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Evorel® Conti
Estradiol hemihydrate, norethisterone acetate
Evorel is a registered trademark
Read all of this leaflet carefully before you start using this medicine
because it contains important information for you.
• Keep this leaflet. You may need to read it again
• If you have any further questions, ask your doctor or pharmacist
• This medicine has been prescribed for you only. Do not pass it on to others.
It may harm them, even if their signs of illness are the same as yours
• If you get any side effects, talk to your doctor or pharmacist. This includes
any possible side effects not listed in this leaflet. See section 5.
What is in this leaflet
1. What Evorel Conti is and what it is used for
2. What you need to know before you use Evorel Conti
3. Safety of HRT
4. How to use Evorel Conti
5. Possible side effects
6. How to store Evorel Conti
7. Contents of the pack and other information

1. What Evorel Conti is and what it is used for
The name of your medicine is Evorel Conti. It belongs to a group of medicines
called hormone replacement therapy (HRT).
Evorel Conti contains two medicines:
• An oestrogen (estradiol)
• A progestogen (norethisterone)
They are both female hormones.
Evorel Conti comes in a ‘memory pack’. This can be used to help you remember
when to change your patches. Each pack contains eight or twenty-four patches.
The hormones are spread evenly in each patch. They pass slowly into your
body through the skin.
What Evorel Conti is used for
Evorel Conti is used:
• For the symptoms of the menopause (see ‘What is the menopause?’). It is
suitable for women who have not had a period (menstrual bleed) for at least
18 months
• To prevent osteoporosis (fragile bones) in women who have had the
menopause and are most likely to have bone problems. Evorel Conti is only
used if other medicines for osteoporosis have been tried first and they have
not worked

What is the menopause?
Women produce oestrogen hormones from their ovaries throughout their adult
life. These hormones are important in sexual development and control of the
menstrual cycle.
The menopause happens when the level of hormones produced by the ovaries
goes down. This is a gradual process. During this time the levels of oestrogen
can go up and down. This can cause:
• Hot flushes, night sweats or mood swings
• Vaginal problems such as dryness or itching
• Uncomfortable or painful sexual intercourse
You may get the same symptoms if you have had your ovaries taken out in an
How Evorel Conti works
Evorel Conti is known as ‘continuous combined’ HRT. This is because both
hormones in the patch are released all the time.
Evorel Conti patches replace the oestrogen that is normally released by the
ovaries. However, in women who still have a womb, taking an oestrogen
hormone regularly may cause the lining of your womb to build up and get
• This means it is necessary to add a progestogen hormone to the
• This helps shed the lining of the womb and stop any problems happening
Most women do not have a regular monthly period with Evorel Conti.
However, bleeding or spotting does often occur in the first few months until
treatment settles down.
Evorel Conti is not a contraceptive. If it is less than 12 months since your last
menstrual period or you are under 50 years old, you may still need to use
additional contraception to prevent pregnancy. Speak to your doctor for advice.

2. What you need to know before you use Evorel Conti
Do not use Evorel Conti if:
• You are allergic to anything in the patches (listed in section 7)
• You have (or have ever had), or think you may have, breast cancer
• You have (or are suspected of having) or ever had a cancer that was made
worse by oestrogens (such as endometrial cancer)
• You have a thickening of the lining of the womb (endometrial hyperplasia)
which has not been treated
• You have vaginal bleeding you cannot explain
• You have ever had blood clots in a vein (thrombosis), such as in the legs
(deep vein thrombosis) or a blood clot that has travelled to your lung
(pulmonary embolism)
• You have problems with your blood which increases the likelihood of
developing a blood clot (thrombosis) (such as protein C, protein S or
antithrombin deficiency)
• You have (or have ever had) a liver disease and your liver function tests
have not returned to normal

You have ever had blocked arteries (arterial thrombo-embolic disease) that
gave you angina or a heart attack resulted in a stroke
You have a blood problem called ‘porphyria’

