,18-21H,4,6-13H2,1,3H3/t18-,19+,20+,21-,22-,23-/m0/s1

HIDE SMILES / InChI

Description
Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/021225s031lbl.pdfhttps://www.drugbank.ca/drugs/DB09389 | https://www.drugs.com/drp/norgestrel.html | https://www.ncbi.nlm.nih.gov/pubmed/8136310
Curator's Comment: description was created based on several sources, including https://www.ncbi.nlm.nih.gov/pubmed/25698840

Norgestrel is synthetic steroidal progestin that is used in combination with ethinyl estradiol for oral contraception. Norgestrel is composed of a racemic mixture of two stereoisomers, dextronorgestrel and levonorgestrel. However, only the levorotary enantiomer (levonorgestrel) is biologically active. Norgestrel (and more specifically the active stereoisomer levonorgestrel) binds to the progesterone and estrogen receptors within the female reproductive tract, the mammary gland, the hypothalamus, and the pituitary. Once bound to the receptor, progestins like levonorgestrel will slow the frequency of release of gonadotropin releasing hormone (GnRH) from the hypothalamus and blunt the pre-ovulatory LH (luteinizing hormone) surge. Loss of the LH surge inhibits ovulation and thereby prevents pregnancy. Norgestrel in combination with ethinyl estradiol is indicated for the prevention of pregnancy in women who elect to use this product as a method of contraception.

Originator

Approval Year

Targets

Primary Target	Pharmacology	Condition	Potency
Progesterone receptor 61 Target ID: CHEMBL208 Sources: https://www.ncbi.nlm.nih.gov/pubmed/3139361	Binding Agent 1064
Progesterone receptor 61 Target ID: CHEMBL208 Sources: https://www.ncbi.nlm.nih.gov/pubmed/8136310 \| https://www.ncbi.nlm.nih.gov/pubmed/11521119 \| http://www.genome.jp/dbget-bin/www_bget?dr:D00954	Agonist 2678
Androgen Receptor 167 Target ID: CHEMBL1871 Sources: https://www.ncbi.nlm.nih.gov/pubmed/3139361	Binding Agent 1064

Conditions

Condition	Modality	Highest Phase	Product
Fertilization 4 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/021225s031lbl.pdf	Preventing	Approved 8429	MIRENA Approved Use Mirena is indicated for intrauterine contraception for up to 5 years. Mirena is also indicated for the treatment of heavy menstrual bleeding in women who choose to use intrauterine contraception as their method of contraception. Mirena is recommended for women who have had at least one child. The system should be replaced after 5 years if continued use is desired. Launch Date 2000
Heavy menstrual bleeding 5 Sources: http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/021225s031lbl.pdf	Primary	Approved 8429	MIRENA Approved Use Mirena is indicated for intrauterine contraception for up to 5 years. Mirena is also indicated for the treatment of heavy menstrual bleeding in women who choose to use intrauterine contraception as their method of contraception. Mirena is recommended for women who have had at least one child. The system should be replaced after 5 years if continued use is desired. Launch Date 2000
Pregnancy 65 Sources: https://www.drugs.com/drp/norgestrel.html	Preventing	Approved 8429	OVRETTE Approved Use Progestin-only oral contraceptives are indicated for the prevention of pregnancy. Launch Date 1973
Pregnancy 65 Sources: https://www.drugs.com/pro/elinest.html	Preventing	Approved 8429	ELINEST Approved Use Oral contraceptives are indicated for the prevention of pregnancy in women who elect to use oral contraceptives as a method of contraception. Launch Date 2012

C_max

Value	Dose	Co-administered	Analyte	Population
16.2 ng/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/30703352	1.5 mg single, oral dose: 1.5 mg route of administration: Oral experiment type: SINGLE co-administered:		LEVONORGESTREL blood	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: FASTED
14.11 ng/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/12169384	0.75 mg single, oral dose: 0.75 mg route of administration: Oral experiment type: SINGLE co-administered:		LEVONORGESTREL plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: FASTED

AUC

Value	Dose	Co-administered	Analyte	Population
360.1 ng × h/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/30703352	1.5 mg single, oral dose: 1.5 mg route of administration: Oral experiment type: SINGLE co-administered:		LEVONORGESTREL blood	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: FASTED
123.1 ng × h/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/12169384	0.75 mg single, oral dose: 0.75 mg route of administration: Oral experiment type: SINGLE co-administered:		LEVONORGESTREL plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: FASTED

T_1/2

Value	Dose	Co-administered	Analyte	Population
29.7 h EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/30703352	1.5 mg single, oral dose: 1.5 mg route of administration: Oral experiment type: SINGLE co-administered:		LEVONORGESTREL blood	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: FASTED
24.4 h EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/12169384	0.75 mg single, oral dose: 0.75 mg route of administration: Oral experiment type: SINGLE co-administered:		LEVONORGESTREL plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE food status: FASTED

