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Estropipate Dosage

Applies to the following strengths: 0.75 mg; 1.5 mg; 3 mg

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Usual Adult Dose for Osteoporosis

Dose depends on the presence or absence of an intact uterus.

Recommendations with intact uterus:

Regimen 1 (Continuous Unopposed Estrogen Therapy):

0.625 mg orally once a day.

Regimen 2 (Cyclic Combined Estrogen-Progestin Therapy):

0.625 mg orally once a day for 25 days AND Medroxyprogesterone acetate 5 to 10 mg orally once a day for 10 to 14 days of the cycle.

Regimen 3 (Continuous Combined Estrogen-Progestin Therapy):

0.625 mg orally once a day AND Medroxyprogesterone acetate 2.5 mg orally once a day.

Recommendation following hysterectomy:

0.625 mg orally once a day.

In addition to hormonal therapy, adequate calcium intake is important for postmenopausal women who require treatment or prevention of osteoporosis. The average diet of older American women contains 400 to 600 mg of calcium per day. The optimal intake suggested is 1500 mg per day. If dietary intake is insufficient to achieve 1500 mg per day, dietary supplementation may be useful in women who have no contraindication to calcium supplementation.

Long-term therapy (for more than 5 years) is generally necessary in order to obtain substantive benefits in reducing the risk of bone fracture. Maximal benefits are obtained if estrogen therapy is initiated as soon after menopause as possible. The optimal duration of therapy has not been definitively determined.

Usual Adult Dose for Postmenopausal Symptoms

Dose depends on the presence or absence of an intact uterus.

Recommendations with intact uterus:

Regimen 1 (Continuous Unopposed Estrogen Therapy):

0.625 mg to 5 mg orally once a day.

Regimen 2 (Cyclic Combined Estrogen-Progestin Therapy):

0.625 mg to 5 mg orally once a day for 25 days AND Medroxyprogesterone acetate 5 to 10 mg orally once a day for 10 to 14 days of the cycle.

Regimen 3 (Continuous Combined Estrogen-Progestin Therapy):

0.625 mg to 5 mg orally once a day AND Medroxyprogesterone acetate 2.5 mg orally once a day.

Recommendation following hysterectomy:

0.625 mg to 5 mg orally once a day.

Many women may require higher dosages during the initiation of therapy. The dosage of estropipate should be adjusted to the minimum dose that will achieve the desired clinical effect.

In general, the duration of hormone therapy for the treatment of postmenopausal symptoms should be limited. Treatment for one to five years is generally sufficient. However, long-term therapy (for the treatment/prophylaxis of osteoporosis and for risk reduction of cardiovascular disease) may be considered during the time in which the patient is being treated for postmenopausal symptoms.

Usual Adult Dose for Atrophic Vaginitis

Dose depends on the presence or absence of an intact uterus.

Recommendations with intact uterus:

Regimen 1 (Continuous Unopposed Estrogen Therapy):

0.625 mg to 5 mg orally once a day.

Regimen 2 (Cyclic Combined Estrogen-Progestin Therapy):

0.625 mg to 5 mg orally once a day for 25 days AND Medroxyprogesterone acetate 5 to 10 mg orally once a day for 10 to 14 days of the cycle.

Regimen 3 (Continuous Combined Estrogen-Progestin Therapy):

0.625 mg to 5 mg orally once a day AND Medroxyprogesterone acetate 2.5 mg orally once a day.

Recommendation following hysterectomy:

0.625 mg to 5 mg orally once a day.

Many women may require higher dosages during the initiation of therapy. The dosage of estropipate should be adjusted to the minimum dose that will achieve the desired clinical effect.

In general, the duration of hormone therapy for the treatment of postmenopausal symptoms like atrophic vaginitis, kraurosis vulvae, or atrophic urethritis should be limited. Treatment for one to five years is generally sufficient.

Usual Adult Dose for Atrophic Urethritis

Dose depends on the presence or absence of an intact uterus.

Recommendations with intact uterus:

Regimen 1 (Continuous Unopposed Estrogen Therapy):

0.625 mg to 5 mg orally once a day.

Regimen 2 (Cyclic Combined Estrogen-Progestin Therapy):

0.625 mg to 5 mg orally once a day for 25 days AND Medroxyprogesterone acetate 5 to 10 mg orally once a day for 10 to 14 days of the cycle.

Regimen 3 (Continuous Combined Estrogen-Progestin Therapy):

0.625 mg to 5 mg orally once a day AND Medroxyprogesterone acetate 2.5 mg orally once a day.