Do not use this medicine if any of the above applies to you. If you are not sure,
talk to your doctor or pharmacist before using Evorel Conti.
Stop using Evorel Conti at once if any of the above appears for the first
time and talk to your doctor immediately.
Evorel Conti should not be used by children.
Medical check-ups
Before taking HRT, your doctor should ask about you and your family’s medical
history. Your doctor may decide to examine your breasts or your tummy, and
may do an internal examination. They will only do this if it is necessary for you,
or if you have any special concerns.
Once you have started on HRT, see your doctor for regular check-ups (at least
once a year). At these check-ups, your doctor may discuss the benefits and
risks of continuing to take HRT.
Make sure that you:
• Go for regular breast screening and cervical smear tests
• Regularly check your breasts for any changes such as dimpling of the skin,
changes in the nipple, or any lumps you can see or feel
Tell your doctor if you have ever had any of the following. You may need
these checks more often.
• A problem caused by growth of the womb lining:
• Inside the womb (fibroids)
• Outside the womb (endometriosis)
• Thickening of the lining of the womb (endometrial hyperplasia)
• Increased risk of blood clots (see ‘Blood clots’ in section 3 below)
• A family history of increased risk of cancers related to oestrogens (see
‘Breast cancer’ in section 3 below) such as having a mother, sister or
grandmother who has had breast cancer
• High blood pressure (hypertension). Your doctor may tell you to stop using
Evorel Conti if your blood pressure goes up
• Diabetes
• Gallstones
• Migraine or severe headaches
• Systemic lupus erythematosus (SLE). This is an allergic condition that
causes joint pain, skin rashes and fever
• Epilepsy
• Asthma
• A disease affecting the eardrum and hearing(otosclerosis)
• A liver disorder, such as a benign liver tumour
• Fluid retention due to heart or kidney problems
• High levels of fat (triglycerides) in your blood as you may have a higher
risk of pancreatitis (inflammation of the pancreas, which causes severe
pain in the abdomen and back)

Any breast problems
Thyroid problems
History of sudden swelling of the face or throat, which may cause difficulty
in swallowing or breathing, rapid swelling of the hands and feet and
stomach cramps

You may still be able to use Evorel Conti, but you should discuss this with your
doctor first. Also tell your doctor if these illnesses return or get worse while you
are using Evorel Conti.
If you have had a premature menopause the risk of using HRT may be different.
Talk to your doctor about the risks.
Stop using Evorel Conti and see a doctor immediately
If you notice any of the following when using Evorel Conti
• any of the conditions mentioned in the ‘DO NOT use Evorel Conti’
• yellowing of your skin or the whites of your eyes (jaundice). These may
be signs of a liver disease
• a large rise in your blood pressure (symptoms may be headache,
tiredness, dizziness)
• migraine-like headaches which happen for the first time
• if you become pregnant
• if you notice signs of a blood clot, such as:

painful swelling and redness of the legs


sudden chest pain


difficulty in breathing

For more information, see ‘Blood clots in a vein (thrombosis)
Other medicines and Evorel Conti
Tell your doctor or pharmacist if you are taking, have recently taken or might
take any other medicines. This includes medicines that you buy without a
prescription or herbal medicines.
In particular, tell your doctor or pharmacist if you are taking any of the
• Medicines for epilepsy such as phenobarbital, phenytoin or carbamazepine
• Medicines for tuberculosis such as rifampicin or rifabutin,
• Medicines for HIV infection, such as nevirapine, efavirenz, ritonavir and
• Medicine for Hepatitis C infection, telaprevir
• Bosentan - for high blood pressure in the blood vessels of the lungs
• St. John’s Wort - for depression
Taking these medicines with Evorel Conti can stop Evorel Conti from working as
well. Because of this you may get some bleeding, like a period, when you are
not expecting it.

A medicine for epilepsy called lamotrigine. Using Evorel Conti with
lamotrigine could affect control of your epilepsy

Operations or tests
Tell your doctor if you are going to have surgery. You may need to stop taking
HRT about 4 to 6 weeks before the operation to reduce the risk of a blood
clot. Your doctor will tell you when you can start taking HRT again.
If you visit a hospital or your family doctor for a blood or urine test, tell them
that you are taking Evorel Conti. This is because this medicine may affect the
results of the tests.
Pregnancy and breast-feeding
Do not use this medicine if you are pregnant, think you may be pregnant or
might become pregnant. This is because it may affect the baby.
Evorel Conti is for postmenopausal women only. If you become pregnant,
contact your doctor straight away and remove the patch.
Do not use this medicine if you are breast-feeding.
Ask your doctor or pharmacist for advice before taking any medicine if you are
pregnant or breast-feeding.
Driving or using machines
There is no information about whether Evorel Conti affects your ability to drive or
use machines. See how this medicine affects you before you drive or use any
tools or machines.

