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Re: E-DRUG: E-DRUG HRT Request

I am afraid that this discussion may end up with promoting
another unecessary "innovation" unless somebody intervenes.
The new estrogen agonists are "dirty" agonists with more
than one agonist activity - not only estrogen, but also
gestagenic and androgenic activity. Practically speaking
they are combination drugs. The development of these
substances are in my view attempts from the industry of
replacing endogenous substances with xenobiotics -
patentable xenobiotics. This is not desirable in my view.

I think I saw recently - could it have been Scrip? - that
there was a French study showing that a minimal dose of
estriol compared favourably with more highly dosed estrogens
- maybe Premarin - with respect to endometrial stimulation
and symptomatic relief. I am not sure about osteoporosis.
The study and accompanying product was supressed for some
formal reason - so there is hardly any chance of having this
0,5 mg estriol regimen established for the next 5 years.

What risk would we run if we implemented this? The primary
test is relief of postmenopausal symptoms. This answer we
would have within a few days or weeks in single women. If
this were achieved, bone density measurements could be
performed as in normal clinical routine. And the harmful
effects of estrogen would presumably be less with a
lower-than-usual dose.

If my memory is correct, we could perhaps have
postmenopausal hormone replacement with estrogen alone - in
a minimal dose - with minimal endometrial or mammary
stimulation - at a minimal price. 

Has anybody else read about this, or do I have to dig myself
through last year's Scrip to confirm it?

Gaut Gadeholt MD
Clinical pharmacologist
The National Hospital (Rikshospitalet)
Department of Clinical Chemistry
N-0027  OSLO, Norway
gaut.gadeholt@labmed.uio.no (w)
gaut@online.no (p)

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