What is/are Premarin?
CONJUGATED ESTROGENS is an estrogen. It is mostly used as hormone replacement in menopausal women. It helps to treat hot flashes and prevent osteoporosis. It is also used to treat women with low hormone levels or in those who have had their ovaries removed. This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.
What should I tell my health care providers before I take this medicine?
They need to know if you have any of these conditions:
abnormal vaginal bleeding blood vessel disease or blood clots breast, cervical, endometrial, ovarian, liver, or uterine cancer dementia diabetes endometriosis fibroids gallbladder disease heart disease or recent heart attack high blood pressure high cholesterol high level of calcium in the blood kidney disease liver disease mental depression migraine headaches stroke tobacco smoker an unusual or allergic reaction to estrogens, other medicines, foods, dyes, or preservatives pregnant or trying to get pregnant breast-feeding
How should I use this medicine?
Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Take your medicine at regular intervals, at the same time each day. Do not take your medicine more often than directed.
A patient information sheet for the product will be given with each prescription and refill. Read this sheet carefully each time. The sheet may change frequently.
Talk to your pediatrician regarding the use of this medicine in children. This medicine is not approved for use in children.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
Note: This medicine is only for you. Do not share this medicine with others.
What if I miss a dose?
If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.
What may interact with this medicine?
Do not take this medicine with any of the following:
aromatase inhibitors like aminoglutethimide, anastrozole, exemestane, letrozole, testolactone metyrapone
This medicine may also interact with the following:
barbiturates, such as phenobarbital carbamazepine clarithromycin erythromycin grapefruit juice medicines for fungal infections like ketoconazole and itraconazole phenytoin rifampin ritonavir St. John's Wort thyroid hormones
This list may not describe all possible interactions. Give your health care providers a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
What side effects may I notice from this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:
allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue breast tissue changes or discharge changes in vision chest pain confusion, trouble speaking or understanding dark urine general ill feeling or flu-like symptoms light-colored stools nausea, vomiting pain, swelling, warmth in the leg right upper belly pain severe headaches shortness of breath sudden numbness or weakness of the face, arm or leg trouble walking, dizziness, loss of balance or coordination unusual vaginal bleeding yellowing of the eyes or skin
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
hair loss increased hunger or thirst increased urination symptoms of vaginal infection like itching, irritation or unusual discharge unusually weak or tired
This list may not describe all possible side effects.
What should I watch for while using this medicine?
Visit your health care professional for regular checks on your progress. You will need a regular breast and pelvic exam and Pap smear while on this medicine. You should also discuss the need for regular mammograms with your health care professional, and follow his or her guidelines for these tests.
This medicine can make your body retain fluid, making your fingers, hands, or ankles swell. Your blood pressure can go up. Contact your doctor or health care professional if you feel you are retaining fluid.
If you have any reason to think you are pregnant; stop taking this medicine at once and contact your doctor or health care professional.
Smoking increases the risk of getting a blood clot or having a stroke while you are taking this medicine, especially if you are more than 35 years old. You are strongly advised not to smoke.
If you wear contact lenses and notice visual changes, or if the lenses begin to feel uncomfortable, consult your eye care specialist.
This medicine can increase the risk of developing a condition (endometrial hyperplasia) that may lead to cancer of the lining of the uterus. Taking progestins, another hormone drug, with this medicine lowers the risk of developing this condition. Therefore, if your uterus has not been removed (by a hysterectomy), your doctor may prescribe a progestin for you to take together with your estrogen. You should know, however, that taking estrogens with progestins may have additional health risks. You should discuss the use of estrogens and progestins with your health care professional to determine the benefits and risks for you.
If you are going to have surgery, you may need to stop taking this medicine. Consult your health care professional for advice before you schedule the surgery.
Where should I keep this medicine?
Keep out of the reach of children.
Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.
Since estrogen circulating in the blood can negatively feed-back to reduce circulating levels of FSH and LH, most oral contraceptives contain a synthetic estrogen, along with a synthetic progestin. Even in men, the major hormone involved in LH feedback is estradiol, not testosterone.
Hormone replacement therapy
Estrogen and other hormones are given to postmenopausal women in order to prevent osteoporosis as well as treat the symptoms of menopause such as hot flushes, vaginal dryness, urinary stress incontinence, chilly sensations, dizziness, fatigue, irritability, and sweating. Fractures of the spine, wrist, and hips decrease by 50–70% and spinal bone density increases by ~5% in those women treated with estrogen within 3 years of the onset of menopause and for 5–10 years thereafter.