3. Safety of HRT
As well as benefits, HRT has some risks. Consider the following when
deciding to take or continue HRT.
Effect of HRT on heart and circulation

Heart disease (heart attack)
HRT is not recommended for women who have had heart disease recently. If
you have ever had heart disease, talk to your doctor to see if you should be
taking HRT.
HRT will not help to prevent heart disease.
Women over the age of 60 years who use oestrogen-progestogen HRT are
slightly more likely to develop heart disease than those not taking any HRT.
If you get a pain in your chest that spreads to your arm and neck
• See a doctor as soon as possible
• Do not take any more HRT until your doctor says you can
This pain may be a sign of heart disease.

Research suggests that HRT slightly increases the risk of having a stroke.
Other things that can increase the risk of stroke include:
• Getting older

• High blood pressure
• Smoking
• Drinking too much alcohol
• An irregular heartbeat
If you are worried about any of these things, or if you have had a stroke in the
past, talk to your doctor to see if you should take HRT.
How likely is a stroke?
The risk of getting stroke is about 1.5 times higher in HRT users than in nonusers. The number of extra cases of stroke due to use of HRT will increase
with age.
Looking at women in their 50s, on average, over 5 years:
• In women not taking HRT - 8 in 1000 would be expected to have a
• In women taking HRT - 11 in 1000 would be expected to have a stroke
(an extra 3 cases)
If you get migraine-type headaches which you cannot explain:
• See a doctor as soon as possible
• Do not take any more HRT until your doctor says you can
These headaches may be an early warning sign of a stroke.
Blood clots in a vein (thrombosis)
HRT may increase the risk of blood clots in the veins (also called deep vein
thrombosis, or DVT). The risk of blood clots in the veins is about 1.3 to 3 times
higher in HRT users than in non-users, especially during the first year of
taking it.
These blood clots are not always serious. However, if a clot travels to the
lungs, it can cause chest pain, breathlessness, collapse or even death. This is
called pulmonary embolism, or PE.
You are more likely to get a blood clot if:
• You are very overweight (BMI above 30 kg/m2)
• You are getting older
• You have had a blood clot before
• You are taking medicine containing an oestrogen
• You have cancer
• Any of your close family have had blood clots
• You are pregnant or have just had a baby
• You have had one or more miscarriages
• You have any blood clotting problem that needs treatment with a medicine
such as warfarin
• You are off your feet for a long time because of major surgery, injury or
• You are going on a long journey and will not be moving about for some time
• You have a rare illness called SLE (Systemic lupus erythematosus)
If any of these things apply to you, talk to your doctor to see if you should take


How likely is a blood clot?
Looking at women in their 50s, on average, over 5 years:
• In women not taking HRT – between 4 and 7 in 1000 would be
expected to get a blood clot
• In women taking oestrogen-progestogen HRT - 9 and 12 in 1000
would be expected to get a blood clot (an extra 5 cases)
If you get painful swelling in your leg, sudden chest pain or have difficulty
• See a doctor as soon as possible
• Do not take any more HRT until your doctor says you can
These may be signs of a blood clot.
HRT and Cancer

Breast cancer
Women who have breast cancer, or have had breast cancer in the past,
should not take HRT.
Taking HRT slightly increases the risk of breast cancer. The risk is also
slightly increased if you have a later menopause.
• Postmenopausal women taking oestrogen-only HRT for 5 years - the
risk is about the same as for a woman of the same age who is still
having periods over that time, and not taking HRT
• Women taking oestrogen plus progestogen HRT - the risk is higher
than for oestrogen-only HRT. However, oestrogen plus progestogen
HRT is beneficial for the endometrium (see ‘Endometrial cancer’)
For all kinds of HRT, the extra risk of breast cancer goes up the longer you
take it. However, it returns to normal within about 5 years after stopping HRT.
Your risk of breast cancer is also higher if:
• You have a close relative (mother, sister or grandmother) who has had
breast cancer
• You are very overweight
How likely is breast cancer?
Looking at women aged 50 to 79, on average, over the next 5 years:
• In women not taking combined HRT between 9 and 17 in 1000 will
get breast cancer

