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Brand Name
Premarin
Common Name
conjugated estrogens
How does this medication work? What will it do for me?

Conjugated estrogens belong to the class of medications known as estrogen replacement therapy. Estrogen is a female hormone that is produced by the ovaries. Once menopause is reached, the ovaries produce less estrogen and symptoms of menopause can occur. Conjugated estrogen is an estrogen replacement hormone used to manage menopausal symptoms such as abnormal uterine bleeding (spotting), hot flashes, sweating, and chills. This medication may also help treat and prevent osteoporosis caused by estrogen deficiency when combined with diet, calcium, and exercise.

For women who are not having menopause symptoms, this medication should only be used if the woman is at serious risk of osteoporosis and cannot take other medications normally given to prevent osteoporosis. It may also be used to treat a condition where the tissues of the vagina become weak (vaginal atrophy or atrophic vaginitis), but if a woman is not having any other symptoms of menopause, an estrogen product applied to the skin (such as a cream) may be an more appropriate choice. It is also used to replace estrogen hormones in situations where the body can no longer produce estrogen, and to treat men with inoperable progressing prostate cancer when other treatments have not worked.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

The recommended adult dose of conjugated estrogens ranges from 0.3 mg to 1.25 mg daily, depending on the condition being treated. It is recommended that this medication be taken at the lowest dose possible and for the shortest duration required to treat the condition. It is important to have regular checkups with your doctor to decide if this medication is still necessary. Tablets can either be taken every day or in a cycle, such as 25 days on the medication each month and 5 days off.

Women who have not had their uterus removed should also take a progestogen (a different type of female hormone that protects the uterus from potential harmful effects caused by estrogen) for 10 to 14 days each month, or every day depending on the hormone strength and whether a menstrual period is desired or not. Talk with your doctor or pharmacist about the advantages and disadvantages of the different dosing schedules of estrogen and progestogen.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

What form(s) does this medication come in?

0.3 mg
Each green, oval, sugar-coated tablet, imprinted with "Premarin", contains 0.3 mg of conjugated estrogens. Nonmedicinal ingredients: calcium phosphate tribasic, calcium sulfate anhydrous, carnauba wax, D&C Yellow No. 10, edible ink, FD&C Blue No. 1, FD&C Yellow No. 6, glyceryl monooleate, lactose, magnesium stearate, methylcellulose, methylparaben, microcrystalline cellulose, polyethylene glycol, polysorbate 60, polyvinylpyrrolidone, propylparaben, shellac, sodium benzoate, sucrose, sucrose syrup, and titanium dioxide. This medication does not contain alcohol, gluten, sulfites, or tartrazine.

0.625 mg
Each maroon, oval, sugar-coated tablet, imprinted with "Premarin", contains 0.625 mg of conjugated estrogens. Nonmedicinal ingredients: calcium phosphate tribasic, calcium sulfate anhydrous, carnauba wax, edible ink, FD&C Blue No. 2, FD&C Red No. 3, FD&C Yellow No. 6, glyceryl monooleate, gum acacia, lactose, magnesium stearate, methylcellulose, microcrystalline cellulose, polyethylene glycol, polysorbate 60, propylparaben, shellac, sodium benzoate, sucrose, sucrose syrup, and titanium dioxide. This medication does not contain alcohol, gluten, sulfites, or tartrazine.

1.25 mg
Each yellow, oval, sugar-coated tablet, imprinted with "Premarin", contains 1.25 mg of conjugated estrogens. Nonmedicinal ingredients: calcium phosphate tribasic, calcium sulfate anhydrous, carnauba wax, D&C Yellow No. 10, edible ink, FD&C Yellow No. 6, glyceryl monooleate, lactose, magnesium stearate, methylcellulose, microcrystalline cellulose, polyethylene glycol, polysorbate 60, propylparaben, shellac, sucrose, and titanium dioxide. This medication does not contain alcohol, gluten, sulfites, or tartrazine.

Who should NOT take this medication?

Conjugated estrogens should not be taken by anyone who:

  • is allergic to conjugated estrogens or to any of the ingredients of the medication
  • is or may be pregnant
  • has a history of known or suspected estrogen-dependent tumours such as breast or uterine cancer
  • has active liver disease or dysfunction
  • has active thrombophlebitis, thrombosis, or thromboembolic disorders (blood clotting problems)
  • has endometrial hyperplasia (increase in the thickness of the lining of the uterus)
  • has had partial or complete loss of vision due to blood vessel-related eye disease
  • has undiagnosed abnormal vaginal bleeding
What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • bloating of stomach
  • change in sexual desire
  • cramps of lower stomach
  • darkening of the skin
  • diarrhea (mild)
  • dizziness (mild)
  • headaches (mild)
  • loss of appetite
  • migraine headaches
  • nausea
  • problems with wearing contact lenses
  • vomiting (usually with high doses)

