Home Drug Guide Estradiol Valerate

Drug Guide

Generic Name

Estradiol Valerate

Brand Names Delestrogen

Classification

Therapeutic: Hormone Replacement Therapy

Pharmacological: Estrogen

FDA Approved Indications

Hormone therapy for menopausal symptoms
Hormone therapy for estrogen deficiency
Hormone therapy in certain breast and prostate cancers (palliative)

Mechanism of Action

Estradiol Valerate is a form of estrogen that acts by binding to estrogen receptors, stimulating genomic pathways that control gene expression, leading to development and maintenance of female reproductive tissues, secondary sexual characteristics, and other estrogen-dependent functions.

Dosage and Administration

Adult: Typically, 10-20 mg IM every 4 weeks, but varies based on indication and patient response.

Pediatric: Not commonly used in children.

Geriatric: Dosing should be cautious, considering increased risk of thromboembolic events.

Renal Impairment: Adjust based on clinical response; no specific standard dose adjustments.

Hepatic Impairment: Use caution; estrogen therapy may be contraindicated or require adjustment.

Pharmacokinetics

Absorption: Good intramuscular absorption.

Distribution: Widely distributed in the body, with high affinity for sex hormone-binding globulin.

Metabolism: Metabolized primarily in the liver via hydroxylation and conjugation.

Excretion: Excreted mainly in urine as conjugates.

Half Life: Approximately 5-7 days.

Contraindications

History of thromboembolic events
Estrogen-dependent neoplasia
Abnormal genital bleeding of unknown etiology
Pregnancy

Precautions

Use with caution in liver disease, smoking, and hypertension; monitor for breast cancer risk.

Adverse Reactions - Common

Nausea (Common)
Breast tenderness (Common)
Fluid retention (Common)

Adverse Reactions - Serious

Thromboembolism (Serious and less common)
Endometrial hyperplasia or cancer with unopposed estrogen (Serious)

Drug-Drug Interactions

Certain antibiotics (can affect estrogen levels)
Anticoagulants (may increase bleeding risk)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor patient for signs of thromboembolism, abnormal bleeding, liver function, and breast changes.

Diagnoses:

Risk for thromboembolic events
Disturbed body image

Implementation: Administer intramuscularly as prescribed, monitor for adverse effects, educate patient.

Evaluation: Assess symptom relief, monitor side effects, and adjust dosage accordingly.

Patient/Family Teaching

Take medication exactly as prescribed.
Report any signs of blood clots, such as leg swelling, chest pain, or sudden shortness of breath.
Use contraception if pregnancy is contraindicated.
Report any abnormal vaginal bleeding.

Special Considerations

Black Box Warnings:

Endometrial cancer, cardiovascular disease, and probable increased risk of breast cancer with combined estrogen-progestin therapy.

Genetic Factors: Estrogen receptor polymorphisms may influence response.

Lab Test Interference: May interfere with hormonal blood tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, vaginal bleeding, breast tenderness.

Treatment: Supportive care, symptomatic treatment, discontinue medication.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable for specified period; consult product label.