Prescription Drug Information

Information on Premarin^Ž

Generic name: Conjugated estrogens
Other brand names: Cenestin, Premphase, Prempro

USES: Premarin is an estrogen replacement drug. The tablets are used to reduce symptoms of menopause, including feelings of warmth in face, neck, and chest, and the sudden intense episodes of heat and sweating known as "hot flashes." Cenestin tablets, containing a synthetic form of conjugated estrogens, may also be prescribed for these symptoms.

In addition to the symptoms of menopause, Premarin tablets are prescribed for teenagers who fail to mature at the usual rate, and to relieve the symptoms of certain types of cancer, including some forms of breast and prostate cancer.

In addition, either the tablets or Premarin vaginal cream can be used for other conditions caused by lack of estrogen, such as dry, itchy external genitals and vaginal irritation.

Along with diet, calcium supplements, and exercise, Premarin tablets are also prescribed to prevent osteoporosis, a condition in which the bones become brittle and easily broken.

HOW TO TAKE THIS MEDICATION:

PREMARIN TABLETS

Your doctor will start therapy with this medication at a low dose. He or she will want to check you periodically at 3- to 6-month intervals to determine the need for continued therapy.

Hot Flashes Associated with Menopause The usual dosage is 0.3 to 1.25 milligrams daily. If you are still having periods, the doctor will start the Premarin on the fifth day of your cycle, have you take it for 3 weeks, then give you 1 week off.

Tissue Degeneration in the Vagina The usual dosage is 0.3 to 1.25 milligrams or more daily. The drug is taken cyclically (3 weeks on and 1 week off).

Low Estrogen Levels Due to Reduced Ovary Function The usual dosage is 2.5 to 7.5 milligrams daily, taken in several small doses, for 20 days, followed by a 10-day rest period. If you do not have your period by the end of this time, the same dosage schedule is repeated.

If you start to bleed before the end of the 10-day period your doctor will start you on another 20-day cycle, with an oral progestin added during the last 5 days. If you start to bleed before the second cycle is over, stop taking the medication and tell your doctor.

Ovary Removal or Ovarian Failure The usual dosage is 1.25 milligrams daily, cyclically (3 weeks on and 1 week off). Your doctor will adjust the dosage according to the severity of your symptoms and your response to treatment.

Prevention of Osteoporosis (Loss of Bone Mass) The usual dosage is 0.625 milligram daily, taken cyclically (3 weeks on and 1 week off).

Advanced Androgen-Dependent Cancer of the Prostate, for Relief of Symptoms Only The usual dosage is 1.25 to 2.5 milligrams 3 times daily.

Breast Cancer (for Relief of Symptoms Only) in Appropriately Selected Women and Men with Metastatic Disease The suggested dosage is 10 milligrams 3 times daily for a period of at least 3 months. Tell your doctor if you have any unusual bleeding.

PREMARIN VAGINAL CREAM

Given cyclically for short-term use only.

Degeneration of Genital Tissue or Severe Itching in the Genital Area The recommended dosage is one-half to 2 grams daily, inserted into the vagina, depending on the severity of the condition. You will use the cream for 3 weeks, then stop for 1 week. Tell your doctor if you notice any unusual bleeding.

PREMPHASE TABLETS

Follow a 28-day cycle. Take 1 maroon Premarin tablet every day for the first 14 days; on the 15th day, begin taking 1 light-blue tablet daily.

PREMPRO TABLETS

The usual starting dose is one 0.625-milligram/2.5-milligram tablet once a day. If this dose proves insufficient, your doctor may increase the dose to one 0.625-milligram/5-milligram tablet once a day.

CENESTIN TABLETS

The usual starting dose is 0.625 milligrams a day. If this proves insufficient, the doctor may gradually increase the dose up to a maximum of 1.25 milligrams daily.

SIDE EFFECTS: Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor immediately. Only your doctor can determine whether it is safe to continue taking Premarin.

Side effects of conjugated estrogens may include: Abdominal cramps, abnormal vaginal bleeding, bloating, blood clots, breast swelling and tenderness, depression, dizziness, enlargement of benign tumors in the uterus, fluid retention, gallbladder disease, hair loss from the scalp, increased body hair, inflammation of the pancreas, intolerance to contact lenses, migraine headache, nausea, sex-drive changes, skin darkening, especially on the face, skin rash or redness, swelling of wrists and ankles, vaginal yeast infection, vomiting, weight gain or loss, yellow eyes and skin

Other possible side effects of Premphase and Prempro may include: Appetite changes, backache, changes in blood pressure, excessive flow of breast milk, eye disorders, fatigue, fever, headache, nervousness, sleep disturbances, twitching

Other possible side effects of Cenestin may include: Constipation, cough, diarrhea, gas, heavy bleeding during menstruation, increased heartbeat, increased muscle tone, indigestion, infection, joint pain, leg cramps, muscle pain, pain, painful menstruation, runny nose, skin tingling, sore throat, weakness

PRECAUTIONS: Because estrogens have been linked with increased risk of endometrial cancer (cancer in the lining of the uterus), it is essential to have regular checkups and to report any unusual vaginal bleeding to your doctor immediately.