Doses

Dose	Population	Adverse events
20 ug 1 times / day multiple, intrauterine Recommended Dose: 20 ug, 1 times / day Route: intrauterine Route: multiple Dose: 20 ug, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/25934164 Page: p.10	healthy, 16-45 n = 1714 Health Status: healthy Condition: Prevention of pregnancy Age Group: 16-45 Sex: F Population Size: 1714 Sources: https://pubmed.ncbi.nlm.nih.gov/25934164 Page: p.10	Disc. AE: Bleeding... AEs leading to discontinuation/dose reduction: Bleeding (1.5%) Sources: https://pubmed.ncbi.nlm.nih.gov/25934164 Page: p.10
20 ug 1 times / day multiple, intrauterine Recommended Dose: 20 ug, 1 times / day Route: intrauterine Route: multiple Dose: 20 ug, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/29560743 Page: p.2	healthy, 27.3 ± 5.7 n = 1700 Health Status: healthy Condition: Prevention of pregnancy Age Group: 27.3 ± 5.7 Sex: F Population Size: 1700 Sources: https://pubmed.ncbi.nlm.nih.gov/29560743 Page: p.2	Disc. AE: Menstrual irregularity, Amenorrhea... AEs leading to discontinuation/dose reduction: Menstrual irregularity (0.7%) Amenorrhea (0.06%) Sources: https://pubmed.ncbi.nlm.nih.gov/29560743 Page: p.2
90 ug 1 times / day multiple, oral Recommended Dose: 90 ug, 1 times / day Route: oral Route: multiple Dose: 90 ug, 1 times / day Co-administed with:: ethinyl estradiol, p.o(20 ug; q.d; 1 year) Sources: https://pubmed.ncbi.nlm.nih.gov/19913143 Page: p.507	healthy, 27.6±6.7 n = 323 Health Status: healthy Condition: Prevention of pregnancy Age Group: 27.6±6.7 Sex: F Population Size: 323 Sources: https://pubmed.ncbi.nlm.nih.gov/19913143 Page: p.507	Disc. AE: Metrorrhagia, Bleeding vaginal... AEs leading to discontinuation/dose reduction: Metrorrhagia (8.7%) Bleeding vaginal (3.7%) Sources: https://pubmed.ncbi.nlm.nih.gov/19913143 Page: p.507

AEs

AE	Significance	Dose	Population
Bleeding	1.5% Disc. AE	20 ug 1 times / day multiple, intrauterine Recommended Dose: 20 ug, 1 times / day Route: intrauterine Route: multiple Dose: 20 ug, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/25934164 Page: p.10	healthy, 16-45 n = 1714 Health Status: healthy Condition: Prevention of pregnancy Age Group: 16-45 Sex: F Population Size: 1714 Sources: https://pubmed.ncbi.nlm.nih.gov/25934164 Page: p.10
Amenorrhea	0.06% Disc. AE	20 ug 1 times / day multiple, intrauterine Recommended Dose: 20 ug, 1 times / day Route: intrauterine Route: multiple Dose: 20 ug, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/29560743 Page: p.2	healthy, 27.3 ± 5.7 n = 1700 Health Status: healthy Condition: Prevention of pregnancy Age Group: 27.3 ± 5.7 Sex: F Population Size: 1700 Sources: https://pubmed.ncbi.nlm.nih.gov/29560743 Page: p.2
Menstrual irregularity	0.7% Disc. AE	20 ug 1 times / day multiple, intrauterine Recommended Dose: 20 ug, 1 times / day Route: intrauterine Route: multiple Dose: 20 ug, 1 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/29560743 Page: p.2	healthy, 27.3 ± 5.7 n = 1700 Health Status: healthy Condition: Prevention of pregnancy Age Group: 27.3 ± 5.7 Sex: F Population Size: 1700 Sources: https://pubmed.ncbi.nlm.nih.gov/29560743 Page: p.2
Bleeding vaginal	3.7% Disc. AE	90 ug 1 times / day multiple, oral Recommended Dose: 90 ug, 1 times / day Route: oral Route: multiple Dose: 90 ug, 1 times / day Co-administed with:: ethinyl estradiol, p.o(20 ug; q.d; 1 year) Sources: https://pubmed.ncbi.nlm.nih.gov/19913143 Page: p.507	healthy, 27.6±6.7 n = 323 Health Status: healthy Condition: Prevention of pregnancy Age Group: 27.6±6.7 Sex: F Population Size: 323 Sources: https://pubmed.ncbi.nlm.nih.gov/19913143 Page: p.507
Metrorrhagia	8.7% Disc. AE	90 ug 1 times / day multiple, oral Recommended Dose: 90 ug, 1 times / day Route: oral Route: multiple Dose: 90 ug, 1 times / day Co-administed with:: ethinyl estradiol, p.o(20 ug; q.d; 1 year) Sources: https://pubmed.ncbi.nlm.nih.gov/19913143 Page: p.507	healthy, 27.6±6.7 n = 323 Health Status: healthy Condition: Prevention of pregnancy Age Group: 27.6±6.7 Sex: F Population Size: 323 Sources: https://pubmed.ncbi.nlm.nih.gov/19913143 Page: p.507

