G: Genito-urinary system and sex hormones
ATC group G for modelers: the level 2 map with example drugs, and notes held at G03 (sex hormones) and G04 (urologicals).
Sex hormones and their modulators, together with the drugs acting on the genito-urinary tract. Two subgroups set the agenda: sex hormones (G03) are dosed into an axis that already produces them [1], and the urologicals (G04) are judged on patient-reported endpoints [2].
Margaret Sanger pushed for an oral contraceptive, Katharine Dexter McCormick paid for it, and Gregory Pincus and John Rock did the work. The FDA approved Enovid in 1957 for menstrual disorders, and only in 1960 for contraception [3,4].
| Level 2 code | Description | In plain terms | Example drug |
|---|---|---|---|
| G01 | Gynecological antiinfectives and antiseptics | Clotrimazole (G01AF02) / metronidazole (G01AF01), both vaginal | |
| G02 | Other gynecologicals | uterus drugs: labour induction, tocolytics, prolactin inhibitors | Misoprostol (G02AD06) / dinoprostone (G02AD02) |
| G03 | Sex hormones and modulators of the genital system | contraceptives, menopause hormone therapy, fertility drugs | Levonorgestrel and ethinylestradiol (G03AA07) / estradiol (G03CA03) |
| G04 | Urologicals | for bladder and prostate problems | Tamsulosin (G04CA02) / solifenacin (G04BD08) |
Modeling notes
Non-monotonic response GnRH agonists produce a flare before downregulation, so the response is not monotonic [5,6], and ATC files them outside this group entirely, under L02AE and H01CA.
References
[1]
Tornøe CW, Agersø H, Senderovitz T, Nielsen HA, Madsen H, Karlsson MO, et al. Population pharmacokinetic/pharmacodynamic (PK/PD) modelling of the hypothalamic-pituitary-gonadal axis following treatment with GnRH analogues. British Journal of Clinical Pharmacology 2007;63:648–64. https://doi.org/10.1111/j.1365-2125.2006.02820.x.
[2]
Lyauk YK, Jonker DM, Lund TM, Hooker AC, Karlsson MO. Integrated item response theory modeling of multiple patient-reported outcomes assessing lower urinary tract symptoms associated with benign prostatic hyperplasia. The AAPS Journal 2020;22:98. https://doi.org/10.1208/s12248-020-00484-7.
[3]
Dhont M. History of oral contraception. The European Journal of Contraception & Reproductive Health Care 2010;15:S12–8. https://doi.org/10.3109/13625187.2010.513071.
[4]
Junod SW, Marks L. Women’s trials: The approval of the first oral contraceptive pill in the united states and great britain. Journal of the History of Medicine and Allied Sciences 2002;57:117–60. https://doi.org/10.1093/jhmas/57.2.117.
[5]
Romero E, Vélez de Mendizabal N, Cendrós J-M, Peraire C, Bascompta E, Obach R, et al. Pharmacokinetic/pharmacodynamic model of the testosterone effects of triptorelin administered in sustained release formulations in patients with prostate cancer. The Journal of Pharmacology and Experimental Therapeutics 2012;342:788–98. https://doi.org/10.1124/jpet.112.195560.
[6]
Lim CN, Salem AH. A semi-mechanistic integrated pharmacokinetic/pharmacodynamic model of the testosterone effects of the gonadotropin-releasing hormone agonist leuprolide in prostate cancer patients. Clinical Pharmacokinetics 2015;54:963–73. https://doi.org/10.1007/s40262-015-0251-9.