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Selective oestrogen receptor modulator Drug Class

Medicines in this drug class are grouped together in the Everyone Healthy medication database. This page is educational only and should not be used as personal prescribing advice.

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Caution: A drug class groups medicines that may share similar actions or uses. Individual medicines in the same class can still have different cautions, interactions and suitability.

Drug class overview

Selective oestrogen receptor modulator overview

Selective estrogen receptor modulator

Selective Estrogen Receptor Modulators (SERMs) are a class of compounds that act on the estrogen receptor.^[1] A characteristic that distinguishes these substances from pure receptor agonists and antagonists is that their action is different in various tissues, thereby granting the possibility to selectively inhibit or stimulate estrogen-like action in various tissues. Phytoserms are scientifically accepted SERMs from a botanical source.

Members

Members include:

Uses

SERMs are used dependent on their pattern of action in various tissues:

clomifene is used in anovulation
femarelle is used for managing menopause symptoms and maintaining bone health
ormeloxifene is used for contraception
raloxifene is used for osteoporosis and reducing risk of invasive breast cancer
tamoxifen and toremifene are used for breast cancer

Some SERMs may be good replacements for hormone replacement therapy (HRT), which had been commonly used to treat menopause symptoms until the publication of wide scale studies showing that HRT slightly increases the risk of breast cancer ^[3] and thrombosis.^[4] Some of the above agents still have significant side-effects which contraindicate widespread use.

SERMs are also commonly used during PCT or Post Cycle Therapy after the use of anabolic steroids, or during a steroid cycle in case of the sudden onset of estrogenic symptoms. Bodybuilders who take hormonal supplements can experience gynecomastia and similar symptoms because the body metabolizes some steroids into estrogen. This increase in estrogen can occur during or after a steroid cycle, so responsible body builders will usually cycle a SERM after a steroid cycle to ensure that their body is not flooded with excess estrogen. They also often keep a SERM on hand in case of emergency.

Mechanism of action

Estrogenic compounds span a spectrum of activity ranging from:

full agonists (agonistic in all tissues) such as the natural endogenous hormone estrogen
mixed agonists/antagonistics (agonistic in some tissues while antagonist in others) such as tamoxifen (a SERM)
pure antagonists (antagonistic in all tissues) such as fulvestrant (ICI-182780).

The mechanism of mixed agonism/antagonism may differ depending on the chemical structure of the SERM, but for at least for some SERMs, it appears to be related to (1) the ratio of co-activator to co-repressor proteins in different cell types and (2) the conformation of the estrogen receptor induced by drug binding which in turn determines how strongly the drug/receptor complex recruits co-activators (resulting in an agonist response) relative to co-repressors (resulting in antagonism). For example, the prototypical SERM tamoxifen acts as an antagonist in breast and conversely an agonist in uterus. The concentration of steroid receptor co-activator 1 (SRC-1; NCOA1) is higher in uterus than in breast, therefore SERMs such as tamoxifen are more agonistic in uterus than in breast. In contrast, raloxifene behaves as an antagonist in both tissues. It appears that raloxifene more strongly recruits co-repressor proteins and consequently is still an antagonist in the uterus despite the higher concentration of co-activators relative to co-repressors.^[5]^[6]

Actions

The actions of SERMs on various tissues:

Bone turnover and postmenopausal osteoporosis respond favorably to most SERMs.
Breast - all SERMs decrease breast cancer risk, and tamoxifen is mainly used for its ability to inhibit growth in estrogen receptor-positive breast cancer.
Cholesterol and triglycerides - levels respond favorably to SERMs.
Deep venous thrombosis - the risk may be elevated in at least some SERMs.
Hot flashes are increased by some SERMs.
Pituitary gland - clomifene blocks estrogen action, leading to an increase of follicle-stimulating hormone.
Uterus - tamoxifen may increase endometrial carcinoma risk, but raloxifene and femarelle do not. Data on toremifene and clomifene is insufficient.

References

^ Riggs BL, Hartmann LC (2003). "Selective estrogen-receptor modulators -- mechanisms of action and application to clinical practice". N Engl J Med 348 (7): 618–29. doi:10.1056/NEJMc030651. PMID 12584371.
^ Somjen D, Katzburg S, Knoll E, Hendel D, Stern N, Kaye AM, Yoles I (May 2007). "DT56a (Femarelle): a natural selective estrogen receptor modulator (SERM)". J. Steroid Biochem. Mol. Biol. 104 (3-5): 252–8. doi:10.1016/j.jsbmb.2007.03.004. PMID 17428655.
^ Reeves GK, Beral V, Green J, Gathani T, Bull D (November 2006). "Hormonal therapy for menopause and breast-cancer risk by histological type: a cohort study and meta-analysis". Lancet Oncol. 7 (11): 910–8. doi:10.1016/S1470-2045(06)70911-1. PMID 17081916.
^ Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators (July 2002). "Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial". JAMA 288 (3): 321–33. doi:10.1001/jama.288.3.321. PMID 12117397. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12117397.
^ Shang Y, Brown M (2002). "Molecular determinants for the tissue specificity of SERMs". Science 295 (5564): 2465–8. doi:10.1126/science.1068537. PMID 11923541.
^ Smith CL, O'Malley BW (2004). "Coregulator function: a key to understanding tissue specificity of selective receptor modulators". Endocr Rev 25 (1): 45–71. doi:10.1210/er.2003-0023. PMID 14769827.

External links

Linked medicines

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