# 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Butagest, also known as buterol is a modification of megestrol acetate in which the C-3 ketone has been replaced by a C3β butanoyloxy moeity. 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-δ$^6$-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.

## 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.

### 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.

### Chronic Toxicity

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

### Carcinogenicity

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

### Environmental Toxicity

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