Reproductive Health drug

Conjugated Estrogens

Premarin

Indication of Premarin

Abnormal uterine bleeding; breast cancer; postmenopausal osteoporosis prevention; prostate cancer; secondary amenorrhea due to hypoestrogenism, vasomotor symptoms associated with menopause with or without vuvlar/vaginal atrophy associated with menopause

Mechanism of action of Premarin

The mixture of estrogens in this product replaces the estrogens produced by the body responsible for the development and maintenence  of the fame reproductive system and secondary sex characteristics. Responsible for modulation of gonadotropins through negative feedback.

Contraindications of Premarin

Angioedema or anaphylactic reaction, undiagnosed abnormal genital bleeding. active or history of arterial thromboembolic disease; breast cancer; estrogen dependent tumor; hepatic impairment or disease; known protein C, S, antithrombin deficiency or other know thrombophilia disorders; pregnancy.

Black box warning Premarin

Endometrial cancer, breast cancer, cardiovascular disease, dementia, risk v. benefits.

Common side effect of Premarin

Weight change, headache, migraine, depression, disorder of menstruation, breast pain, edema, vasodilation, abdominal pain, hirsutism, stomach cramps, backache, NVD.

Serious side effects of Premarin

heart disease, HTN, MI, breast cancer, diabetes mellitus, hypercalcemia, venous thromboembolism, anaphylaxis, cerebrovascular accident, cervical cancer, malignant neoplasm of endometrium of corpus uteri, ovarian cancer, PE. 

Progesterone

Prometrium

Prometrium Indication

Prevention of estrogen-induced endometrial hyperplasia while conjugated estrogen are administered; secondary physiologic amenorrhea

MOA of Prometrium

Progesterone transforms proliferative endometrium into secretory endometrium. Systemically administered progesterone inhibits gonadotropin production, which in turn prevents follicular maturation and ovulation.

Contraindication of prometrium

Abnormal vaginal bleeding, history of estrogen- or progesterone-dependent neoplasia, active or history of DVT or PE, known or suspected pregnancy

Black box warning of prometrium

Should not be used for the prevention of cardiovascular disorders, dementia or breast cancer

Common side effects of prometrium

More than 10% weight changes, headache, amenorrhea, breast tenderness, abdominal pain, nausea, asthenia, feeling nervous, break through bleeding.

Serious side effect of Progesterone - prometrium

Thromboembolism, thrombophlebitis, osteoporosis

Medroxyprogesterone

Provera -oral, Provera- injection

Indication of Medroxyprogesterone, Provera

Abnormal uterine bleeding unrelated to menstrual cycle; prevention of estrogen-induced endometrial hyperplasia secondary physiologic amenorrhea, prevention of pregnancy, endometriosis

MOA of Provera - Medroxyprogesterone

Transforms proliferative into secretory endometrium. Androgenic and anabolic effects have been noted, but the drug is devoid of significant estrogenic activity. 

Contraindication of Medroxyprogesterone - provera

Hypersensitivity to medroxyprogesterone, abnormal genital bleeding, history of estrogen- or progesterone-dependent neoplasia, active or history of DVT or PE, severe liver dysfunction, known or suspected pregnancy

Black box warning of Medroxyprogesterone - provera

Increase risk of cardiovascular disorders, breast cancer and dementia loss of BMD- not for long-term use.

Common side effect of povera

More than 10% weight gain, headache, amenorrhea, breast tenderness, nervousness, abdominal pain, asthenia, breakthrough bleeding.

Serious side effect of Medroxyprogesterone

DVT, thrombophlebitis, osteoporosis, PE.

Estrogen/Progestin combination - Oral contraceptives

Various brand names

Indication of Oral contraceptives

Contraception

Some formulation for acne 

MOA of oral contraceptives

Estrogen inhibits FSH and LH to inhibit ovulation, cause edematous endometrial changes that are hostile to implantation of the fertilized ovum, accelerated ovum transport and produce degeneration of the corpus luteum. Progestins inhibit ovulation by suppression of LH, inhibit sperm capacitation, slow ovum transport, produce a thinning endometrium that hampers implantation, and cause cervical mucus changes that are hostile to sperm migration.