Overview

CYP3A4	CYP2C9	CYP2D6	hERG
substrate 1737 inhibitor 1587	substrate 1037 inhibitor 1767	inhibitor 1852

OverviewOther

Other Inhibitor	Other Substrate	Other Inducer
CYP1A2 1524 CYP2A6 707 CYP2C19 1478 CYP2E1 882 CYP2C8 911 CYP2B6 810 BSEP 402 MRP2 383 MRP3 157 MRP4 204	CYP1A2 1054 CYP2A6 543 CYP2C19 991 CYP2E1 667

Drug as perpetrator

Target	Modality	Activity
OATP1B3 715	activator 214 Sources: https://pubmed.ncbi.nlm.nih.gov/25603031/	likely
BSEP 403	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/23956101/	no [IC50 >133 uM]
MRP2 475	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/23956101/	no [IC50 >133 uM]
MRP3 207	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/23956101/	no [IC50 >133 uM]
MRP4 238	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/23956101/	no [IC50 >133 uM]
CYP1A2 1692	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17-18	no [IC50 >250 uM]
CYP2A6 739	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17-18	no [IC50 >250 uM]
CYP2C19 1553	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17-18	no [IC50 >250 uM]
CYP2C9 1819	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17-18	no [IC50 >250 uM]
CYP2D6 1891	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17-18	no [IC50 >250 uM]
CYP2E1 970	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17-18	no [IC50 >250 uM]
CYP3A4 1925	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17-18	yes [IC50 13.6 uM]
CYP2B6 1001	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/17101742/	yes
CYP2C8 965	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/15601807/	yes

Drug as victim

Target	Modality	Activity	Clinical evidence
CYP2A6 543	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17	likely
CYP2C9 1037	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17	likely
CYP2E1 667	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17	likely
CYP3A4 1737	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=16, https://www.medicines.org.uk/emc/product/5143/smpc#INTERACTIONS Page: (ClinPharm) 16-17	major	yes (co-administration study) Comment: Concomitant administration of efavirenz (moderate CYP3A inducer) has been found to reduce plasma levels of levonorgestrel (AUC) by around 50%. Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=16, https://www.medicines.org.uk/emc/product/5143/smpc#INTERACTIONS Page: (ClinPharm) 16-17
CYP2C19 991	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17	minor
CYP1A2 1054	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203159Orig1s000ClinPharmR.pdf#page=17 Page: (ClinPharm) 17	unlikely

Sourcing

Vendor/Aggregator	ID	URL
ChEBI	CHEBI:6443	https://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:6443
ChemicalBook	CB2752440	https://www.chemicalbook.com/ChemicalProductProperty_EN_CB2752440
ChemicalBook	CB7125746	https://www.chemicalbook.com/ChemicalProductProperty_EN_CB7125746
MolPort	MolPort-002-510-453	https://www.molport.com/shop/molecule-link/MolPort-002-510-453
Selleck Chemicals	Levonorgestrel(Levonelle)	http://www.selleckchem.com/products/Levonorgestrel(Levonelle).html
ZINC	ZINC000003814395	http://zinc15.docking.org/substances/ZINC000003814395
eMolecules	29781161	https://www.emolecules.com/cgi-bin/more?vid=29781161
eMolecules	494705	https://www.emolecules.com/cgi-bin/more?vid=494705

