• Explain dose schedule and maintenance routine. Discontinuing medication suddenly may cause withdrawal bleeding. Bleeding is anticipated during the wk when conjugated estrogens are withheld.
• If nausea becomes a problem, advise patient that eating solid food often provides relief.
• Advise patient to report signs and symptoms of fluid retention (swelling of ankles and feet, weight gain), thromboembolic disorders (pain, swelling, tenderness in extremities; headache; chest pain; blurred vision), depression, hepatic dysfunction (yellowed skin or eyes, pruritus, dark urine, light-colored stools), or abnormal vaginal bleeding to health care professional.
• Caution patient that cigarette smoking during estrogen therapy may increase risk of serious side effects, especially for women over age 35.
• Inform patient that Premarin tablet may appear in stool; this is not harmful.
• Caution patient to use sunscreen and protective clothing to prevent increased pigmentation.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise patient to notify health care professional of medication regimen before treatment or surgery.
• Advise patient treated for osteoporosis that exercise has been found to arrest and reverse bone loss. The patient should discuss any exercise limitations with health care professional before beginning program.
• May cause fetal harm. Instruct patient to stop taking medication and notify health care professional if pregnancy is planned or suspected, and to avoid breastfeeding during therapy.
• Emphasize the importance of routine follow-up physical exams, including BP; breast, abdomen, and pelvic examinations; Papanicolaou (Pap) smears every 6–12 mo; and mammogram every 12 mo or as directed. Health care professional will evaluate possibility of discontinuing medication every 3–6 mo. If on continuous (not cyclical) therapy or without concurrent progestins, endometrial biopsy may be recommended if uterus is intact.

Instruct patient in the correct use of applicator. Patient should remain recumbent for at least 30 min after administration. May use sanitary napkin to protect clothing, but do not use tampon. If a dose is missed, do not use the missed dose, but return to regular dosing schedule.