Premarin and/or Equivalent Conj. Estrogen Prescription Information
Premarin contains Conjugated Estrogens which are used for various Menopausal Symptoms. Conjugated estrogens (CEs) are usually obtained from various natural sources like animals or plants and though not actually identical to human estrogens, they can be used safely in human beings. Premarin, on the market since 1942, is manufactured from CEs isolated from mare's urine by Wyeth Pharmaceuticals, which joined forces with Pfizer Inc. in January 2009. It has been marketed since 1942 and is only available by prescription.
Premarin is approved for Menopausal Symptoms like Vaginal Burning and Irritation, Hot Flashes, and Vaginal Dryness. It is also used in the prevention of Osteoporosis in postmenopausal women and as Estrogen Replacement Therapy in women with Ovarian Failure or Lack of Natural Estrogen Synthesis. Additional indications for Premarin are as follows:
Moderate to severe symptoms of menopausal vulvar and vaginal atrophy,
Hypoestrogenism because of hypogonadism, castration or ovarian failure,
Breast cancer and advanced androgen-dependent prostate cancer (for palliation only),
Part of chemotherapy for cancer in both women and men.
Dose, Administration and Dosage forms:
Premarin is available in tablets, vaginal cream, and intravenous injection solutions. Oval-shaped tablets are available in color-coded strengths as follows: 0.3mg green; 0.45mg blue; 0.625mg maroon; 0.9mg white; and 1.25mg yellow. Tablets and vaginal cream formulations should be stored at temperatures between 20 to 25 C (68 to 77 F). Tablets dosages are prescribed in strengths according to indication. The usual dose of vaginal cream (0.625 mg/g) is 1g or 2g daily administered with an applicator. The typical dose of intravenous solution is 25mg which is prepared by cryodesiccation. The IV solution should be stored at 2 to 8 C.
Mechanism of Action
Estrogens produced by ovaries are responsible for the development and maintenance of various hormonal functions and need to be replenished by external sources when normal levels are suppressed. Premarin's conjugated estrogens act by binding to nuclear receptors in estrogen-responsive tissues. These estrogens modulate the pituitary secretion of various hormones like gonadotropins, luteinizing hormone (LH), and follicle stimulating hormone (FSH) via a negative feedback mechanism. Estrogens reduce the increased levels of gonadotropins in postmenopausal women, which in turn suppress FSH and LH in the pituitary gland. This entire process balances the normal estrogen functions in postmenopausal women.
Side-effects and safety profile:
Various mild to moderately serious and commonly reported side-effects of Premarin include: headache, nausea, vomiting, abdominal cramps, bloating, fluid retention, breast pain, hair loss, weakness, fatigue, vaginal yeast infection, etc.
Side-effects and safety profile:
Lexapro side-effects seen during various clinical trials are as follows:
Serious but less common side-effects include: severe allergic reactions, heart attack, stroke, high BP, hyperglycemia, blood clotting, dementia, breast cancer, uterus lining cancer, ovarian cancer, gallbladder disorders, hepatic problems, enlargement of benign tumors of the uterus, new breast lumps, abnormal vaginal bleeding, altered vision, altered speech, sudden severe headaches, severe chest pains, severe leg pain, shortness of breath, swelling of lips, tongue and face, etc.A rare but serious side-effect called serotonin syndrome may occur when Lexapro is prescribed with other drugs.
Patients experiencing any of the above serious side-effects should seek immediate medical care.
Premarin increases the risk of uterine cancer, whose primary symptom is unusual vaginal bleeding.
Reports indicate that estrogens, with or without progestin, may increase the risk of endometrial cancer, heart attacks, strokes, dementia, breast cancer, and blood clots. Therefore, Premarin, with or without progestins, must be prescribed with the lowest effective dose for the shortest possible duration.Premarin therapy is reported to cause deep vein thrombosis (DVT) and dementia in postmenopausal women over 65-year-old.
Premarin is contraindicated in patients with a history of heart attack, stroke, abnormal vaginal bleeding, blood clotting issues, hepatic disease, and breast, uterine, or hormonal cancer.Patients must discuss their medical history with the prescribing physician, especially as regards cardiac issues, seizures, migraines, diabetes, endometriosis, renal disorder, asthma, underactive thyroid, high cholesterol or triglycerides, systemic lupus erythematosus, gallbladder disease and hysterectomy.Premarin is an FDA pregnancy category X drug which means it may cause birth defects to fetus, and thus must not be prescribed in pregnant women.Premarin is an FDA pregnancy category X drug which means it may cause birth defects to fetus, and thus must not be prescribed in pregnant women.Premarin must not be prescribed to nursing women.
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