Estradiol stearate
Estradiol stearate (brand name Depofollan), or estradiol octadecanoate, is a naturally occurring steroidal estrogen and an estrogen ester – specifically, the C17β stearate ester of estradiol. It occurs in the body as a very long-lasting metabolite and prohormone of estradiol. In addition, estradiol stearate is or has been available as a pharmaceutical drug for use via depot intramuscular injection. The drug was introduced in 1941 as Depofollan and was the first long-acting estrogen, although it has never been widely used. It has been reported in at least one source to have a duration of at least one month.
Pharmacokinetics of estradiol
Transdermal administration of estradiol via patch or gel produces an estradiol to estrone ratio of about 1:1. Estradiol patches delivering a daily dosage of 0.05 mg (50 µg) achieve mean estradiol and estrone levels of 30 to 65 pg/mL and 40 to 45 pg/mL, respectively, while a daily dosage of 0.1 mg (100 µg) attains respective mean levels of 50 to 90 pg/mL and 30 to 65 pg/mL of estradiol and estrone. Once daily application of 1.25 g topical gel containing 0.75 mg estradiol (brand name EstroGel) for 2 weeks was found to produce mean peak estradiol and estrone levels of 46.4 pg/mL and 64.2 pg/mL, respectively. The time-averaged levels of circulating estradiol and estrone with this formulation over the 24-hour dose interval were 28.3 pg/mL and 48.6 pg/mL, respectively. Levels of estradiol and estrone are stable and change relatively little over the course of the 24 hours following an application, indicating a long duration of action of this route. Steady-state levels of estradiol are achieved after 3 days of application. A higher dosage of estradiol gel containing 1.5 mg estradiol per daily application has been found to produce mean estradiol levels of 40 to 100 pg/mL and estrone levels of 90 pg/mL, while 3 mg per day has been found to result in respective mean estradiol and estrone levels of 60 to 140 pg/mL and 45 to 155 pg/mL. Topical estradiol at a dosage of 3 mg/day has been reported to be equipotent with 2 mg oral estradiol in terms of therapeutic effects and FSH suppression, as well as to produce similar estradiol levels. Following removal of an estradiol patch, circulating estradiol levels decrease to baseline within 24 hours.