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All about: Premarin

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Generic Name: conjugated estrogens (KON joo gay ted ES troe jenz)
Brand Names: Cenestin, Premarin

What are conjugated estrogens?

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

Conjugated estrogens are a mixture of estrogen hormones used to treat symptoms of menopause such as hot flashes, and vaginal dryness, burning, and irritation. Other uses include prevention of osteoporosis in postmenopausal women, and replacement of estrogen in women with ovarian failure or other conditions that cause a lack of natural estrogen in the body. Conjugated estrogens are sometimes used as part of cancer treatment in women and men.

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

Conjugated estrogens may also be used for purposes other than those listed in this medication guide.

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

Do 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. This medication can cause birth defects in an unborn baby. Do not use conjugated estrogens if you are pregnant.

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 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 conjugated estrogens.

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 taking conjugated estrogens?

Do not use conjugated estrogens 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.

Before using conjugated estrogens, tell your doctor if you are allergic to any drugs, or if you have:

  • 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);

  • gallbladder disease; or

  • if you have had your uterus removed (hysterectomy).

If you have any of these conditions, you may not be able to use conjugated estrogens, or you may need a dosage adjustment or special tests during treatment.

Conjugated estrogens increase your risk of developing endometrial hyperplasia, a condition that may lead to cancer of the uterus. Taking progestins while using 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 conjugated estrogens.

Long-term conjugated estrogens treatment may increase your risk of stroke or blood clots. Talk with your doctor about your individual risks before using 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.

FDA pregnancy category X. This medication can cause birth defects. Do not use conjugated estrogens if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication. 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 give this medication to anyone under 18 years old without the advice of a doctor.

How should I take conjugated estrogens?

Take this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor.

Conjugated estrogens are sometimes taken on a daily basis. For certain conditions, the medication is given in a cycle, such as 3 weeks on followed by 1 week off. Follow the directions on your prescription label.

Take this medication with a full glass of water.

You may take conjugated estrogens with or without food. Try to take the medicine at the same time each day.

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

It is important to take conjugated estrogens regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your thyroid function may also need to be tested. Do not miss any scheduled visits to your doctor.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking conjugated estrogens. You may need to stop using the medicine for a short time.

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

Store conjugated estrogens at room temperature away from moisture and heat. Keep the medicine container tightly closed.

What happens if I miss a dose?

Take the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of a conjugated estrogens overdose may include nausea, vomiting, or vaginal bleeding.

What should I avoid while taking conjugated estrogens?

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

Conjugated estrogens side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking this medication and call your doctor at once if you have any of these serious side effects:
  • 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 headache, confusion, problems with vision, speech, or balance;

  • pain or swelling in your lower leg;

  • 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.

Continue taking conjugated estrogens and talk to your doctor if you have any of these less serious side effects:

  • 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.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect conjugated estrogens?

Before taking conjugated estrogens, tell your doctor if you are taking any of the following medicines:

  • a blood thinner such as warfarin (Coumadin);

  • a thyroid medication such as levothyroxine (Synthroid);

  • insulin or diabetes medicine taken by mouth;

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

  • ketoconazole (Nizoral) or itraconazole (Sporanox);

  • seizure medicines such as phenytoin (Dilantin), carbamazepine (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 (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil).

If you are using any of these drugs, you may not be able to use conjugated estrogens, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect 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 has information about conjugated estrogens written for health professionals that you may read.

What does my medication look like?

Conjugated estrogens are available with a prescription under the brand names Premarin and Cenestin. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

  • Premarin 0.3 mg--oval, green tablets

  • Premarin 0.625 mg--oval, maroon tablets

  • Premarin 0.9 mg--oval, white tablets

  • Premarin 1.25 mg--oval, yellow tablets

  • Premarin 2.5 mg--oval, purple tablets

  • Cenestin 0.625 mg-round, red, film-coated tablets

  • Cenestin 0.9 mg-round, white, film-coated tablets

  • 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.
  • 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 1996-2006 Cerner Multum, Inc. Version: 5.05. Revision Date: 9/27/06 11:16:18 AM.

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