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conjugated estrogens

Pronunciation

Generic Name: conjugated estrogens (vaginal) (KON joo gay ted ES troe jenz)
Brand Name: Premarin Vaginal, Synthetic Conjugated Estrogens, A

What are vaginal conjugated estrogens?

Estrogen is a female sex hormone produced by the ovaries. Estrogen is necessary for many processes in the body.

Vaginal conjugated estrogens are a mixture of estrogen hormones used to treat the vaginal symptoms of menopause such as dryness, burning, irritation, and painful sexual intercourse.

Vaginal conjugated estrogens should not be used to prevent heart disease or dementia, because this medication may actually increase your risk of developing these conditions.

Vaginal conjugated estrogens may also be used for purposes not listed in this medication guide.

What is the most important information I should know about vaginal conjugated estrogens?

Vaginal conjugated estrogens can harm an unborn baby or cause birth defects. Do not use if you are pregnant.

You should not use this medication if you have any of the following conditions: a history of heart attack, stroke, or blood clot (especially in your lung or your lower body), liver disease, abnormal vaginal bleeding, or a hormone-related cancer such as breast or uterine cancer.

Slideshow: Flashback: FDA Drug Approvals 2013

Long-term treatment with conjugated estrogens may increase your risk of breast cancer, heart attack, or stroke. Talk with your doctor about your individual risks before using vaginal conjugated estrogens long term, especially if you smoke or are overweight. Your doctor should check your progress on a regular basis (every 3 to 6 months) to determine whether you should continue this treatment.

Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using vaginal conjugated estrogens.

Vaginal conjugated estrogens should not be used to prevent heart disease or dementia, because this medication may actually increase your risk of developing these conditions.

What should I discuss with my healthcare provider before using vaginal conjugated estrogens?

You should not use vaginal conjugated estrogens if you are pregnant, or if you have:

  • a history of heart attack, stroke, or blood clot (especially in your lung or your lower body);

  • abnormal vaginal bleeding that a doctor has not checked;

  • liver disease; or

  • any type of breast, uterine, or hormone-dependent cancer.

To make sure you can safely use vaginal conjugated estrogens, tell your doctor if you have any of these other conditions:

  • high blood pressure, heart disease, or circulation problems;

  • a personal or family history of stroke;

  • endometriosis;

  • liver or kidney disease;

  • asthma;

  • epilepsy or other seizure disorder;

  • migraines;

  • diabetes;

  • underactive thyroid;

  • high cholesterol or triglycerides;

  • high or low levels of calcium in your blood;

  • porphyria;

  • systemic lupus erythematosus (SLE); or

  • gallbladder disease.

Long-term treatment with conjugated estrogens may increase your risk of breast cancer, heart attack, or stroke. Talk with your doctor about your individual risks before using vaginal conjugated estrogens long term, especially if you smoke or are overweight. Your doctor should check your progress on a regular basis (every 3 to 6 months) to determine whether you should continue this treatment.

Conjugated estrogens increase your risk of developing endometrial hyperplasia, a condition that may lead to cancer of the uterus. Taking progestins while using vaginal conjugated estrogens may lower this risk. If your uterus has not been removed, your doctor may prescribe a progestin for you to take while you are using vaginal conjugated estrogens.

FDA pregnancy category X. This medication can harm an unborn baby or cause birth defects. Do not use vaginal conjugated estrogens if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medication. You should know that conjugated estrogens vaginal cream can weaken the latex of a condom, diaphragm, or cervical cap. Talk to your doctor about the best contraceptive methods to use.

Conjugated estrogens can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. Do not use if you are breast-feeding a baby.

Do not use this medication in anyone under 18 years old without the advice of a doctor.

How should I use vaginal conjugated estrogens?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Vaginal conjugated estrogens are usually prescribed for only a short time and are most often used in a cycle, such as 3 weeks on followed by 1 week off. Some conditions require daily use and others require use only twice a week during the treatment period. Follow the directions on your prescription label.

To apply this medication, use only the vaginal applicator provided. After each use, take the applicator apart and clean it with mild soap and warm water. Do not use hot or boiling water.

Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using vaginal conjugated estrogens.

If you need surgery or medical tests or if you will be on bed rest, you may need to stop using this medication for a short time. Any doctor or surgeon who treats you should know that you are using vaginal conjugated estrogens.

This medication can affect the results of certain medical tests. Tell any doctor who treats you that you are using vaginal conjugated estrogens.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, or vaginal bleeding.

What should I avoid while using vaginal conjugated estrogens?

Do not smoke while using this medication. Smoking can increase your risk of blood clots, stroke, or heart attack caused by vaginal conjugated estrogens.

Vaginal conjugated estrogens side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using vaginal conjugated estrogens and call your doctor at once if you have a serious side effect such as:

  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;

  • sudden numbness or weakness, especially on one side of the body;

  • sudden severe headache, confusion, problems with vision, speech, or balance;

  • pain, swelling, warmth, or redness in one or both legs;

  • abnormal vaginal bleeding;

  • migraine headache;

  • pain, swelling, or tenderness in your stomach;

  • confusion, problems with memory or concentration;

  • jaundice (yellowing of the skin or eyes);

  • swelling in your hands, ankles, or feet; or

  • a breast lump.

Less serious side effects may include:

  • mild nausea, vomiting, bloating, stomach cramps;

  • breast pain, tenderness, or swelling;

  • freckles or darkening of facial skin;

  • increased hair growth, loss of scalp hair;

  • changes in weight or appetite;

  • problems with contact lenses;

  • vaginal itching or discharge;

  • changes in your menstrual periods, decreased sex drive; or

  • headache, nervousness, dizziness, tired feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Conjugated estrogens Dosing Information

Usual Adult Dose for Atrophic Vaginitis:

Treatment of Atrophic Vaginitis and Kraurosis Vulvae:

Conjugated estrogens topical (Premarin Vaginal): cyclic administration of 0.5 to 2 g intravaginally (daily for 21 days then off for 7 days).
Conjugated estrogens topical synthetic A (Duramed): 1 gram intravaginally daily for one week followed by 1 gram intravaginally twice a week.

Usual Adult Dose for Postmenopausal Symptoms:

Treatment of Moderate to Severe Dyspareunia, a Symptom of Vulvar and Vaginal Atrophy, due to Menopause:

Conjugated estrogens topical (Premarin Vaginal): Twice-weekly administration of 0.5 g intravaginally, for example, Monday and Thursday.
Conjugated estrogens topical synthetic A (Duramed): 1 gram intravaginally daily for one week followed by 1 gram intravaginally twice a week.

What other drugs will affect vaginal conjugated estrogens?

Tell your doctor about all other medicines you use, especially:

  • a blood thinner such as warfarin (Coumadin, Jantoven);

  • a thyroid medication such as levothyroxine (Synthroid, Levoxyl, Levothroid and others);

  • insulin or diabetes medicine taken by mouth;

  • rifampin (Rifadin, Rifater, Rifamate, Rimactane);

  • ketoconazole (Nizoral) or itraconazole (Sporanox);

  • seizure medicines such as phenytoin (Dilantin), carbamazepine (Carbatrol, Equetro, Tegretol), felbamate (Felbatol), oxcarbazepine (Trileptal), or primidone (Mysoline);

  • a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton); or

  • antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil).

This list is not complete and there may be other drugs that can interact with vaginal conjugated estrogens. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about vaginal conjugated estrogens.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.05. Revision Date: 2012-04-05, 10:39:26 AM.

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