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Important Warning

Estrogen may increase the risk of heart attack, stroke, breast cancer, endometrial cancer, and blood clots in the lungs or legs. Tell your doctor if you smoke and if you have or have ever had a heart attack; a stroke; blood clots; high blood pressure; high blood levels of cholesterol or fats; or diabetes. If you are having surgery or will be on bedrest, talk to your doctor about stopping estrogen at least 4 to 6 weeks before the surgery or bedrest.

If you experience any of the following side effects, call your doctor immediately: sudden, severe headache; sudden, severe vomiting; sudden partial or complete loss of vision; speech problems; dizziness or faintness; weakness or numbness of an arm or a leg; unusual vaginal bleeding; crushing chest pain or chest heaviness; coughing up blood; sudden shortness of breath; or calf pain.

Talk to your doctor about the risks and benefits of taking estrogen.

What is Premarin?

Estrogen is a hormone, a substance produced by the body. It is needed for normal growth and development of female sex organs and for functions such as bearing children. During menopause, the body's production of estrogen is decreased. Estrogen replacement is used for symptoms associated with menopause: hot flashes (feelings of warmth in the face, neck, and chest), sweating, sleep disturbance, vaginal discomfort (dryness and itchiness), poor concentration, and irritability. It also is used in the treatment of breast cancer in postmenopausal women and breast and prostate cancer in men.

Estrogen is also used with diet, calcium supplements, and exercise to slow the progression of osteoporosis, a disease common in women after menopause resulting in bones that break easily.

Premarin Warnings

Before taking estrogen,

• tell your doctor and pharmacist if you are allergic to estrogen, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other medications.

• tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially antibiotics or anti-infectives, anticoagulants ('blood thinners') such as warfarin (Coumadin), carbamazepine (Tegretol), phenobarbital, phenylbutazone, phenytoin (Dilantin), primidone (Mysoline), rifampin, steroids (Decadron, Medrol, Prednisone), and vitamins.

• tell your doctor if you have or have ever had asthma; epilepsy (seizures); migraine headaches; history of depression; liver, heart, gallbladder, or kidney disease; jaundice (yellowing of the skin or eyes); genital bleeding; and excessive weight gain and fluid retention (bloating) during the menstrual cycle.

• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking estrogen, call your doctor immediately.

• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking estrogen.

• tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this drug.

• tell your doctor and pharmacist if you wear contact lenses.

Premarin Side Effects

Estrogen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• stomach cramps
• bloating
• diarrhea
• appetite and weight changes
• glucose intolerance (increased blood sugar)
• brown or black skin patches
• acne
• swelling of the hands, feet, or lower legs (fluid retention)
• increased blood pressure
• bleeding or spotting between menstrual periods
• changes in menstrual flow
• painful or missed periods
• breast tenderness, enlargement, or secretion
• intolerance to contact lenses

Some side effects may be serious. The following symptoms are uncommon, but if you experience any of them or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• severe stomach pain
• yellowing of the skin or eyes
• severe mental depression
• unusual bleeding
• loss of appetite

Estrogen may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Premarin Dosage

Estrogen comes as a tablet to take by mouth, patches to apply externally to the skin, and as a cream to be inserted into the vagina.

Oral estrogen is usually taken by mouth with food or milk either every day or on a cyclical basis: once a day for 21 days and then none for 7 days; then the cycle is repeated. However, for treating cancer it usually is taken three times a day every day for at least 3 months.

Skin patches are usually applied either once or twice weekly for three weeks (on the same days each week), followed by 1 week without the drug (patch); then the cycle is repeated. The package is designed to help you remember when to apply fresh skin patches.

To apply a skin patch, follow the directions provided and these steps:

1. Remove the skin patch from its protective pouch and peel off the protective strip, exposing the adhesive surface.
2. Place the adhesive side against a clean, dry, and not excessively hairy area of skin on the trunk of your body, preferably your abdomen (not your waistline or breasts, since tight clothing may rub the patch). Do not apply the patch to oily, broken, or irritated skin.
3. Press the patch on the selected site firmly with the palm of your hand for about 10 seconds, making sure that the edges adhere to your skin. If the patch accidentally comes off, you can either reapply it or apply a fresh patch, but follow your regular dosing schedule.

Remove and discard the patch and apply a fresh patch according to the schedule prescribed by your doctor. To prevent skin irritation, use a different site for each application and wait at least 1 week before using a particular area again. Used patches should be cut up and disposed in a way that keeps them out of reach of children and pets.

To use the vaginal cream, your doctor will set up a dosage schedule for you. If you are to use it once a day, it is best to use it at bedtime. Follow the directions that come with the vaginal cream and these steps:

1. Fill the special applicator that comes with the cream to the level indicated.
2. Lie on your back with your knees drawn upward and spread apart.
3. Gently insert the applicator into the vagina; then push the plunger to release the medication.
4. Withdraw the applicator.
5. Discard the applicator if it is disposable. If the applicator is reusable, pull it apart and clean it with soap and warm water after each use.
6. Wash your hands promptly.

Ask your pharmacist or doctor any questions you have about using the vaginal cream. You may wish to wear a sanitary napkin after inserting the cream to keep your clothes clean.

Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take estrogen exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking estrogen without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Premarin - Missed Dose

If you forget to apply a skin patch, apply it as soon as you remember; note the date on the package, and adjust your schedule. If you miss a dose of tablets or vaginal cream, take it (or apply it) as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What storage conditions are needed for this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not remove skin patches from their protective pouches until just before applying them. Discard patches by cutting them into pieces and disposing of them in a way that keeps them out of reach of children and pets. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination, including blood pressure measurements, breast and pelvic exams, and a Pap test at least yearly. Follow your doctor's directions for examining your breasts; report any lumps immediately.

Before you have any laboratory tests, tell the laboratory personnel that you take estrogen, because this medication may interfere with some laboratory tests.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.