Adult Dosing
Atrophic vaginitis and kraurosis vulvae
- Start 0.5 g PV qd, in a cyclic regime of 21 days on and 7 days off
- Adjust dose as per response; usual dose: 0.5-2 g
Moderate to severe dyspareunia
- 0.5 g PV x 2/wk continuously or in a cyclic regime of 21 days on and 7 days off
Vulvar and vaginal atrophy, due to Menopause
- 0.5 g PV x 2/wk continuously or in a cyclic regime of 21 days on and 7 days off
Notes:- In postmenopausal women with a uterus, add progestin for at least 12-14 days every 28 day cycle to reduce the risk to the endometrial cancer
- Use lowest effective dose of estrogen/progestin combination for shortest duration
Pediatric Dosing
[Outline]
- Estrogen conjugated Vaginal cream is absorbed systemically hence the warnings, precautions, and adverse reactions associated with oral conjugated estrogen should be taken into account
- Estrogen alone therapy increases the risk of stroke and DVT and when used in combination with progestin therapy increases the risk of pulmonary embolism, DVT, stroke and myocardial infarction. Discontinue the treatment immediately if any of these occur [US Black Box Warning]
- Risk factors for arterial vascular disease and/or venous thromboembolism should be managed appropriately
- Estrogen alone or in combination with progestin therapy increases the risk of venous thromboembolism. Discontinue the estrogen therapy 4-6 wks before surgery associated with an increased risk of thromboembolism, or require prolong immobilization
- Unopposed use of estrogens in women with intact uteri increases the risk of endometrial cancer 2-12 times greater than in non-users [US Black Box warning]
- Estrogens and progestins use in postmenopausal women increase the risk of breast cancer. Perform breast examination and mammogram yearly, based on patient age, risk factors and prior mammogram results
- Estrogen alone or in combination with progestin increases the risk of ovarian cancer, however the duration of exposure associated with increased risk is not consistent. Some report shows no association
- Estrogen and estrogen/progestin therapy increases the risk of dementia in postmenopausal women 65 years of age and older [US Black Box warning]
- Increases the risk of gallbladder diseases by 2 to 4 fold in postmenopausal women receiving estrogen therapy
- Estrogen therapy causes severe hypercalcemia in patients with breast cancer and bone metastases. Discontinue the therapy and provide appropriate measures, if hypercalcemia occurs
- Retinal vascular thrombosis occurs in patients receiving estrogens. Discontinue the drug if there is sudden partial or complete loss of vision, or a sudden onset of proptosis, diplopia or migraine. Permanently discontinue if papilledema or retinal vascular lesions are seen on examination
- Use of progestin with estrogen in continuous regimen lowers the incidence of endometrial hyperplasia, than would be induced by estrogen alone treatment. However there is possible increased risk of breast cancer, adverse effects on lipoprotein metabolism and impairment of glucose tolerance, with the use of progestins along with estrogens compared to estrogen-alone regimens
- Estrogen use causes increases in blood pressure, monitor BP at regular interval
- Estrogen therapy elevates the plasma triglycerides in patients with preexisting hypertriglyceridemia, leading to pancreatitis and other complications
- Use cautiously in patients with a history of cholestatic jaundice associated with past estrogen use or with pregnancy, discontinue the drug in case of recurrence
- Estrogen administration causes increased thyroid-binding globulin (TBG) levels. Patients on thyroid hormone replacement therapy receiving estrogen require increased doses of their thyroid replacement therapy. Monitor thyroid function regularly to maintain free thyroid hormone levels in an acceptable range
- Estrogen causes fluid retention, use cautiously in patients with conditions like asthma, epilepsy, migraine, and cardiac or renal dysfunction
- Administration of estrogen therapy can exacerbate endometriosis
- Estrogen induced hypocalcemia can occur in patients with hypoparathyroidism
- Exacerbation of asthma, diabetes mellitus, epilepsy, migraine, porphyria, systemic lupus erythematosus, and hepatic hemangiomas has been reported with estrogen therapy, hence use cautiously in these patients
- Estrogen vaginal cream weakens and contribute to the failure of condoms, diaphragms, or cervical caps made of latex or rubber
Cautions: Use cautiously in
- Cardiovascular diseases
- Hypertension
- Hypertriglyceridemia
- History of Cholestatic Jaundice
- Hypothyroidism
- Asthma
- Diabetes mellitus
- Epilepsy
- Migraine
- Surgery or prolonged immobilization
- Porphyria
- Systemic lupus erythematosus
- Hepatic hemangiomas
- Endometriosis
Pregnancy Category:X
Breastfeeding: Estrogen administration during breastfeeding interferes with lactation by decreasing the quantity and quality of the milk. Detectable amount is secreted in breast milk; manufacturer advises to use cautiously in nursing mother.
Pricing data from www.DrugStore.com in U.S.A.
- Premarin 0.625 MG/GM CREA [Tube] (WYETH)
42.5 gm = $150.99
127.5 gm = $429.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
