These findings suggest that lower doses of oral EMP may be a safer option than higher doses for the treatment of prostate cancer. However, a subsequent 2004 meta-analysis of 23 studies of thromboembolic events with EMP found substantial incidence of thromboembolic events regardless of dosage and no association of EMP dose with risk of these complications. Overdose
There has been no clinical experience with overdose of EMP. Overdose of EMP may result in pronounced manifestations of the known adverse effects of the medication. There is no specific antidote for overdose of EMP. In the event of overdose, gastric lavage should be used to evacuate gastric contents as necessary and treatment should be symptom-based and supportive. In the case of dangerously low counts of red blood cells, white blood cells, or platelets, whole blood may be given as needed. Liver function should be monitored with EMP overdose. After an overdose of EMP, hematological and hepatic parameters should continue to be monitored for at least 6 weeks.EMP has been used at high doses of as much as 1,260 mg/day by the oral route and 240 to 450 mg/day by intravenous injection. Interactions
EMP has been reported to increase the efficacy and toxicity of tricyclic antidepressants like amitriptyline and imipramine. When products containing calcium, aluminium, and/or magnesium, such as dairy products like milk, various foods dietary supplements, and antacids, are consumed concomitantly with EMP, an insoluble chelate complex/phosphate salt between EMP and these metals can be formed, and this can markedly impair the absorption and hence oral bioavailability of EMP.
It was initially developed for the treatment of breast cancer. The idea for EMP was inspired by the uptake and accumulation of radiolabeled estrogens into breast cancer tissue. However, initial clinical findings of EMP in women with breast cancer were disappointing. Subsequently, radiolabeled EMP was found to be taken up into and accumulated rat prostate gland, and this finding culminated in the medication being repurposed for the treatment of prostate cancer. EMP was introduced for medical use in the treatment of this condition in the early 1970s, and was approved in the United States for this indication in 1981. EMP was originally introduced for use by intravenous injection. Subsequently, an oral formulation was introduced, and the intravenous preparation was almost abandoned in favor of the oral version. Society and culture
Generic names
EMP is provided as the sodium salt for oral administration, which has the generic names estramustine phosphate sodium (USAN) and estramustine sodium phosphate (BANM, JAN), and as the meglumine salt for intravenous administration, which has the generic name estramustine phosphate meglumine. The INNM is estramustine phosphate. The name estramustine phosphate is a contraction of estradiol normustine phosphate. EMP is also known by its former developmental code names Leo 299, Ro 21-8837, and Ro 21-8837/001. Brand names
EMP is most commonly marketed under the brand names Estracyt and Emcyt, but has also been sold under a number of other brand names, including Amsupros, Biasetyl, Cellmustin, Estramustin HEXAL, Estramustina Filaxis, Estranovag, Multosin, Multosin Injekt, Proesta, Prostamustin, and Suloprost.