Formulary
Prasterone: Indications, Dosing, Side Effects and Interactions
Prasterone is biochemically and biologically identical to endogenous dehydroepiandrosterone (DHEA), and is converted to oestrogens and androgens.
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Prasterone: Indications, Dosing, Side Effects and Interactions
Prasterone is biochemically and biologically identical to endogenous dehydroepiandrosterone (DHEA), and is converted to oestrogens and androgens.
Drug action
Prasterone is biochemically and biologically identical to endogenous dehydroepiandrosterone (DHEA), and is converted to oestrogens and androgens.
Cautions
Assess need for continued treatment at least every 6 months; cholelithiasis; diabetes mellitus; factors predisposing to thromboembolism; history of endometrial hyperplasia; hypertriglyceridaemia; migraine (or migraine-like headaches); prolonged exposure to unopposed oestrogens may increase risk of developing endometrial cancer; risk factors for oestrogen-dependent tumours (e.g. breast cancer in first-degree relative); symptoms of endometriosis may be exacerbated; uterine fibroids may increase in size Cautions, further information Risk of endometrial cancer The increased risk of endometrial cancer depends on the dose and duration of oestrogen-only HRT. Bleeding or spotting occurring during treatment should be investigated. For oestrogen products for vaginal application, where systemic exposure to oestrogen remains within the normal postmenopausal range, it is not recommended to add a progestogen. Risk of ovarian cancer Long-term use of combined HRT or oestrogen-only HRT is associated with a small increased risk of ovarian cancer. This excess risk disappears within a few years of stopping. Risk of venous thromboembolism Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and of pulmonary embolism especially in the first year of use. In women who have predisposing factors (such as a personal or family history of deep vein thrombosis or pulmonary embolism, severe varicose veins, obesity, trauma, major surgery or prolonged bed-rest) it is prudent to review the need for HRT, as in some cases the risks of HRT may exceed the benefits. Travel involving prolonged immobility further increases the risk of deep vein thrombosis. Although the level of risk of thromboembolism associated with non-oral routes of administration of HRT has not been established, it may be lower for the transdermal route compared to the oral route; studies have found the risk associated with transdermal HRT to be no greater than the baseline population risk of thromboembolism. Risk of stroke Risk of stroke increases with age, therefore older women have a greater absolute risk of stroke. Combined HRT or oestrogen-only HRT slightly increases the risk of stroke. Other conditions The product literature advises caution in other conditions including hypertension, asthma, epilepsy, otosclerosis, and systemic lupus erythematosus. Evidence for caution in these conditions is unsatisfactory and many women with these conditions may stand to benefit from HRT.
Contraindications
Active or recent arterial thromboembolic disease (e.g. angina or myocardial infarction); Acute porphyrias ; history of breast cancer; oestrogen-dependent cancer; thrombophilic disorder; undiagnosed vaginal bleeding; untreated endometrial hyperplasia; venous thromboembolism
Side effects
Common or very common Cervical abnormalities; weight change Uncommon Breast neoplasm benign; uterine polyp
Pregnancy
Manufacturer advises avoid-no information available.
Breast feeding
Manufacturer advises avoid-no information available.
Hepatic impairment
Avoid in acute or history of liver disease, where liver function tests have failed to return to normal. M Caution in liver disorders e.g. liver adenoma. M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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