Butagest

Butagest, also known as buterol is a modification of megestrol acetate in which the C-3 ketone has been replaced by a C3β butanoyloxy moeity.^[1] It is chemically known as 3β-hydroxy-6-methyl-17α-hydroxypregna-4,6-dien-20-one 3β-butanoate 17α-acetate or 6-methyl-17α-hydroxy-δ⁶-progesterone 3β-butanoate 17α-acetate and is a steroidal progestin which was developed in Russia for potential clinical use as a progesterone supplement primarily for Hormone replacement therapy but it was never marketed for reasons which are still unclear.^{[2][3][4][5][6]}

Butagest

Clinical data
Other names	Buterol; 17α-Acetoxy-3β-butanoyloxy-6-methyl-pregna-4,6-dien-20-one; 17α-Acetoxy-6-methyl-20-oxopregna-4,6-dien-3β-yl butyrate; 6-Methyl-17α-hydroxy-δ6-progesterone 3β-butanoate 17α-acetate
Drug class	Progestogen; Progestogen ester
Identifiers
IUPAC name [(3S,8R,9S,10R,13S,14S,17R)-17-Acetyl-17-acetyloxy-6,10,13-trimethyl-1,2,3,8,9,11,12,14,15,16-decahydrocyclopenta[a]phenanthren-3-yl] butanoate
CAS Number	205993-31-3 Y
PubChem CID	15816431
ChemSpider	21377535
CompTox Dashboard (EPA)	DTXSID201336951
Chemical and physical data
Formula	C28H40O5
Molar mass	456.623 g·mol−1
3D model (JSmol)	Interactive image
SMILES CCCC(=O)O[C@H]1CC[C@@]2([C@H]3CC[C@]4([C@H]([C@@H]3C=C(C2=C1)C)CC[C@@]4(C(=O)C)OC(=O)C)C)C
InChI InChI=1S/C28H40O5/c1-7-8-25(31)32-20-9-12-26(5)22-10-13-27(6)23(21(22)15-17(2)24(26)16-20)11-14-28(27,18(3)29)33-19(4)30/h15-16,20-23H,7-14H2,1-6H3/t20-,21+,22-,23-,26+,27-,28-/m0/s1 Key:VWKIFEBMJRFARL-NAEKRLSBSA-N

Pharmacology

Butagest is a synthetic progestin that mimics the physiological actions of natural progesterone. It is used in various therapeutic contexts, including hormone replacement therapy, fertility treatments, and menstrual irregularities.

Mechanism of Action

Butagest acts as an agonist at progesterone receptors in various tissues. Its primary actions include:

• Promoting endometrial secretory changes to support embryo implantation and pregnancy.
• Suppressing the hypothalamic-pituitary-gonadal axis to prevent ovulation.
• Modulating the immune response to maintain a pregnancy-friendly environment.

By stabilizing the endometrium, it prevents abnormal uterine bleeding and aids in maintaining hormonal balance during assisted reproductive therapies.

Pharmacokinetics

• Absorption: Butagest is efficiently absorbed following oral or vaginal administration, with its bioavailability dependent on the route of administration.
• Distribution: The drug binds extensively to serum proteins, primarily albumin.
• Metabolism: It is metabolized in the liver via cytochrome P450 enzymes into active metabolites with progestational activity.
• Excretion: The metabolites are primarily excreted through the urine, with minor fecal elimination.

Adverse Effects

The use of Butagest, which contains progesterone, is associated with several adverse effects. These vary depending on the dose, route of administration, and individual susceptibility.

Common Adverse Effects

Gastrointestinal

• Nausea
• Vomiting
• Constipation or diarrhea

Neurological

• Headache
• Dizziness
• Fatigue

Breasts

• Tenderness
• Swelling

Mood and Behavioral

• Mood swings
• Irritability
• Depression or anxiety

Skin

• Acne
• Rash or itching (rare)

Reproductive

• Irregular menstrual bleeding
• Spotting

Serious Adverse Effects

These effects require immediate medical attention:

Cardiovascular

• Blood clots (thromboembolism)
• Stroke
• Hypertension

Hepatic

• Jaundice
• Elevated liver enzymes

Endocrine and Metabolic

• Weight gain
• Fluid retention

Neurological

• Severe headaches
• Visual disturbances (potential sign of thrombosis)

Allergic Reactions

• Anaphylaxis (rare)
• Angioedema

Cancer Risks

• Increased risk of hormone-sensitive cancers, such as breast and ovarian cancers, especially with combined hormone therapy.^[7]

Precautions

Butagest should be used cautiously in patients with a history of:

• Thromboembolic disorders
• Hormone-sensitive cancers
• Severe liver disease

Regular monitoring is recommended for those with:

• Cardiovascular risks
• Migraines
• Diabetes

Toxicology

The toxicology of progesterone, the active ingredient in Butagest, has been studied extensively. Below are key findings:

Acute Toxicity

Progesterone exhibits low acute toxicity. Overdose typically results in mild symptoms such as nausea and dizziness, without life-threatening effects.^[8]

Chronic Toxicity

Long-term high-dose use may increase the risk of thromboembolic disorders, cardiovascular diseases, and hormone-sensitive cancers such as breast cancer.^[7]

Carcinogenicity

Progesterone is classified by the International Agency for Research on Cancer (IARC) as possibly carcinogenic to humans (Group 2B).^[9]

Environmental Toxicity

Improper disposal of progesterone can disrupt aquatic ecosystems, as it is an endocrine-disrupting compound.^[10]

See also

• Acetomepregenol
• Clogestone
• Clogestone acetate
• Mecigestone
• List of Russian drugs