diethylstilbestrol: clinical use

Prescribing considerations

• Reserve for castration-resistant prostate cancer when alternatives are unsuitable because of carcinogenic and thromboembolic risks.
• Assess cardiovascular, cerebrovascular, thromboembolic, hepatic and renal history.
• Consider thromboprophylaxis while accounting for bleeding risk and other medicines.
• Discuss breast effects; breast-bud irradiation may be considered.
• Review treatment if surgery is planned or thrombosis is suspected.

Contraindications and cautions

• Pregnancy, premenopausal status, children or young adults
• Previous thromboembolism, cardiovascular or cerebrovascular disease, or strong predisposition to thrombosis
• Moderate to severe hypertension, severe or active liver disease, pulmonary hypertension or hyperlipoproteinaemia
• Porphyria, sickle-cell anaemia or untreated polycythaemia
• Oestrogen-dependent genital neoplasms, premenopausal breast cancer, endometrial hyperplasia, fibroids or unexplained vaginal bleeding
• Relevant hereditary galactose intolerance, lactase deficiency or glucose-galactose malabsorption

Monitoring

• Blood pressure
• Evidence of thrombosis, fluid retention or heart failure
• Glucose control in people with diabetes
• Liver function and symptoms of cholestasis where indicated
• Thyroid-function test interpretation
• Breast symptoms and other oestrogenic effects

Clinical pharmacology

An orally absorbed synthetic non-steroidal oestrogen that binds intracellular oestrogen receptors and alters gene transcription. It is metabolised slowly in the liver, and enterohepatic recycling has been reported.

Formulation and product differences

• The selected product is a pink, biconvex film-coated oral tablet.
• It contains lactose and colourings including sunset yellow, which may cause allergic reactions.
• No special storage conditions are specified.

Tablet

Route: Oral

Strengths: 1 mg