In women taking oestrogen-progestogen HRT at age 50 to 79 and
take it for 5 years, between 13 and 23 in 1000 will get breast cancer
(an extra 4-6 cases)

If you notice any changes in your breast, such as:
• Dimpling of the skin
• Changes in the nipple
• Any lumps you can see or feel
Make an appointment to see your doctor as soon as possible.
Additionally, you are advised to join mammography screening programs when
offered to you. For mammography screening, it is important that you inform

the nurse/healthcare professional who is actually taking the x-ray that you use
HRT, as this medication may increase the density of your breasts which may
affect the outcome of the mammogram. Where the density of the breast is
increased, mammography may not detect all lumps.

Excessive thickening of the lining of the womb (endometrial
hyperplasia) and cancer of the lining of the womb (endometrial
Taking oestrogen-only HRT for a long time can increase the risk of
cancer of the lining of the womb (the endometrium). Taking a progestogen
as well as the oestrogen helps to lower the extra risk.
If you still have your womb, your doctor will usually prescribe a progestogen
as well as oestrogen. These may be prescribed separately, or as a combined
HRT product.
If you have had your womb removed (a hysterectomy), your doctor will
discuss with you whether you can safely take oestrogen without a
If you have had your womb removed because of endometriosis, any
endometrium left in your body may be at risk of cancer. This means your
doctor may prescribe HRT that includes a progestogen as well as an
Your product, Evorel Conti, contains a progestogen.
How likely is endometrial cancer?
Looking at women aged 50 to 65 who still have a womb, on average:
• In women not taking HRT - 5 in 1000 will get endometrial cancer
• In women taking oestrogen-only HRT- between 10 and 60 in1000
will get endometrial cancer, (i.e. between 5 and 55 extra cases)
depending on the dose and how long you take it for.
The addition of a progestogen to oestrogen-only HRT substantially reduces
the risk of endometrial cancer.
If you get breakthrough bleeding or spotting, it is usually nothing to worry
about, especially during the first few months of taking HRT.
But if the bleeding or spotting:
• Carries on for more than the first few months
• Starts after you have been on HRT for a while
• Carries on even after you’ve stopped taking HRT
Make an appointment to see your doctor as soon as possible. It could be
a sign that your endometrium has become thicker.

Ovarian cancer
Ovarian cancer (cancer of the ovaries) is rare, much rarer than breast cancer.
The use of oestrogen-only or combined oestrogen-progestogen HRT has
been associated with a slightly increased risk of ovarian cancer. The risk of
ovarian cancer varies with age. For example, in women aged 50 to 54 who
are not taking HRT, about 2 women in 2000 will be diagnosed with ovarian
cancer over a 5-year period. For women who have been taking HRT for 5

years, there will be about 3 cases per 2000 users (i.e. about 1 extra case).
Evorel Conti and medicines like it will not stop memory loss (dementia).
Women who start using medicines like Evorel Conti after the age of 65 may
have a small increase in the risk of dementia.

4. How to use Evorel Conti
Always use Evorel Conti exactly as your doctor has told you. You should check
with your doctor or pharmacist if you are not sure. Your doctor will aim to reduce
your symptoms with the lowest possible dose for the shortest amount of time.
When to start using Evorel Conti
You may put an Evorel Conti patch on at any time if:
• You have not been using another type of HRT
Put an Evorel Conti patch on at the end of a treatment cycle or one week
after you finish using another HRT product if:
• You are changing from an HRT medicine that gives you a withdrawal bleed
If you are using another type of HRT:
• The day you start will depend on the type of HRT you have been using
Talk to your doctor if you are not sure which type of HRT you are using.
Using the patches
The patches need to be changed twice a week.
Start a new pack of Evorel Conti as soon as you finish one. Do not leave a break
between packs.
Changing your patches
• You must change the patches twice a week to give your body a steady
supply of hormones. There is enough hormone in each patch to last for
several days
• Change your patch on the same two days every week. This will mean that
one patch is on for three days and the next patch for four days
• For example, if you apply your first patch on a Monday, change it on
Thursday and again on the following Monday. You can work out your two
days from the following table, starting from the first day of use:
If you put your
first patch on:

