Adult Dosing
Severe vasomotor symptoms
estradiol
- 1-2 mg PO qd; administer in a cyclic regimen 3 wks on and 1 wk off
- Discontinue or taper medicine at 3-6 month interval
- Use lowest effective dose for maintenance therapy by titration
Femtrace (estradiol acetate)
- 0.45-1.8 mg PO qd, use lowest effective dose for maintenance therapy by titration
- Discontinue or taper medicine at 3-6 month interval
- Add progestin in postmenopausal women with intact uterus
Vulval and vaginal atrophy associated with the menopause
estradiol
- 1-2 mg PO qd; administer in a cyclic regimen 3 wks on and 1 wk off
- Discontinue or taper medicine at 3-6 month interval
- Use lowest effective dose for maintenance therapy by titration
Hypoestrogenism
estradiol
- Initial 1-2 mg PO qd
- Use lowest effective dose for maintenance therapy by titration
Palliative treatment of breast cancer
estradiol
Androgen-dependent prostate cancer
estradiol
Prevention of osteoporosis
estradiol
- 0.5 mg PO qd in a cyclic regimen, the lowest effective dose has not been determined
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Estradiol
- Moderate to severe vasomotor symptoms associated with the menopause
- Vulvar and vaginal atrophy associated with the menopause
- Hypoestrogenism due to hypogonadism, castration or primary ovarian failure
- Palliative treatment of breast cancer with metastatic disease
- Palliative treatment of advanced androgen-dependent prostate cancer
- Postmenopausal osteoporosis
Femtrace (estradiol acetate)
- Moderate to severe vasomotor symptoms associated with the menopause
- Estrogen and estrogen/progestin therapy increases the risk of cardiovascular events like myocardial infarction and stroke, discontinue the drug immediately if any of these event suspected [US Black Box warning]
- Unopposed use of estrogens in women with intact uteri increases the risk of endometrial cancer [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 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 if hypercalcemia occurs, and provide appropriate measures
- 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
- Estrogen use causes increases in blood pressure, monitor BP at regular interval
- Use of progestin with estrogen in continuous regimen lowers the incidence of endometrial hyperplasia, than would be induced by estrogen treatment alone. However there is possible increased risk of breast cancer associated with the use of progestins with estrogens compared to estrogen-alone regimens
- 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 and in the case of recurrence discontinue the drug
- 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
- Use of estrogen alone for 10 or more years increases the risk of ovarian cancer
- Topical vaginal products should be considered when prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy
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
- Severe hypocalcemia
- Gallbladder Disease
- Obesity
- Patients >65 yrs
- Tobacco use
Pregnancy Category:X
Breastfeeding: Limited data on the use of estradiol during breastfeeding indicates that the amount transferred into breastmilk is influenced by route of administration and dosage form. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 24 December 2010). Though this drug has found to be compatible with breastfeeding, withdrawal bleeding may occur after drug is withdrawn based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776)As per manufacturer's data, estrogen administration during breastfeeding interferes with lactation by decreasing the quantity and quality of the milk. Detectable amount is secreted in breast milk; use cautiously when estradiol is administered to a nursing woman.
US Trade Name(s)
- Estrace (Discontinued)
- Femtrace
US Availability
estradiol (generic)
Estrace (estradiol)
Femtrace (estradiol acetate)
Canadian Trade Name(s)
Canadian Availability
Estrace (estradiol)
UK Trade Name(s)
- Climaval
- Elleste solo
- Progynova
- Zumenon
UK Availability
Climaval, Progynova (estradiol valerate)
Elleste solo(estradiol hemihydrate)
Zumenon
Australian Trade Name(s)
Australian Availability
Estrofem (estradiol hemihydrate)
Progynova (estradiol valerate)
Zumenon (estradiol)
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Femtrace 0.45 MG TABS [Bottle] (WARNER CHILCOTT PROF PROD DIV)
100 mg = $224
300 mg = $608.99 - Estrace 1 MG TABS [Bottle] (WARNER CHILCOTT PROF PROD DIV)
30 mg = $75.99
90 mg = $209.96 - Femtrace 0.9 MG TABS [Bottle] (WARNER CHILCOTT PROF PROD DIV)
100 mg = $187
200 mg = $370.95 - Femtrace 1.8 MG TABS [Bottle] (WARNER CHILCOTT PROF PROD DIV)
100 mg = $236.98
300 mg = $665.96 - Estrace 2 MG TABS [Bottle] (WARNER CHILCOTT PROF PROD DIV)
30 mg = $95.99
90 mg = $259.97
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.