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conjugated estrogens and medroxyprogesterone (Oral route)

KON-joo-gay-ted ES-troe-jenz, me-drox-ee-proe-JES-ter-one AS-e-tate

Oral route(Tablet)

Estrogens with or without progestins should not be used for the prevention of cardiovascular disease or dementia. Increased risks of stroke and deep vein thrombosis in postmenopausal women (50 to 79 years of age) using estrogen alone have been reported. Increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) using estrogens combined with progestins have been reported. An increased risk of developing probable dementia in postmenopausal women 65 years of age or older has also been reported in women receiving estrogen alone or estrogen combined with progestins. Unopposed estrogens increase the risk of endometrial cancer. Adding a progestin will reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. Diagnostic measures should be undertaken to rule out malignancy in postmenopausal women with undiagnosed persistent or recurring abnormal genital bleeding. Risks should be assumed to be similar for other doses, combinations, and dosage forms of estrogens and progestins. Estrogens, with or without progestins, should be prescribed at the lowest effective doses and for the shortest duration possible ..

Commonly used brand name(s)

In the U.S.

  • Premphase
  • Prempro
  • Prempro Low Dose

Available Dosage Forms:

  • Tablet

Therapeutic Class: Estrogen/Progestin Combination

Pharmacologic Class: Estrogen

Uses For conjugated estrogens and medroxyprogesterone

Conjugated estrogens and medroxyprogesterone acetate combination is used to treat moderate to severe hot flashes, dryness in and around the vagina, and other symptoms of menopause. conjugated estrogens and medroxyprogesterone is also used to prevent osteoporosis (thinning of the bones) after menopause.

Slideshow: Flashback: FDA Drug Approvals 2013

conjugated estrogens and medroxyprogesterone is available only with your doctor's prescription.

Before Using conjugated estrogens and medroxyprogesterone

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For conjugated estrogens and medroxyprogesterone, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to conjugated estrogens and medroxyprogesterone or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Conjugated estrogens and medroxyprogesterone acetate combination is not recommended for children.

Geriatric

Although appropriate studies on the relationship of age to the effects of conjugated estrogens and medroxyprogesterone combination have not been performed in the geriatric population, no geriatric-specific problems have been documented to date. However, elderly patients are more likely to have certain unwanted effects (eg, breast cancer, stroke, or dementia), which may require caution in patients receiving conjugated estrogens and medroxyprogesterone.

Pregnancy

Pregnancy Category Explanation
All Trimesters X Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking conjugated estrogens and medroxyprogesterone, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using conjugated estrogens and medroxyprogesterone with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Tranexamic Acid

Using conjugated estrogens and medroxyprogesterone with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Carbamazepine
  • Ceritinib
  • Dabrafenib
  • Eslicarbazepine Acetate
  • Isotretinoin
  • Mitotane
  • Piperaquine
  • Siltuximab
  • Theophylline

Using conjugated estrogens and medroxyprogesterone with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alprazolam
  • Amprenavir
  • Aprepitant
  • Atazanavir
  • Bacampicillin
  • Betamethasone
  • Bexarotene
  • Bosentan
  • Clarithromycin
  • Colesevelam
  • Cyclosporine
  • Darunavir
  • Delavirdine
  • Efavirenz
  • Etoricoxib
  • Etravirine
  • Fosamprenavir
  • Fosaprepitant
  • Fosphenytoin
  • Ginseng
  • Griseofulvin
  • Itraconazole
  • Ketoconazole
  • Lamotrigine
  • Levothyroxine
  • Licorice
  • Modafinil
  • Mycophenolate Mofetil
  • Mycophenolic Acid
  • Nelfinavir
  • Oxcarbazepine
  • Phenobarbital
  • Phenytoin
  • Pioglitazone
  • Prednisolone
  • Primidone
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Rosuvastatin
  • Rufinamide
  • Selegiline
  • St John's Wort
  • Telaprevir
  • Tipranavir
  • Topiramate
  • Troglitazone
  • Troleandomycin
  • Voriconazole
  • Warfarin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using conjugated estrogens and medroxyprogesterone with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use conjugated estrogens and medroxyprogesterone, or give you special instructions about the use of food, alcohol, or tobacco.