Recommendation following hysterectomy:

0.625 mg to 5 mg orally once a day.

Many women may require higher dosages during the initiation of therapy. The dosage of estropipate should be adjusted to the minimum dose that will achieve the desired clinical effect.

In general, the duration of hormone therapy for the treatment of postmenopausal symptoms like atrophic vaginitis, kraurosis vulvae, or atrophic urethritis should be limited. Treatment for one to five years is generally sufficient.

Usual Adult Dose for Hypoestrogenism

1.25 to 7.5 mg orally once a day for 21 days followed by an 8 to 10 day rest period. The dosage of estropipate should be adjusted to the minimum dose that will achieve the desired clinical effect. This schedule is repeated as necessary to produce bleeding. If satisfactory withdrawal bleeding does not occur, a progestin, like medroxyprogesterone acetate, is added on the last several days of the monthly treatment.

Treatment is usually initiated at the expected time of puberty and may continue for prolonged periods.

Therapeutic goals of estrogen-progestin treatment differ at different times in the life of a hypogonadal patient and titration of dosage is often necessary to achieve the desired level of developmental maturation and menstruation.

Usual Adult Dose for Primary Ovarian Failure

1.5 mg to 7.5 mg

Dose depends on the presence or absence of an intact uterus.

Recommendations with intact uterus:

Regimen 1 (Continuous Unopposed Estrogen Therapy):

1.5 mg to 7.5 mg orally once a day.

Regimen 2 (Cyclic Combined Estrogen-Progestin Therapy):

1.5 mg to 7.5 mg orally once a day for 25 days AND Medroxyprogesterone acetate 5 to 10 mg orally once a day for 10 to 14 days of the cycle.

Regimen 3 (Continuous Combined Estrogen-Progestin Therapy):

1.5 mg to 7.55 mg orally once a day AND Medroxyprogesterone acetate 2.5 mg orally once a day.

Recommendation following hysterectomy:

1.5 mg to 7.5 mg orally once a day.

Many women may require higher dosages during the initiation of therapy. The dosage of estropipate should be adjusted to the minimum dose that will achieve the desired clinical effect.

Usual Adult Dose for Oophorectomy

1.5 mg to 7.5 mg

Dose depends on the presence or absence of an intact uterus.

Recommendations with intact uterus:

Regimen 1 (Continuous Unopposed Estrogen Therapy):

1.5 mg to 7.5 mg orally once a day.

Regimen 2 (Cyclic Combined Estrogen-Progestin Therapy):

1.5 mg to 7.5 mg orally once a day for 25 days AND Medroxyprogesterone acetate 5 to 10 mg orally once a day for 10 to 14 days of the cycle.

Regimen 3 (Continuous Combined Estrogen-Progestin Therapy):

1.5 mg to 7.5 mg orally once a day AND Medroxyprogesterone acetate 2.5 mg orally once a day.

Recommendation following hysterectomy:

1.5 mg to 7.5 mg orally once a day.

Many women may require higher dosages during the initiation of therapy. The dosage of estropipate should be adjusted to the minimum dose that will achieve the desired clinical effect.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Contraindicated

Precautions

US BOXED WARNINGS:
-ENDOMETRIAL CANCER: Estrogens increase the risk of endometrial cancer. Close clinical surveillance of all women taking estrogens is important. Adequate diagnostic measures, including endometrial sampling when indicated, should occur to rule out malignancy in all cases of undiagnosed persistent or recurrent abnormal vaginal bleeding. There is no evidence that the use of "natural" estrogens result in a different endometrial risk profile than "synthetic" estrogens at equivalent estrogen doses.
-CARDIOVASCULAR DISORDERS AND PROBABLE DEMENTIA: Estrogen with or without progestins should not be used for prevention of cardiovascular disease. The Women's Health Initiative (WHI) study reported an increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, myocardial infarction (MI), and invasive breast cancer in postmenopausal women (50 to 79 years of age) during 5 years of treatment with oral conjugated estrogens (CE) (0.625 mg) relative to placebo. The WHI Memory Study (WHIMS) reported an increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 4 years of treatment with oral CE plus medroxyprogesterone acetate relative to placebo. It is unknown whether this finding applies to younger postmenopausal women or women taking estrogen alone.
-Other doses of conjugated estrogens with medroxyprogesterone acetate, and other combinations and dosage forms of estrogens and progestins were not studied in the WHI clinical trials and, in the absence of comparable data, risks should be assumed to be similar; estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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