Contraindication for oral contraceptives

Hypersensitivity to ethinyl estradiol or progestin component, history or risk of thromboembolic disorders, breast or endometrial cancer, uncontrolled HTN, hepatic disease, known or suspected pregnancy, thrombogenic cardiac value or rhythm disease, headaches with focal neurologic symptoms, women > 35 y of age who smoke.

Black box warning of oral contraceptives

Women >35 y age who smoke

Common side effects of oral contraceptives

More than 10% weight change, breast tenderness, breast swelling, bloating, nausea, stomach cramps, vomiting, depression.

Serious side effect of Oral contraceptives

Arterial thromboembolism, AMI, thrombophlebitis, cerebral hemorrhage, cerebral thrombosis, PE, HTN.

Ethinyl Estradiol/Etonogestrel Ring

Nuvaring

Indication of Nuvaring

Contraception

MOA of Nuvaring

Same as COC

Contraindication of Nuvaring

Hypersensitivity to ethinyl estradiol or progestin component, history of thromboembolic disorders, endometrial cancer, uncontrolled HTN, pregnancy, smoking > 15 cigarettes per d and > 35 year of age.

Black box warning of Nuvaring

Smoking risk

Common side effects of Nuvaring

>10% headache, intermenstrual bleeding, vaginitis

1-10% mood changes, acne, weight gain, amenorrhea, nausea, vomiting, abdominal pain, vaginal discharge

Serious side effect of Nuvaring

AMI, anaphylaxis, angioedema, thromboembolism, galactorrhea not associated with childbirth, hypersensitivity reaction, toxic shock syndrome, urticaria, thromboembolism.

Testosterone

AndroGel, Androderm

Indication of AndroGel, Androderm

Hypogaonadism

MOA of AndroGel, Androderm

Testosterone is an endogenous androgen. Androgens are responsible for normal growth and development of male sex organs. Testosterone is involved in the growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution; laryngeal enlargement, vocal cord thickening, alteration in body musculature, and fat distribution.

Contraindication of AndroGel, Androderm

hypersensitivity to testosterone, men with breast or prostate cancer, women who are pregnant, who may become pregnant, or who are breast-feeding.

Black box warning of AndroGel, Androderm

Secondary exposure, BP increases; pulmonary oil microembolism

Common side effects of AndroGel, Androderm

>10% benign prostatic hyperplasia, testicular atrophy, PSA increase

1-10% acne, headache, gynecomastia, alopecia, impotence, aggressive behavior, HTN.

Serious side effect of AndroGel, Androderm

Cardiac arrest, cerebrovascular accident, hepatotoxicity, hallucination, hostility, and aggression. 

Folic acid

Folacin-800

Indication of Folacin - 800

Megaloblastic and macrocytic anemia due folic acid deficiency

MOA of Folacin-800

Folic acid is required for the conversion of deoxyuridylate to thymidylate, which is a rate-limiting step in DNA synthesis. Folic acid deficiency presents clinically as macrocytic anemia when red blood cells are unable to extrude their nucleus. 

Major contraindication of Folacin-800

Hypersensitivity

Black box warning of Folacin-800

None

Common side effects of Folacin-800

>10% loss of appetite

1-10% confusion, irritation

Serious side effects of Folacin-800

Anaphylaxis

Parental Vitamin D     

PreCare, Prenexa

Indication of PreCare, PreNexa

Diet supplementation during pregnancy

MOA of PreCare, PreNexa

Provide vitamin and mineral supplementation throughout pregnancy and during the postnatal period for both the lactating and the non-lactating mother. It is also useful for improving nutritional status prior to conception.

Contraindication of PreCare, PreNexa

Hypersensitivity

Black box warning of PreCare, PreNexa

Iron toxicity

Common side effects of PreCare, PreNexa

Nausea, vomiting, constipation

Serious side effects of PreCare, PreNexa

None