Conjugated Estrogens T300 26-27

Conjugated Estrogens

Premarin

Conjugated Estrogens Drug Class

Estrogen Hormone

Conjugated Estrogens Dosage Forms

Oral Tablet: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg

Conjugated Estrogens Dosing By Indication

1. Abnormal vasomotor function (menopause), genitourinary syndrome of menopause, postmenopausal osteoporosis prophylaxis, female hypogonadism syndrome: 0.3 mg po daily, continuously or cyclically; adjust dose to individual response

2. Primary ovarian failure: 1.25 mg po daily cyclically (3 wk on, 1 wk off); adjust dose to individual response

3. Acute treatment of abnormal uterine bleeding, hemodynamically stable: 2.5 mg po q6 h, on symptom improvement decrease to 2.5 mg po bid for 21-25 d, then administer progestin-based treatment for 10 d

Conjugated Estrogens Off Label Uses

None

Conjugated Estrogens MOA

Estrogens are largely responsible for the development and maintenance of the female reproductive system and secondary sexual characteristics. The primary source of estrogen in normally cycling adult women is the ovarian follicle. After menopause, most endogenous estrogen is produced by conversion of androstenedione to estrone by peripheral tissues. Estrogens act through binding to nuclear receptors in estrogen-responsive tissues. Circulating estrogens modulate the pituitary secretion of the gonadotropins, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), through a negative-feedback mechanism. Estrogens act to reduce the elevated levels of these gonadotropins seen in postmenopausal women.

Conjugated Estrogens Common Adverse Effects

Abdominal pain, breast pain, disorder of menstruation, headache, migraine, weight change

Conjugated Estrogens Efficacy Monitoring Parameters

Resolution of clinical signs of abnormal bleeding or hot flashes or other symptoms, prevention of osteoporosis.

Conjugated Estrogens Safety Monitoring Parameters

Monitor BMD; conduct diagnostic evaluation to rule out malignancy in the event of persistent or recurring vaginal bleeding or new palpable breast mass.

Conjugated Estrogens Key Counseling Points

Discuss potential long-term adverse effects of hormone therapy including MI, stroke, DVT, PE, and breast cancer. Take at bedtime to minimize side effects. Take with or without meals.

Conjugated Estrogens Clinical Pearls

Injectable and vaginal cream is also available for other indications requiring estrogen replacement therapy. Combination of estrogens and progestins should not be used for the prevention of cardiovascular disease. Increased risk (over placebo) of MI, stroke, invasive breast cancer, pulmonary emboli, and DVT has been shown in postmenopausal women. Because of these risks, estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman. In postmenopausal women with a uterus, a progestin (eg, medroxyprogesterone) should be added to estrogen to reduce the risk of endometrial cancer. Increased incidence of dementia was observed in women ≥65 y of age taking estrogens. Also available in combination with bazedoxifene (Duavee) for osteoporosis prevention and vasomotor symptoms.