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • breast changes (lumps, swelling, discharge)
  • changes in vaginal bleeding (spotting, breakthrough bleeding, prolonged or heavier bleeding, or complete stoppage of bleeding)
  • decline of memory or mental ability
  • first migraine headache
  • persistent sad mood
  • rapid weight gain
  • signs of liver problems (yellowing of the skin or eye whites)
  • swelling of feet of lower legs

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • sudden partial or complete loss of vision
  • symptoms of a blood clot in the leg (e.g., sharp pain in the foot or unexplained leg swelling, pain, redness, or tenderness)
  • symptoms of a blood clot in the lung (e.g., sharp pain in the chest, coughing blood, or sudden shortness of breath)
  • symptoms of a heart attack (e.g., sudden pain or discomfort in the chest, neck, jaw, shoulder, arms, or back; shortness of breath; nausea or vomiting; cool, clammy skin; anxiety or denial)
  • symptoms of a stroke (e.g., sudden weakness or numbness in the face, arm, or leg - even if the weakness is temporary; sudden trouble speaking; sudden confusion; sudden vision changes; sudden severe and unusual headache; or sudden dizziness or loss of balance)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Note the following important information about estrogen:

  • Estrogens with or without progesterins should be used for the shortest time period possible at the lowest dose that relieves your menopausal symptoms.
  • Estrogens with or without progestins should not be used to prevent heart disease, heart attacks, or strokes.

Blood pressure: There have been reports of increased blood pressure in a small number of people taking this medication. Regular checkups by your doctor are recommended.

Breast cancer: Some studies have found an association between a modest increase in the risk of developing breast cancer and the use of hormone replacement therapy after menopause. Women who have history of breast cancer should not use estrogens. If you have a family history of breast cancer, breast nodules, fibrocystic disease of the breast, or abnormal mammograms, you should be closely monitored by your doctor if you use estrogens.

Women using estrogens should have regular breast examinations and should be taught how to do a breast self-examination. Your doctor may also recommend regular mammograms depending on your age, risk factors, and previous mammogram results. Discuss the benefits and risks with your doctor so that you can make an informed choice about using this medication.

Cholesterol: Oral estrogens can increase triglyceride levels in the blood. Your doctor may check your cholesterol levels if you are taking estrogen.

Diabetes: People who have diabetes (or a predisposition to diabetes) should monitor their blood glucose levels closely to detect changes in blood glucose control that sometimes occur with the use of estrogens.

Endometrial cancer: There is evidence from several studies that estrogen replacement therapy increases the risk of cancer of the endometrium (uterus). To lower the risk to the same level as those of women not taking estrogen, all women who have not had their uteruses removed should also take a progestogen if they are using estrogens.

Fibroids: This medication may worsen fibroids, causing sudden enlargement, pain, or tenderness. If you notice these effects, contact your doctor.

Fluid retention: Estrogen may cause fluid retention. Women with heart or kidney problems, epilepsy, or asthma should be monitored carefully by their doctor while taking this medication.

Gallbladder: An increased risk of gallbladder disease has been reported in postmenopausal women taking oral estrogens.

Heart disease and stroke: Studies indicate an increased risk of heart disease and stroke with estrogen (with or without progestins) for postmenopausal women. If you experience symptoms of a heart attack (chest pain, tightness or pressure, sweating, nausea, feeling of impending doom) or stroke (sudden dizziness, headache, loss of speech, changes in vision, weakness or numbness in the arms and legs) while taking this medication, get immediate medical attention.

Kidney disease: People with kidney disease should be monitored by their doctor while using estrogen.

Lab tests: Estrogen can affect certain laboratory tests and cause inaccurate readings.

Liver disease: If you have or have had liver problems, you may require special monitoring by your doctor while you use this medication. Make sure to tell your doctor if you have ever had liver problems.

Other medical conditions: People with hypocalcemia (low calcium in the blood), lupus, migraines, phlebitis, porphyria, or thyroid disease should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Ovarian cancer: Some studies have demonstrated an increased risk of ovarian cancer associated with the use of hormone replacement therapy (estrogen alone or estrogen with a progestogen), especially when used for 5 years or more.

Regular physical examinations: While on this medication, be sure to have regular examinations, particularly breast exams and mammograms, as recommended by your physician.

Pregnancy: Estrogen should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk and is not recommended for breast-feeding women.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between conjugated estrogens and any of the following:

  • anastrozole
  • ascorbic acid (vitamin C)
  • barbiturates (e.g., phenobarbital)
  • blood pressure-lowering agents (e.g., propranolol, enalapril, diltiazem)
  • carbamazepine
  • corticosteroids (e.g., hydrocortisone, prednisolone, prednisone)
  • cyclosporine
  • medications for diabetes (e.g., insulin, glyburide)
  • meprobamate
  • nevirapine
  • peginterferon alfa-2b
  • phenylbutazone
  • phenytoin
  • primidone
  • protease inhibitors (e.g., ritonavir, tipranavir)
  • rifampin
  • ropinirole
  • somatropin
  • St. John's wort
  • thyroid medications (e.g., levothyroxine, liothyronine)
  • topiramate
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.





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