STIMUCARE-TWO 25MG CAPSULE

Indications

• Adrenal insufficiency
• Congenital adrenal hyperplasia
• Polycystic ovary syndrome
• Adrenal tumors
• Hormonal supplementation in aging

Dosage

Children: Refer to the BNF for Children for specific dosing information, as pediatric dosing can vary significantly based on age and condition.

Adults: The usual dose for adults is 25 to 50 mg daily, which may be adjusted based on clinical response and laboratory results.

Mechanism of action

DHEA acts as a prohormone for sex steroids, with DHEAS serving as a reservoir and buffer. It is produced in the adrenal cortex, primarily in the zona reticularis, and is involved in the regulation of adrenal activity. Elevated levels of DHEAS/DHEA can indicate conditions such as adrenal cancer or hyperplasia, and it is linked to polycystic ovary syndrome in women.

Pharmacodynamics

DHEA is synthesized from cholesterol through a series of enzymatic reactions involving cytochrome P450 enzymes. Cholesterol is first converted to pregnenolone by P450 scc, followed by conversion to 17α-hydroxypregnenolone and then to DHEA by CYP17A1. DHEA levels can increase due to factors such as physical exercise and caloric restriction, which some studies suggest may contribute to increased longevity.

Pharmacokinetics

DHEA is absorbed via the gastrointestinal tract and is subject to extensive first-pass metabolism in the liver. It is predominantly bound to serum proteins, primarily albumin and sex hormone-binding globulin. The half-life of DHEA is relatively short, necessitating multiple doses for sustained effects. Metabolism occurs mainly in the liver, with elimination via urine as sulfate and glucuronide conjugates.

Contra-indications

• Pregnancy
• Breastfeeding
• Hormone-sensitive conditions
• Adrenal tumors

Adverse effects

• Acne
• Oily skin
• Mood changes
• Hair loss
• Increased body hair
• Menstrual irregularities
• Headache

Interactions

• Anticoagulants
• Insulin
• Corticosteroids
• Antidepressants

Precautions

• Monitor for hormonal side effects
• Use caution in patients with cardiovascular disease
• Assess for potential effects on mood
• Consider monitoring in patients with liver impairment

Pregnancy

DHEA is contraindicated during pregnancy due to potential hormonal effects on the developing fetus.

Breast-feeding

DHEA is contraindicated during breastfeeding as it may affect milk production and quality.

Storage

Store in a cool, dry place away from direct light. Keep out of reach of children.

Formulations

• Tablets
• Capsules

Mechanism of action

DHEA can be understood as a prohormone for the sex steroids. DHEAS may be viewed as buffer and reservoir. As most DHEA is produced by the zona reticularis of the adrenal cortex, it is argued that there is a role in the immune and stress response. DHEAS/DHEA are useful to detect excess adrenal activity as seen in adrenal cancer or hyperplasia, including certain forms of congenital adrenal hyperplasia as it is produced nearly entirely by the adrenal glands. Women with polycystic ovary syndrome tend to have elevated levels of DHEAS.

Pharmacodynamics

DHEA is naturally produced from cholesterol through two cytochrome P450 enzymes. Cholesterol is converted to pregnenolone by the enzyme P450 scc (side chain cleavage); then another enzyme, CYP17A1, converts pregnenolone to 17α-Hydroxypregnenolone and then to DHEA. DHEA is increased by exercise and calorie restriction. Some theorize that the increase in endogenous DHEA brought about by calorie restriction is partially responsible for the longer life expectancy known to be associated with calorie restriction.