Premarin

Overview

About Premarin

Except in certain special circumstances, you should not be given Premarin if you have ever had breast cancer, uterine cancer, or any other "estrogen-dependent" cancer.

Do not take Premarin if you have had any circulation problem involving blood clots, or have had a stroke or heart attack in the past year.

Do not take Premarin if you have liver disease or your liver is not working properly.

Do not use Premarin if you are pregnant or trying to become pregnant.

Special warnings about Premarin

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For women who have not had a hysterectomy, the risk of endometrial and uterine cancer increases when estrogen-only drugs are used for a long time or taken in large doses. Estrogen therapy can also worsen endometriosis (uterine tissue growing outside the uterus). If you've ever had endometriosis, make sure the doctor is aware of it. If you've had a hysterectomy but still have residual endometriosis, your doctor may want you to use an estrogen/progesterone combination.

Certain studies have shown that women taking estrogen for prolonged periods of time (4 years or more) face an increased risk of breast cancer, and a study by the National Heart, Lung and Blood Institute (NHLBI) has confirmed an increased risk among women taking estrogen/progesterone combinations. Use combination products (and estrogen-only preparations, too) with special caution if you have a family history of breast cancer or have ever had an abnormal mammogram. Be sure to get an annual breast exam from your doctor, and do your own self-examination each month.

The NHLBI study also found an increased risk of dementia for women taking estrogen/progesterone combinations. It's unknown whether this applies to estrogen-only drugs.

Because Premarin can increase the risk of heart attack, stroke, blood clots, and certain estrogen-dependent cancers, contact 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

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

Estrogens such as Premarin can cause hypercalcemia, a severe increase of calcium levels in the blood. Women with breast or bone cancer are especially at risk and should stop taking Premarin immediately if they develop hypercalcemia. In addition, women with the opposite problem—hypocalcemia, or a severe decrease of calcium in the blood—should use Premarin with caution.

Women who have not had a hysterectomy and take estrogen along with progesterone have a lower risk of precancerous endometrial changes. However, you should be aware that estrogen/progesterone combinations could increase "bad" LDL cholesterol and blood sugar levels as well as increase the risk of breast cancer.

There is a slight chance that estrogen therapy could cause an increase in blood pressure. Ask your doctor to check your blood pressure regularly.

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

Use Premarin with caution if you have a history of liver problems, including jaundice. Call your doctor right away if you develop abdominal pain or yellowing of the skin.

Premarin can alter thyroid function. If you're taking thyroid medication, you may need your dosage adjusted.

Premarin can also cause fluid retention. Use the drug with caution if you have heart or kidney problems, or any other condition that's affected by excess fluid in the body.

Some studies have shown that using estrogen-only drugs, especially for 10 years or more, could increase the risk of ovarian cancer. It's unknown whether this also applies to estrogen/progesterone combinations. Another study showed that certain estrogen/progesterone combinations increased the risk of dementia (e.g., Alzheimer's disease).

Estrogens such as Premarin have been known to make certain conditions worse, including asthma, diabetes, epilepsy, migraine, porphyria (a genetic enzyme deficiency), lupus, and liver tumors.

If you are using Premarin vaginal cream, you should be aware that this product can weaken latex condoms, diaphragms, and cervical caps.

Possible food and drug interactions when taking Premarin

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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
Carbamazepine
Clarithromycin
Drugs used for epilepsy
Erythromycin
Grapefruit juice
Itraconazole
Ketoconazole
Major tranquilizers
Oral diabetes drugs
Rifampin
Ritonavir
St. John's wort
Steroid medications
Thyroid preparations
Tricyclic antidepressants
Vitamin C

Special information if you are pregnant or breastfeeding

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If you are pregnant or plan to become pregnant, notify your doctor immediately. Premarin and conjugated estrogens 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.

Recommended dosage for Premarin

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

PREMARIN TABLETS

Hot flashes associated with menopause

The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles such as 25 days on Premarin and 5 days off.

Tissue degeneration in the vagina

The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles.

Low estrogen levels due to reduced ovary function

The usual dosage is 0.3 to 0.625 milligrams daily, taken cyclically.

Ovary removal or ovarian failure

The usual dosage is 1.25 milligrams daily, taken cyclically.

Prevention of osteoporosis (loss of bone mass)

The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles.

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.

PREMPRO TABLETS/PREMPHASE THERAPY

Symptoms associated with menopause (hot flashes, night sweats, and vaginal tissue degeneration) or for the prevention of osteoporosis (loss of bone mass)

The usual starting dose for Prempro is one 0.3-milligram/1.5-milligram tablet once a day. If this dose proves insufficient, your doctor may increase the dose to one 0.625-milligram/0.25- or 0.5-milligram tablet once a day.

For Premphase therapy, follow a 28-day cycle. Take 1 maroon Premarin tablet (equal to 0.625 milligrams estrogen) every day for the first 14 days; on the 15th day, begin taking 1 light-blue tablet (equal to 0.625 milligrams estrogen/5 milligrams progesterone) daily.

CENESTIN TABLETS

The usual starting dose is 0.45 milligrams a day. If this proves insufficient, the doctor may gradually increase the dose up to a maximum of 1.25 milligrams daily.