Change on:


Change again on:


























To help you remember your two “patch change" days, mark them here or on
the pack. They are written on the pack like this:







Where to apply the patch
Stick the patch onto a hairless area of skin below the waist. Most women
prefer to wear the patch on the thigh or bottom.
• Do not apply on or near the breasts
• Do not put it on top of cuts, spots or anywhere the skin is irritated
• Do not use cream, moisturiser or talc before applying the patch
• Do not apply the patch on the same area of skin twice in a row
• It can be worn under loose areas of clothing
• Do not wear a patch under elasticated areas or a tight waistband
• Apply the patch to clean, dry, cool skin as soon as you open the protective

Putting a patch on
Do not use a patch if its protective pouch is already open.
Step 1: Open and Peel
• Using the notches as a guide, tear along two
edges of the pouch. Remove the patch
• With the protective backing facing you, bend
and peel off half the backing. Don’t touch the
sticky side - it may not stick properly if you do
Step 2: Apply and Press
• Apply the open half of the patch to your skin
• Remove the remaining backing and press down
the rest of the patch
• Press the patch with the palm of your hand to
make sure it is firmly stuck

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Removing a patch
• Peel an edge of the patch smoothly away
from the skin
• Fold the patch in half, so that the
sticky side sticks to itself
• Put it in with the household rubbish, safely out of
the reach of children and pets
• Do not flush used patches down the toilet
When you remove the patch some glue may remain on your skin. It will
disappear with time, or you can use baby oil to remove it.
If a patch falls off
Apply a new patch but keep to your original ‘patch change’ days. If you have
just had a bath or a shower, wait until your skin cools before applying the new
Talk to your doctor if you need more patches.
If you forget to change the patch
Change it as soon as you remember and then keep to your original ‘patch
change’ days. You may get some bleeding and spotting like a period during
this time.
If you use more Evorel Conti than you should
It is unlikely that you will have too much of the hormones in Evorel Conti. The
most common symptoms of having too much oestrogen or progestogen in
your body are:
• Tender breasts
• Feeling sick (nausea) or being sick
• Unexpected vaginal bleeding
• Feeling depressed
• Tiredness
• Acne
• Growth of body or facial hair
Removing the patch can reverse the effects of too much oestrogen and/or
progestogen. Talk to your doctor or pharmacist before using any more
Contraception while using Evorel Conti
The levels of hormone from the patches are too low to act as a contraceptive.
Use non-hormonal contraceptive methods (such as a condom, diaphragm or
coil) until your periods have completely stopped.
Everyday activities
• You can have a bath or shower as normal. Do not scrub too hard as this
can loosen the edges of the patch
• You can go swimming. The patch will not be affected
• You can exercise and play sports. However, do not wear the patch under
tight clothing or waist bands
• You can sunbathe. However, keep the patch covered, out of direct sunlight

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If you have any further questions on the use of this product, ask your doctor or

5. Possible side effects
Like all medicines, this medicine can cause side effects, although not
everybody gets them.
The following diseases are reported more often in women using HRT
compared to women not using HRT:
• breast cancer
• abnormal growth or cancer of the lining of the womb (endometrial
hyperplasia or cancer)
• ovarian cancer
• blood clots in the veins of the legs or lungs (venous thromboembolism)
• heart disease
• stroke
• probable memory loss if HRT is started over the age of 65
For more information about these side effects, see Section 3.
Take off the patch and tell your doctor straight away if you notice or
suspect any of the following. You may need urgent medical treatment.
• Sudden swelling of the face or throat which may cause difficulty in
swallowing or breathing, rapid swelling of the hands and feet and stomach
• Blood clots (thrombosis) (affects less than 1 in 1000 people) or stroke
(frequency not known)
• Yellowing of the skin or whites of the eyes (jaundice), or other liver
• Migraine-type headaches for the first time or more frequent (affects less
than 1 in 100 people)
• An increase in blood pressure (affects less than 1 in 10 people)
• Breast or ovarian cancer, endometrial cancer or hyperplasia (long, heavy
or irregular periods)

Widespread rash with peeling skin and blistering in the mouth, eyes and
genitals (Stevens-Johnson syndrome) (frequency not known)