  • Caffeine
  • Grapefruit Juice

Other Medical Problems

The presence of other medical problems may affect the use of conjugated estrogens and medroxyprogesterone. Make sure you tell your doctor if you have any other medical problems, especially:

  • Abnormal vaginal bleeding or
  • Antithrombin deficiency (blood clotting disorder) or
  • Blood clots, or history of or
  • Breast cancer, or history of or
  • Deep vein thrombosis (blood clot in the leg), or history of or
  • Heart attack, or history of or
  • Hysterectomy (removal of the uterus), history of or
  • Liver disease or
  • Protein C deficiency (blood clotting disorder) or
  • Protein S deficiency (blood clotting disorder) or
  • Pulmonary embolism (blood clot in the lung), or history of or
  • Stroke, or history of or
  • Tumor (estrogen-dependent)—Should not be used in patients with these conditions.
  • Asthma or
  • Congestive heart failure or
  • Diabetes or
  • Edema (fluid retention or body swelling) or
  • Epilepsy (seizures) or
  • Gallbladder disease or
  • Hereditary angioedema (swelling of the face, mouth, or throat) or
  • Hypertension (high blood pressure) or
  • Hypertriglyceridemia (high fats in the blood) or
  • Hypothyroidism (an underactive thyroid) or
  • Migraine headache or
  • Porphyria (an enzyme problem) or
  • Systemic lupus erythematosus (SLE)—Use with caution. May make these conditions worse.

Proper Use of conjugated estrogens and medroxyprogesterone

It is very important that you use conjugated estrogens and medroxyprogesterone only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may cause unwanted side effects.

conjugated estrogens and medroxyprogesterone comes with a patient information leaflet. Read and follow the instructions in the leaflet carefully. Ask your doctor if you have any questions.

Dosing

The dose of conjugated estrogens and medroxyprogesterone will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of conjugated estrogens and medroxyprogesterone. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For treatment of menopause symptoms and prevention of osteoporosis:
      • Adults—
        • Premphase®: One tablet once a day for 28 days, then repeat the cycle. The maroon colored tablet is taken on days 1 to 14, and the light blue tablet is taken on days 15 to 28.
        • Prempro®: One tablet once a day for 28 days, then repeat the cycle.
      • Children—Use is not recommended.

Missed Dose

If you miss a dose of conjugated estrogens and medroxyprogesterone, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using conjugated estrogens and medroxyprogesterone

It is very important that your doctor check your progress at regular visits to make sure conjugated estrogens and medroxyprogesterone is working properly and does not cause unwanted effects.

It is unlikely that a postmenopausal woman may become pregnant. But you should know that using conjugated estrogens and medroxyprogesterone while you are pregnant can harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.

Using conjugated estrogens and medroxyprogesterone may increase your risk of heart attack, stroke, blood clots, dementia, breast cancer, or uterine cancer. Talk with your doctor about these risks.

Your risk of heart disease or stroke from conjugated estrogens and medroxyprogesterone is higher if you smoke. Your risk is also increased if you have diabetes or high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.

Tell the medical doctor in charge that you are using conjugated estrogens and medroxyprogesterone before you have any kind of surgery. Your doctor will decide whether you should continue using conjugated estrogens and medroxyprogesterone.

Check with your doctor right away if a severe headache or a sudden loss of vision or any change in vision occurs while you are using conjugated estrogens and medroxyprogesterone. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Pancreatitis may occur while you are using conjugated estrogens and medroxyprogesterone. Check with your doctor right away if you have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness.

conjugated estrogens and medroxyprogesterone may cause serious types of allergic reactions, including anaphylaxis and angioedema. Anaphylaxis and angioedema can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, mouth, or throat while you are using conjugated estrogens and medroxyprogesterone.