PubMed

Title	Date	PubMed
A lower dosage levonorgestrel and testosterone combination effectively suppresses spermatogenesis and circulating gonadotropin levels with fewer metabolic effects than higher dosage combinations.	1999 May-Jun	10386821
Safety and efficacy of levonorgestrel implant, intrauterine device, and sterilization.	2001 Apr	11275025
Influence of two low-dose oral contraceptives on pulsatile gonadotropin secretion.	2001 Aug	11560098
Over-the-counter advice for genital problems: the role of the community pharmacist.	2001 Aug	11487391
Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection.	2001 Aug	11476777
Fine structure of prolactin cell of female albino rat as affected by some antifertility drugs--a comparative electron microscopic study.	2001 Feb	11480207
Fluoroscopically guided Norplant removal.	2001 Feb	11265891
Expression of the chemokines, monocyte chemotactic protein (MCP)-1 and MCP-2 in endometrium of normal women and Norplant users, does not support a central role in macrophage infiltration into endometrium.	2001 Feb	11164897
Sixty thousand woman-years of experience on the levonorgestrel intrauterine system: an epidemiological survey in Finland.	2001 Jan	11336430
The levonorgestrel intrauterine system: more than a contraceptive.	2001 Jan	11336429
Intrauterine contraception--what now and what next?	2001 Jan	11336428
Effects of oral contraceptives on breast epithelial proliferation.	2001 Jan	11261832
Comparison of the lipoprotein, carbohydrate, and hemostatic effects of phasic oral contraceptives containing desogestrel or levonorgestrel.	2001 Jan	11257242
Effects of two low-dose oral contraceptives containing ethinylestradiol and either desogestrel or levonorgestrel on serum lipids and lipoproteins with particular regard to LDL size.	2001 Jul	11535207
Multicenter, comparative study of cycle control, efficacy and tolerability of two low-dose oral contraceptives containing 20 microg ethinylestradiol/100 microg levonorgestrel and 20 microg ethinylestradiol/500 microg norethisterone.	2001 Jul	11535206
Third generation oral contraceptives and risk of venous thrombosis: meta-analysis.	2001 Jul 21	11463678
Comparison of a novel norgestimate/ethinyl estradiol oral contraceptive (Ortho Tri-Cyclen Lo) with the oral contraceptive Loestrin Fe 1/20.	2001 Jun	11672549
Hormonal and barrier methods of contraception, oncogenic human papillomaviruses, and cervical squamous intraepithelial lesion development.	2001 Jun	11445043
Implanon contraceptive implants: effects on carbohydrate metabolism.	2001 Mar	11368985
The effects of peri-ovulatory administration of levonorgestrel on the menstrual cycle.	2001 Mar	11368983
Mechanism of action of hormonal preparations used for emergency contraception: a review of the literature.	2001 Mar	11368982
New IUD approved.	2001 Mar	11263093
Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse.	2001 Mar	11262449
Norplant and other implantable contraceptives.	2001 Mar	11219249
Determination of steroid sex hormones and related synthetic compounds considered as endocrine disrupters in water by fully automated on-line solid-phase extraction-liquid chromatography-diode array detection.	2001 Mar 16	11293581
[Contraception with depot gestagens].	2001 May	11464383
[Postcoital emergency contraception].	2001 Sep	11594152
Endometrial expression of glycodelin in women with levonorgestrel-releasing subdermal implants.	2001 Sep	11532467
Effect of hormone replacement therapy on lipids in perimenopausal and early postmenopausal women.	2001 Sep 28	11574180

Patents

Sample Use Guides

In Vivo Use Guide

Mirena contains 52 mg of levonorgestrel (LNG). Initially, LNG is released at a rate of approximately 20 mcg/day. This rate decreases progressively to half that value after 5 years. Mirena must be removed by the end of the fifth year and can be replaced at the time of removal with a new Mirena if continued contraceptive protection is desired.

Route of Administration: Vaginal

In Vitro Use Guide

5 × 10(-5) mol/L Levonorgestrel (LNG) revealed a time-dependent inhibition of cell proliferation and an increase of apoptosis in both human endometrial stromal cells (HESCs) and glandular cells (HEGCs). Furthermore, these cells demonstrated a significant Gap Junctional Intercellular Communication (GJIC) enhancement upon treatment with 5 × 10(-5) mol/L for 48 hours. The effects of LNG were most noticeable in HESCs rather than in HEGCs.

Name

Type

Language

LEVONORGESTREL ACETATE

Common Name

English

NORGESTIMATE IMPURITY A [EP IMPURITY]

Common Name

English

13.BETA.-ETHYL-3-OXO-18,19-DINOR-17.ALPHA.-PREGN-4-EN-20-YN-17-YL ACETATE

Systematic Name

English

LEVONORGESTREL 17-ACETATE

Common Name

English

NORGESTIMATE RELATED COMPOUND A [USP IMPURITY]

Common Name

English

18,19-DINORPREGN-4-EN-20-YN-3-ONE, 17-(ACETYLOXY)-13-ETHYL-, (17.ALPHA.)-

Systematic Name

English

(17.ALPHA.)-17-(ACETYLOXY)-13-ETHYL-18,19-DINORPREGN-4-EN-20-YN-3-ONE

Systematic Name

English

NORGESTIMATE RELATED COMPOUND A [USP-RS]

Common Name

English

Levonorgestrel acetate [WHO-DD]

Common Name

English

Classification Tree Code System Code

NCI_THESAURUS

C776