Select a medication above to begin.
Premarin
estrogens, conjugated
Black Box Warnings .
Estrogen Alone Tx Risk
Endometrial Cancer: unopposed estrogen use incr. endometrial CA risk in pts w/ intact uterus; adding progestin may decr. risk of endometrial hyperplasia, a possible precursor to endometrial CA; use adequate diagnostic measures such as endometrial sampling to rule out malignancy if undiagnosed persistent or recurrent abnormal genital bleeding; Cardiovascular and Probable Dementia: do not use estrogen-alone tx for cardiovascular dz or dementia prevention; incr. risk of stroke and DVT in postmenopausal women 50-79 yo (WHI estrogen-alone substudy regimen = conjugated estrogens 0.625 mg/day x7y); incr. risk of probable dementia in postmenopausal women 65 yo and older (WHIMS estrogen-alone substudy regimen = conjugated estrogens 0.625 mg/day x5y); risk unknown in younger postmenopausal women; other doses and routes of conjugated estrogens or other estrogen-alone products not studied, therefore adverse cardiovascular events and dementia relevance is unknown; weigh risk/benefit; use lowest effective estrogen dose, shortest duration based on individual tx goals and risks
Estrogen Plus Progestin Tx Risk
Cardiovascular and Probable Dementia: do not use estrogen + progestin tx for cardiovascular dz or dementia prevention; incr. risk of MI, stroke, and PE/DVT in postmenopausal women 50-79 yo (WHI estrogen/progestin substudy regimen = conjugated estrogens 0.625 mg/day w/ medroxyprogesterone 2.5 mg/day x6y); incr. risk of probable dementia in postmenopausal women 65 yo and older (WHIMS estrogen/progestin substudy regimen = conjugated estrogens 0.625 mg/day w/ medroxyprogesterone 2.5 mg/day x4y); risk unknown in younger postmenopausal women; Breast CA: estrogen + progestin tx may incr. risk of invasive breast CA in postmenopausal women (WHI estrogen/progestin substudy regimen = conjugated estrogens 0.625 mg/day w/ medroxyprogesterone 2.5 mg/day x6y); doses and routes of other estrogen progestin combos not studied, therefore adverse cardiovascular events, dementia, and breast CA relevance is unknown; weigh risk/benefit; use lowest effective estrogen dose, shortest duration based on individual tx goals and risks
Adult Dosing .
Dosage forms: TAB: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg; INJ: various
vasomotor sx, mod-severe menopausal
- [0.3-1.25 mg PO qd]
- Start: 0.3 mg PO qd; Alt: cycle 25 days on, 5 days off; Info: add progestin x10-14 days/cycle if intact uterus; use lowest effective estrogen dose, shortest effective tx duration
vulvovaginal atrophy, menopausal
- [0.3-1.25 mg PO qd]
- Start: 0.3 mg PO qd; Alt: cycle 25 days on, 5 days off; Info: add progestin x10-14 days/cycle if intact uterus; use lowest effective estrogen dose, shortest effective tx duration; not preferred if local sx only
osteoporosis prevention, postmenopausal
- [0.3-0.625 mg PO qd]
- Start: 0.3 mg PO qd; Alt: cycle 25 days on, 5 days off; Info: add progestin x10-14 days/cycle if intact uterus; weigh estrogen tx risk/benefit
hypoestrogenism
- [assoc. w/ hypogonadism]
- Dose: 0.3-1.25 mg PO qd; Info: cycle 21 days on, 7 days off; titrate to lowest effective maint. dose; add progestin x10-14 days/cycle if intact uterus; reassess tx need q3-6mo
- [assoc. w/ oopherectomy or primary ovarian failure]
- Dose: 1.25 mg PO qd; Info: cycle 21 days on, 7 days off; add progestin x10-14 days/cycle if intact uterus; reassess tx need q3-6mo
metastatic breast CA, palliative tx
- [10 mg PO tid for at least 3mo]
advanced prostate CA, palliative tx
- [1.25-2.5 mg PO tid]
dysfunctional uterine bleeding
- [25 mg IM/IV x1]
- Info: may repeat dose in 6-12h; IV route preferred over IM route
uremic bleeding (off-label)
- [0.6 mg/kg/dose IV qd x5 days]
renal dosing
- [see below]
- renal dz: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: contraindicated
Peds Dosing .
- Dosage forms: TAB: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg
delayed puberty, female
- [assoc. w/ hypogonadism]
- Dose: 0.625 mg PO qd; Start: 0.3 mg PO qod x6mo, then incr. to 0.3 mg PO qd x6mo; Info: give 21 days on, 7 days off; add progestin on last 10-12 days of cycle after breakthrough bleeding occurs or 2y of estrogen tx
- [assoc. w/ constitutional causes (off-label)]
- Dose: 0.3-1.25 mg PO qd x3-6mo
abnormal uterine bleeding (off-label)
- [1.25 mg PO bid x21 days]
- Info: may incr. to 2.5 mg bid, then 2.5 mg qid
renal dosing
- [see below]
- renal dz: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: contraindicated