Before the specific dangers of conjugated equine estrogens were well understood, standard therapy was 0.625 mg/day of conjugated equine estrogens (such as Premarin). There are, however, risks associated with conjugated equine estrogen therapy. Among the older postmenopausal women studied as part of the Women's Health Initiative (WHI), an orally administered conjugated equine estrogen supplement was found to be associated with an increased risk of dangerous blood clotting. The WHI studies used one type of estrogen supplement, a high oral dose of conjugated equine estrogens (Premarin alone and with medroxyprogesterone acetate as PremPro).
In a study by the NIH, esterified estrogens were not proven to pose the same risks to health as conjugated equine estrogens. Hormone replacement therapy has favorable effects on serum cholesterol levels, and when initiated immediately upon menopause may reduce the incidence of cardiovascular disease, although this hypothesis has yet to be tested in randomized trials. Estrogen appears to have a protector effect on atherosclerosis: it lowers LDL and triglycerides, it raises HDL levels and has endothelial vasodilatation properties plus an anti-inflammatory component.
Research is underway to determine if risks of estrogen supplement use are the same for all methods of delivery. In particular, estrogen applied topically may have a different spectrum of side-effects than when administered orally, and transdermal estrogens do not affect clotting as they are absorbed directly into the systemic circulation, avoiding first-pass metabolism in the liver. This route of administration is thus preferred in women with a history of thrombo-embolic disease.
Estrogen is also used in the therapy of vaginal atrophy, hypoestrogenism (as a result of hypogonadism, castration, or primary ovarian failure), amenorrhea, dysmenorrhea, and oligomenorrhea. Estrogens can also be used to suppress lactation after child birth.
About 80% of breast cancers, once established, rely on supplies of the hormone estrogen to grow: they are known as hormone-sensitive or hormone-receptor-positive cancers. Suppression of production of estrogen in the body is a treatment for these cancers.
Recently researchers have discovered that the common table mushroom has anti-aromatase properties and therefore possible anti-estrogen activity. Clinical trials have begun in the United States looking into whether the table mushroom can prevent breast cancer in people. A recent study has highlighted the importance of this research. In 2009, a case-control study of the eating habits of 2,018 women revealed that women who consumed mushrooms had an approximately 50% lower incidence of breast cancer. It has been found that Chinese women who consumed mushrooms and green tea had a 90% lower incidence of breast cancer.
Hormone-receptor-positive breast cancers are treated with drugs which suppress production of estrogen in the body. This technique, in the context of treatment of breast cancer, is known variously as hormonal therapy, hormone therapy, or anti-estrogen therapy (not to be confused with hormone replacement therapy). Certain foods such as soy may also suppress the proliferative effects of estrogen and are used as an alternative to hormone therapy.
Under certain circumstances, estrogen may also be used in males for treatment of prostate cancer.
In humans and mice, estrogen promotes wound healing.
At one time, estrogen was used to induce growth attenuation in tall girls. Recently, estrogen-induced growth attenuation was used as part of the controversial Ashley Treatment to keep a developmentally disabled girl from growing to adult size.
Most recently, estrogen has been used in experimental research as a way to treat patients suffering from bulimia nervosa, in addition to cognitive behavioral therapy, which is the established standard for treatment in bulimia cases. The estrogen research hypothesizes that the disease may be linked to a hormonal imbalance in the brain.
Estrogen has also been used in studies which indicate that it may be an effective drug for use in the treatment of traumatic liver injury.
Some hair shampoos on the market include estrogens and placental extracts; others contain phytoestrogens. There are case reports of young children developing breasts after exposure to these shampoos. On September 9, 1993, the FDA determined that not all topically applied hormone-containing drug products for OTC human use are generally recognized as safe and effective and are misbranded. An accompanying proposed rule deals with cosmetics, concluding that any use of natural estrogens in a cosmetic product makes the product an unapproved new drug and that any cosmetic using the term "hormone" in the text of its labeling or in its ingredient statement makes an implied drug claim, subjecting such a product to regulatory action.
In addition to being considered misbranded drugs, products claiming to contain placental extract may also be deemed to be misbranded cosmetics if the extract has been prepared from placentas from which the hormones and other biologically active substances have been removed and the extracted substance consists principally of protein. The FDA recommends that this substance be identified by a name other than "placental extract" and describing its composition more accurately because consumers associate the name "placental extract" with a therapeutic use of some biological activity.
Estrogens are among the wide range of endocrine-disrupting compounds (EDCs) because they have high estrogenic potency. When this specific EDC makes its way into the environment it may cause male reproductive dysfunction to wildlife. The estrogen excreted from farm animals makes its way into fresh water systems. During the germination period of reproduction the fish are exposed to low levels of estrogen which may cause reproductive dysfunction to male fish.
This article uses material from the Wikipedia article Conjugated Estrogens, which is released under the Creative Commons Attribution-Share-Alike License 3.0.