Estrogens, Conjugated

A to Z Drug Facts

Estrogens, Conjugated

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(ESS-truh-janz, KAHN-juh-gay-tuhd)

Premarin, Premarin IV, C.E.S., Congest

Class: Estrogen

Action Promotes growth and development of female reproductive system and secondary sex characteristics; affects release of pituitary gonadotropins; inhibits ovulation and prevents postpartum breast engorgement; conserves calcium and phosphorous and encourages bone formation; overrides stimulatory effects of testosterone.

Indications Management of moderate to severe vasomotor symptoms associated with menopause; treatment of atrophic vaginitis, kraurosis vulvae, female hypogonadism, symptoms of female castration, and primary ovarian failure; prevention and treatment of osteoporosis; palliative treatment of metastatic breast or prostate cancer in selected women and men; treatment of postpartum breast engorgement and abnormal uterine bleeding (parenteral form).

Contraindications Breast cancer (except in patients being treated for metastatic disease); estrogen-dependent neoplasia; undiagnosed abnormal genital bleeding; thrombophlebitis or thromboembolic disorders associated with previous estrogen use; known or suspected pregnancy.

Route/Dosage

Vasomotor Symptoms

ADULTS: PO 1.25 mg/day.

Female Castration, Primary Ovarian Failure

ADULTS: PO 0.3 to 1.25 mg/day (3 wk on estrogen, 1 wk off).

Atrophic Vaginitis, Atrophic Urethritis, Kraurosis Vulvae

ADULTS: PO 0.3 to 1.25 mg or more/day (3 wk on estrogen, 1 wk off). Intravaginal Insert 0.5 to 2 g daily (3 wk on estrogen, 1 wk off).

Female Hypogonadism

ADULTS: PO 2.5 to 7.5 mg/day in divided doses for 20 days, followed by 10-day rest period.

Prostatic Carcinoma

ADULTS: PO 1.25 to 2.5 mg tid.

Breast Cancer

ADULTS: PO 10 mg tid for ³ 3 mo.

Osteoporosis

ADULTS: PO 0.625 mg/day (3 wk on estrogen, 1 wk off).

Postpartum Breast Engorgement

ADULTS: PO 3.75 mg q 4 hr for 5 doses, or 1.25 mg q 4 hr for 5 days.

Abnormal Uterine Bleeding

ADULTS: IV/IM 25 mg; may repeat in 6 to 12 hr.

Interactions

Antidepressants, tricyclic: Estrogens may alter effects and increase toxicity of these agents. Barbiturates, rifampin: May decrease estrogen concentration. Corticosteroids: An increase in pharmacologic and toxicologic effects of corticosteroids may occur. Hydantoins: Loss of seizure control or decreased estrogenic effects may occur. INCOMPATIBILITIES: Infusion of conjugated estrogen with other agents is not recommended. Solution is compatible with normal saline, dextrose, and invert sugar solutions. It is not compatible with any solution with acidic pH.

Lab Test Interferences Endocrine and liver function test results may be affected; possible decreased PT and increased platelet aggregability; increased thyroid-binding globulin and total T₄; impaired glucose tolerance; decreased serum folate concentration; increased serum triglyceride and phospholipid concentrations; increased corticosteroid binding globulin and sex-hormone binding globulin; increased plasma HDL concentrations; reduced LDL cholesterol concentrations; increased triglyceride levels.

Adverse Reactions

CV: Thrombosis; thrombophlebitis; pulmonary embolism; MI; elevated BP. CNS: Headache; migraine; dizziness; depression; anxiety; emotional lability. DERM: Chloasma; melasma; erythema nodosum/multiforme; scalp hair loss; hirsutism; urticaria; dermatitis; skin hypertrophy; pruritus. EENT: Intolerance to contact lenses. GI: Nausea; vomiting; abdominal cramps; bloating; colitis; acute pancreatitis; diarrhea; dyspepsia; flatulence; gastritis; gastroenteritis; enlarged abdomen; hemorrhoids. GU: Increased risk of endometrial carcinoma; breakthrough bleeding; dysmenorrhea; amenorrhea; vaginal candidiasis; premenstrual-like syndrome; increased size of uterine fibromyomata; hemolytic uremic syndrome; urinary tract infection; vaginitis; vaginal discomfort/pain; cystitis; dysuria; genital pruritus; urinary incontinence. HEPA: Cholestatic jaundice. META: Hyperglycemia; hypercalcemia. RESP: Upper respiratory tract infection; sinusitis; rhinitis; pharyngitis; flu-like symptoms; allergy; bronchitis; chest pain. OTHER: Increase or decrease in weight; reduced glucose tolerance; edema; changes in libido; breast tenderness; acute intermittent porphyria; vaginal bleeding; hypersensitivity reactions; back pain; arthritis; arthralgia; hot flushes; leg edema; otitis media; toothache.

Precautions

Pregnancy: Category X. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Calcium/phosphorus metabolism: Use drug with caution in patients with metabolic bone diseases. Fluid retention: Use with careful observation when conditions that might be affected by this factor are present (eg, asthma, cardiac or renal dysfunction, epilepsy). Gallbladder disease: Risk of gallbladder disease may increase in women receiving postmenopausal estrogens. Hepatic impairment: Metabolism may be impaired; use drug with caution. Induction of malignant neoplasms: May increase risk of endometrial or other carcinomas. Familial hyperlipoproteinemia: May be associated with massive elevations of plasma triglycerides. Uterine leiomyomata: Preexisting uterine leiomyomata may increase in size. Unopposed estrogen administration (eg, without progesterone): Increases risk of uterine cancer. Therefore, when using estrogens on long-term basis in a woman with intact uterus, consider cyclic therapy with progesterone (eg, estrogen on days 1 to 25 of mo with progesterone added for last 12 days) or daily coadministration of estrogen plus progesterone on daily basis. In a woman without a uterus, use of cyclic therapy and/or therapy with progesterone is not necessary.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer IM injection deeply into muscle.
Administer IV injection slowly to avoid flushing.
Insert vaginal cream high in vagina (about length of applicator).
Store vials for parenteral administration in refrigerator.
Use reconstituted solution within a few hr.
Reconstituted solution can be stored for 60 days in refrigerator.
Do not use parenteral preparation if darkening or precipitation is noted.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Monitor blood glucose level in diabetic patients.
Include in physical assessment thorough documentation of BP, breast, abdomen and pelvic examination; review results of Pap smear, which should be conducted at least annually.

OVERDOSAGE: SIGNS & SYMPTOMS
	Nausea, withdrawal bleeding in women

Patient/Family Education

Caution patient that this medication must not be taken during pregnancy or when pregnancy is possible. Advise patient to use reliable form of birth control while taking this drug.
Advise patient regarding importance of smoking cessation or reduction of intake to < 15 cigarettes/day because of risk of cardiovascular complications.
Teach patient proper method of performing breast self-examination.
Advise patient to avoid exposure to sunlight or other sources of UV light. Sunscreens and/or protective clothing should be used until sun tolerance is determined.
Instruct patient to report these symptoms to physician: Pain in groin or calves; sharp chest pain or sudden shortness of breath; abnormal vaginal bleeding; breast lumps; sudden severe headache; dizziness or fainting; vision or speech problems; weakness or numbness in arm or leg; severe abdominal pain; yellowing of skin or eyes; severe depression.
Remind patient to have Pap smear every 6 to 12 mo while undergoing therapy.