Diethylstilbestrol DES Brand Name– Stilphostrol
What is Diethylstilbestrol DES
Diethylstilbestrol DES is a synthetic, nonsteroidal compound with properties similar to those of the natural estrones.
It was originally synthesized in 1938 and was widely used for treatment of threatened abortion in the U.S. from the 1940s until 1971. It had been documented in 1953 that DES was ineffective for preventing miscarriage.
In the 1960’s, DES was prescribed as a postcoital emergency contraceptive. No harmful effects were suspected until 1970 when 6 young women were diagnosed with vaginal clear-cell adenocarcinoma.
The FDA banned the use of DES during pregnancy in 1971 and no longer endorses the use of DES for post-coital contraception. It is clear that the drug may cause severe harm to a fetus.
It has been concluded that the female offspring of women who use diethylstilbestrol during pregnancy have an increased risk of developing structural and functional abnormalities of the genitourinary tract as well as a propensity for developing adenocarcinoma of the vagina and cervix.
This risk may also occur in male offspring although the association between in utero DES exposure and testicular cancer is controversial.
Clinical surveillance of DES-exposed daughters, sons and their children continues. DES was once used for the palliative treatment of inoperable breast carcinoma in both sexes; this use is now obsolete.
DES is sometimes used in the treatment of advanced prostate carcinoma.
Diethylstilbestrol was first marketed in 1941 and the diphosphate form was commercially available in 1955.
DES was marketed before passage of the modern Food, Drug, and Cosmetics Act of 1962, which required that drugs demonstrate effectiveness and safety prior to marketing.
Indications
- palliative treatment of breast cancer
- prostate cancer
For the treatment of progressing, inoperable prostate cancer
Side Effects
- abdominal pain
- acne vulgaris
- acneiform rash
- alopecia
- amenorrhea
- anaphylactoid reactions
- anorexia
- anxiety
- biliary obstruction
- breakthrough bleeding
- breast discharge
- cervical dysplasia
- cholecystitis
- cholelithiasis
- cholestasis
- depression
- diplopia
- dizziness
- ectopic pregnancy
- edema
- elevated hepatic enzymes
- emotional lability
- endometrial hyperplasia
- erythema nodosum
- fatigue
- fluid retention
- gynecomastia
- headache
- hepatitis
- hepatoma
- hirsutism
- hypertension
- infertility
- injection site reaction
- insomnia
- jaundice
- libido decrease
- libido increase
- mastalgia
- melasma
- menorrhagia
- migraine
- myocardial infarction
- nausea
- new primary malignancy
- optic neuritis
- pancreatitis
- peripheral edema
- pruritus
- pulmonary edema
- pulmonary embolism
- rash
- retinal thrombosis
- sodium retention
- stroke
- teratogenesis
- thromboembolism
- thrombosis
- urticaria
- visual impairment
- vomiting
- weight gain
Monitoring Parameters
- LFTs
- prostate-specific antigen (PSA)
- serum lipid profile
Contraindications
- asthma
- breast cancer
- breast-feeding
- cardiac disease
- cerebrovascular disease
- cervical cancer
- children
- contact lenses
- depression
- diabetes mellitus
- endometrial cancer
- endometrial hyperplasia
- endometriosis
- gallbladder disease
- hepatic disease
- hepatocellular cancer
- hypercalcemia
- hypercholesterolemia
- hyperglycemia
- hyperlipoproteinemia
- hypertension
- jaundice
- migraine
- ovarian cancer
- porphyria
- pregnancy
- renal disease
- seizure disorder
- stroke
- surgery
- thromboembolic disease
- thrombophlebitis
- tobacco smoking
- uterine cancer
- uterine leiomyomata
- vaginal bleeding
- vaginal cancer
- visual disturbance
Interactions
- Acarbose
- Acetaminophen; Propoxyphene
- Albiglutide
- Alogliptin; Metformin
- Alpha-glucosidase Inhibitors
- Amiodarone
- Amprenavir
- Anastrozole
- Azelastine; Fluticasone
- Barbiturates
- Beclomethasone
- Betamethasone
- Bexarotene
- Bosentan
- Bromocriptine
- Budesonide
- Budesonide; Formoterol
- Calcium
- Canagliflozin
- Canagliflozin; Metformin
- Carbamazepine
- Cenobamate
- Chenodiol
- Ciclesonide
- Cimetidine
- Clobazam
- Corticosteroids
- Cortisone
- Cosyntropin
- Cyclosporine
- Dantrolene
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Daratumumab; Hyaluronidase
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Deflazacort
- Dexamethasone
- Dipeptidyl Peptidase-4 Inhibitors
- Dulaglutide
- Duloxetine
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Exemestane
- Exenatide
- Felbamate
- Fludrocortisone
- Flunisolide
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Fosamprenavir
- Glipizide; Metformin
- Glyburide; Metformin
- grapefruit juice
- Griseofulvin
- Hemin
- Hyaluronidase
- Hyaluronidase, Recombinant; Immune Globulin
- Hydantoins
- Hydralazine
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydralazine; Isosorbide Dinitrate, ISDN
- Hydrocortisone
- Icosapent ethyl
- Incretin Mimetics
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Lenalidomide
- Letrozole
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linagliptin; Metformin
- Liothyronine
- Liraglutide
- Lixisenatide
- Lorlatinib
- Meglitinides
- Melatonin
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methylprednisolone
- Metreleptin
- Metyrapone
- Miglitol
- Mineral Oil
- Minoxidil
- Mometasone
- Nefazodone
- Nevirapine
- Nitroprusside
- Ospemifene
- Oxcarbazepine
- Phentermine; Topiramate
- Pramlintide
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Prednisolone
- Prednisone
- Propoxyphene
- Raloxifene
- Ribociclib; Letrozole
- Rifamycins
- Rituximab; Hyaluronidase
- Ropinirole
- Semaglutide
- SGLT2 Inhibitors
- Somatropin, rh-GH
- St. John’s Wort, Hypericum perforatum
- Sulfonylureas
- Tacrine
- Tazemetostat
- Testolactone
- Thiazolidinediones
- Thyroid hormones
- Tipranavir
- Topiramate
- Toremifene
- Tranexamic Acid
- Trastuzumab; Hyaluronidase
- Triamcinolone
- Tricyclic antidepressants
- Ursodeoxycholic Acid, Ursodiol
- Warfarin