Convulsions or fits (affects less than 1 in 1,000 people)

Tell your doctor if you notice any of the following side effects while
using Evorel Conti:
Very common (affects more than 1 in 10 people)
• Irritated, itchy, red skin and rash where the patch is applied
Common (affects less than 1 in 10 people)
• Allergic reaction (hypersensitvity)
• Being unable to sleep
• Feeling depressed, nervous or anxious
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Being aware of your heartbeat (palpitations)
Varicose veins
Flushing, skin reddening
Breast pain
Numb or tingling hands or feet
Feeling sick (nausea)
Stomach ache
Pain including pain in the back or joints
Painful periods
Discharge from the vagina
Irregular, heavy or prolonged bleeding from the vagina, including after sex
Water retention or build-up of fluid under the skin (oedema)
Feeling tired
Weight gain

Uncommon (affects less than 1 in 100 people)
• Vaginal infections such as thrush
• Less interest in sex than usual
• Wind
• Itchy skin
• Rash
• Swelling of the hands and feet (peripheral oedema)
• Muscle pain
Frequency not known
• Mood swings
• Feeling dizzy
• Bloated feeling
• Gallstones
• Fuller breasts
The following side effects have been reported with other combined
Very common (affects more than 1 in 10 people)
• Tender breasts
Common (affects less than 1 in 10 people)
• Mood changes
• Indigestion
• Acne
• Dry skin
• Pain in extremity (e.g. back pain, arms, legs, wrists, ankles)
• Severe contractions of the uterus
• Vaginal infection (white or yellowish discharge from the vagina)
Uncommon (affects less than 1 in100 people)
• Dizziness
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Being sick
Skin discolouration
Abnormal liver function tests

Rare (affects less than 1 in 1,000 people)
• Gallstones
• Muscle weakness
• Benign growths in the uterus smooth muscle
• Cysts close to the fallopian tube
Very Rare (affects less than 1 in 10,000 people)
• Yellowing of the skin, itching, dark coloured urine
Frequency not known
• Hair loss
The following side effects have been reported in association with
oestrogen/progestogen treatment

Gall bladder disease
Brown patches on your face or body (chloasma)
Rash with painful reddish skin nodules(eythema nodosum)
Rash with target shaped reddening or sores (erythema multiforme)
Rash with red or purple coloured spots (vascular purpura)
Loss of memory (Dementia) (see section 2)
Dry eyes
Change to composition of tears

Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any
possible side effects not listed in this leaflet. You can also report side effects directly
via the Yellow Card Scheme at: .
By reporting side effects you can help provide more information on the safety of this

6. How to store Evorel Conti
Keep this medicine out of the sight and reach of children. It should be stored at
room temperature (at or below 25°C). Keep in the original pouch and carton.
Do not use Evorel Conti after the expiry date which is stated on the label. The
expiry date refers to the last day of that month.
Do not use a patch if the protective pouch is open.

7. Contents of the pack and other information
The active substances in Evorel Conti are estradiol hemihydrate and
norethisterone acetate.
- 14 -

Each Evorel Conti patch contains 3.2 mg of estradiol hemihydrate and 11.2 mg
of norethisterone acetate. Each Evorel Conti patch delivers 50 micrograms of
estradiol and 170 micrograms of norethisterone acetate a day.
The other ingredients are Duro-Tak 387-2287 (this makes the patches sticky),
guar gum and Hostaphan MN19 (backing film).
What Evorel Conti looks like and contents of the pack
Evorel Conti comes in a memory pack containing eight or twenty-four patches
(marked CEN1).
The patches are square with rounded corners. They are clear with a sticky
backing that can be stuck to the skin. Each patch comes in a protective sealed
pouch and has a surface area of 16 sq cm.
The product licence is held by:
JANSSEN-CILAG LTD, 50-100 Holmers Farm Way, High Wycombe,
Buckinghamshire HP12 4EG, UK
Evorel Conti is made by:
Janssen Pharmaceutica NV, Turnhoutseweg 30, B-2340 Beerse, Belgium
McGregor Cory Ltd, Middleton Road, Banbury, Oxfordshire OX 16 4RS, UK

For information in large print, tape, CD or Braille, telephone
0800 7318450.
This leaflet was last revised in May 2016.

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.