Before you have any medical tests, tell the medical doctor in charge that you are taking conjugated estrogens and medroxyprogesterone. The results of some tests may be affected by conjugated estrogens and medroxyprogesterone.

Do not eat grapefruit or drink grapefruit juice while you are using conjugated estrogens and medroxyprogesterone. Grapefruit and grapefruit juice may cause the amount of medicine in the blood to be too high.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (e.g., St. John's wort) or vitamin supplements.

conjugated estrogens and medroxyprogesterone Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common
  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • blood in the urine
  • blurred vision
  • chest pain
  • clear or bloody discharge from the nipple
  • cough or hoarseness
  • dimpling of the breast skin
  • dizziness
  • fast, irregular, pounding, or racing heartbeat or pulse
  • feeling faint, dizzy, or lightheaded
  • feeling of warmth or heat
  • fever or chills
  • flushing or redness of the skin, especially on the face and neck
  • headache
  • inverted nipple
  • lower back or side pain
  • lump in the breast or under the arm
  • nervousness
  • pain during sexual intercourse
  • painful or difficult urination
  • persistent crusting or scaling of the nipple
  • pounding in the ears
  • redness or swelling of the breast
  • severe cramping of the uterus
  • sore on the skin of the breast that does not heal
  • sweating
  • thick, white vaginal discharge with no odor or with a mild odor
  • tingling of the hands or feet
  • unusual weight gain or loss
  • vaginal bleeding that is unusual and heavy
  • vaginal or genital itching
  • vaginal yeast infection
Incidence not known
  • Absent, missed, or irregular menstrual periods
  • acid or sour stomach
  • anxiety
  • backache
  • breast pain or tenderness
  • confusion
  • constipation
  • darkened urine
  • decreased vision or other changes in vision
  • difficulty with speaking
  • double vision
  • fainting
  • heartburn
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • indigestion
  • loss of appetite
  • nausea
  • pain or discomfort in the arms, jaw, back, or neck
  • pain or feeling of pressure in the pelvis
  • pain, redness, or swelling in the arm or leg
  • painful or tender cysts in the breasts
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • slow speech
  • sudden shortness of breath or troubled breathing
  • unexpected or excess milk flow from the breasts
  • vomiting
  • yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Back pain
  • depression
  • excess gas in the stomach or intestines
  • lack or loss of strength
Less common
  • Blemishes on the skin
  • body aches or pain
  • congestion
  • depersonalization
  • diarrhea
  • difficulty with moving
  • dry skin
  • dryness of the vagina
  • dysphoria
  • euphoria
  • excessive muscle tone
  • feeling paranoid
  • flu-like symptoms
  • fullness or swelling of the breasts
  • hair loss or thinning of the hair
  • headache, severe and throbbing
  • leg cramps
  • loss of bladder control
  • menstrual periods that are longer or heavier
  • muscle pain or stiffness
  • pain in the joints
  • pain or tenderness around the eyes and cheekbones
  • pimples or acne
  • quick to react or overreact emotionally
  • rapidly changing moods
  • rash
  • sleeplessness
  • sore mouth or tongue
  • stuffy or runny nose
  • tender, swollen glands in the neck
  • tightness of the chest or wheezing
  • trouble with sleeping
  • trouble with swallowing
  • vaginal discharge that is clear or white
  • voice changes
  • white patches in the mouth or on the tongue
Incidence not known
  • Changes in appetite
  • hives or welts
  • inability to have or keep an erection
  • increased hair growth, especially on the face
  • increased interest in sexual intercourse
  • irritability
  • loss in sexual ability, desire, drive, or performance
  • loss of scalp hair
  • pain in the ankles or knees
  • painful, red lumps under the skin, mostly on the legs
  • patchy brown or dark brown discoloration of the skin
  • redness of the skin
  • weight changes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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