DRUG INTERACTIONS: If Premarin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Premarin with the following:

NOTES: If you are pregnant or plan to become pregnant, notify your doctor immediately. Premarin and conjugated estrogens in general, should not be taken during pregnancy because of the possibility of harm to the unborn child. Premarin cannot prevent a miscarriage. Estrogens can decrease the quantity and quality of breast milk, and progestins appear in breast milk. Your doctor may advise you not to breastfeed while you are taking this drug.

Any medication taken in excess can have serious consequences. If you suspect an overdose of Premarin, seek medical attention immediately. Symptoms of conjugated estrogen overdose may include: Nausea, vomiting, withdrawal bleeding

The risk of cancer of the uterus increases when estrogen is used for a long time or taken in large doses.

There may be an increased risk of breast cancer in women who take estrogen for a long time. If you have a family history of breast cancer or have ever had an abnormal mammogram, you need to have more frequent breast examinations.

Women who take Premarin after menopause are more likely to develop gallbladder disease.

Premarin also increases the risk of blood clots. These blood clots can cause stroke, heart attack, or other serious disorders.

While taking Premarin, get in touch with your doctor right away if you notice any of the following:

If you have high levels of fat in your blood, specifically a high triglyceride level, conjugated estrogens are likely to cause side effects in the pancreas.

MISSED DOSE: Take the forgotten dose as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Never try to "catch up" by doubling the dose.

STORAGE: : Store at room temperature and keep away from moisture and sunlight. Keep this and all medications out of the reach of children.

SUPPLIER RECOMMENDATION:


Information on Premarin^Ž Generic name: Conjugated estrogens Other brand names: Cenestin, Premphase, Prempro USES: Premarin is an estrogen replacement drug. The tablets are used to reduce symptoms of menopause, including feelings of warmth in face, neck, and chest, and the sudden intense episodes of heat and sweating known as "hot flashes." Cenestin tablets, containing a synthetic form of conjugated estrogens, may also be prescribed for these symptoms. In addition to the symptoms of menopause, Premarin tablets are prescribed for teenagers who fail to mature at the usual rate, and to relieve the symptoms of certain types of cancer, including some forms of breast and prostate cancer. In addition, either the tablets or Premarin vaginal cream can be used for other conditions caused by lack of estrogen, such as dry, itchy external genitals and vaginal irritation. Along with diet, calcium supplements, and exercise, Premarin tablets are also prescribed to prevent osteoporosis, a condition in which the bones become brittle and easily broken. HOW TO TAKE THIS MEDICATION: PREMARIN TABLETS Your doctor will start therapy with this medication at a low dose. He or she will want to check you periodically at 3- to 6-month intervals to determine the need for continued therapy. Hot Flashes Associated with Menopause The usual dosage is 0.3 to 1.25 milligrams daily. If you are still having periods, the doctor will start the Premarin on the fifth day of your cycle, have you take it for 3 weeks, then give you 1 week off. Tissue Degeneration in the Vagina The usual dosage is 0.3 to 1.25 milligrams or more daily. The drug is taken cyclically (3 weeks on and 1 week off). Low Estrogen Levels Due to Reduced Ovary Function The usual dosage is 2.5 to 7.5 milligrams daily, taken in several small doses, for 20 days, followed by a 10-day rest period. If you do not have your period by the end of this time, the same dosage schedule is repeated. If you start to bleed before the end of the 10-day period your doctor will start you on another 20-day cycle, with an oral progestin added during the last 5 days. If you start to bleed before the second cycle is over, stop taking the medication and tell your doctor. Ovary Removal or Ovarian Failure The usual dosage is 1.25 milligrams daily, cyclically (3 weeks on and 1 week off). Your doctor will adjust the dosage according to the severity of your symptoms and your response to treatment. Prevention of Osteoporosis (Loss of Bone Mass) The usual dosage is 0.625 milligram daily, taken cyclically (3 weeks on and 1 week off). Advanced Androgen-Dependent Cancer of the Prostate, for Relief of Symptoms Only The usual dosage is 1.25 to 2.5 milligrams 3 times daily. Breast Cancer (for Relief of Symptoms Only) in Appropriately Selected Women and Men with Metastatic Disease The suggested dosage is 10 milligrams 3 times daily for a period of at least 3 months. Tell your doctor if you have any unusual bleeding. PREMARIN VAGINAL CREAM Given cyclically for short-term use only. Degeneration of Genital Tissue or Severe Itching in the Genital Area The recommended dosage is one-half to 2 grams daily, inserted into the vagina, depending on the severity of the condition. You will use the cream for 3 weeks, then stop for 1 week. Tell your doctor if you notice any unusual bleeding. PREMPHASE TABLETS Follow a 28-day cycle. Take 1 maroon Premarin tablet every day for the first 14 days; on the 15th day, begin taking 1 light-blue tablet daily. PREMPRO TABLETS The usual starting dose is one 0.625-milligram/2.5-milligram tablet once a day. If this dose proves insufficient, your doctor may increase the dose to one 0.625-milligram/5-milligram tablet once a day. CENESTIN TABLETS The usual starting dose is 0.625 milligrams a day. If this proves insufficient, the doctor may gradually increase the dose up to a maximum of 1.25 milligrams daily. SIDE EFFECTS: Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor immediately. Only your doctor can determine whether it is safe to continue taking Premarin. Side effects of conjugated estrogens may include: Abdominal cramps, abnormal vaginal bleeding, bloating, blood clots, breast swelling and tenderness, depression, dizziness, enlargement of benign tumors in the uterus, fluid retention, gallbladder disease, hair loss from the scalp, increased body hair, inflammation of the pancreas, intolerance to contact lenses, migraine headache, nausea, sex-drive changes, skin darkening, especially on the face, skin rash or redness, swelling of wrists and ankles, vaginal yeast infection, vomiting, weight gain or loss, yellow eyes and skin Other possible side effects of Premphase and Prempro may include: Appetite changes, backache, changes in blood pressure, excessive flow of breast milk, eye disorders, fatigue, fever, headache, nervousness, sleep disturbances, twitching Other possible side effects of Cenestin may include: Constipation, cough, diarrhea, gas, heavy bleeding during menstruation, increased heartbeat, increased muscle tone, indigestion, infection, joint pain, leg cramps, muscle pain, pain, painful menstruation, runny nose, skin tingling, sore throat, weakness PRECAUTIONS: Because estrogens have been linked with increased risk of endometrial cancer (cancer in the lining of the uterus), it is essential to have regular checkups and to report any unusual vaginal bleeding to your doctor immediately. DRUG INTERACTIONS: If Premarin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Premarin with the following: Barbiturates such as phenobarbital Blood thinners such as Coumadin Drugs used for epilepsy, such as Dilantin Major tranquilizers such as Thorazine Oral diabetes drugs such as Micronase Rifampin (Rifadin) Steroid medications such as Deltasone Thyroid preparations such as Synthroid Tricyclic antidepressants such as Elavil and Tofranil Vitamin C NOTES: If you are pregnant or plan to become pregnant, notify your doctor immediately. Premarin and conjugated estrogens in general, should not be taken during pregnancy because of the possibility of harm to the unborn child. Premarin cannot prevent a miscarriage. Estrogens can decrease the quantity and quality of breast milk, and progestins appear in breast milk. Your doctor may advise you not to breastfeed while you are taking this drug. Any medication taken in excess can have serious consequences. If you suspect an overdose of Premarin, seek medical attention immediately. Symptoms of conjugated estrogen overdose may include: Nausea, vomiting, withdrawal bleeding The risk of cancer of the uterus increases when estrogen is used for a long time or taken in large doses. There may be an increased risk of breast cancer in women who take estrogen for a long time. If you have a family history of breast cancer or have ever had an abnormal mammogram, you need to have more frequent breast examinations. Women who take Premarin after menopause are more likely to develop gallbladder disease. Premarin also increases the risk of blood clots. These blood clots can cause stroke, heart attack, or other serious disorders. While taking Premarin, get in touch with your doctor right away if you notice any of the following: Abdominal pain, tenderness, or swelling Abnormal bleeding from the vagina Breast lumps Coughing up blood Pain in your chest or calves Severe headache, dizziness, or faintness Sudden shortness of breath Vision changes Yellowing of the skin If you have high levels of fat in your blood, specifically a high triglyceride level, conjugated estrogens are likely to cause side effects in the pancreas. MISSED DOSE: Take the forgotten dose as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Never try to "catch up" by doubling the dose. STORAGE: : Store at room temperature and keep away from moisture and sunlight. Keep this and all medications out of the reach of children. SUPPLIER RECOMMENDATION: