Premarin is an estrogen replacement drug. The tablets are used to reduce moderate to severe symptoms of menopause, including feelings of warmth in the face, neck, and chest, and the sudden intense episodes of heat and sweating known as “hot flashes.” Cenestin tablets, containing a synthetic form of conjugated estrogens, may also be prescribed for these symptoms.
In addition to the symptoms of menopause, Premarin tablets are prescribed for teenagers who fail to mature at the usual rate, and to relieve the symptoms of certain types of cancer, including some forms of breast and prostate cancer.
In addition, either the tablets or Premarin vaginal cream can be used for other conditions caused by lack of estrogen, such as dry, itchy external genitals and vaginal irritation.
Along with diet, calcium supplements, and exercise, Premarin tablets are also prescribed to prevent postmenopausal osteoporosis, a condition in which the bones become brittle and easily broken. Before taking Premarin solely for this purpose, you should carefully consider using alternative, nonestrogen therapies.
The addition of progesterone to estrogen-replacement therapy has been shown to reduce the risk of uterine cancer. Prempro combines estrogen and progesterone in a single tablet taken once daily. Premphase is a 28-day supply of tablets. The first 14 contain only estrogen. The second 14 supply both estrogen and progesterone. Both Prempro and Premphase are prescribed to reduce the symptoms of menopause, including vaginal problems, and to prevent osteoporosis.
Most important fact about Premarin
Because estrogens have been linked with an increased risk of uterine and endometrial cancer (cancer in the lining of the uterus), it is essential to have regular checkups and to report any unusual vaginal bleeding to your doctor immediately.
Premarin and other estrogen drugs, with or without progesterone, should not be used to prevent heart disease. Recent studies have confirmed an increased rate of heart attack, stroke, and dangerous blood clots among women taking estrogen or estrogen combinations for 5 years. Blood clots can lead to phlebitis, stroke, heart attack, a loss of blood supply to the lungs, a blockage in the blood vessels serving the eye, and other serious disorders.
How should you take Premarin?
Take Premarin exactly as prescribed. Do not share it with anyone else.
If you are taking calcium supplements as a part of the treatment to help prevent brittle bones, check with your doctor about how much to take.
You should take a few moments to read the patient package insert provided with your prescription.
If you are using Premarin vaginal cream, apply it as follows:
1. Remove cap from tube.
2. Screw nozzle end of applicator onto tube.
3. Gently squeeze tube from the bottom to force sufficient cream into the barrel to provide the prescribed dose. Use the marked stopping points on the applicator as a guide.
4. Unscrew applicator from tube.
5. Lie on back with knees drawn up. Gently insert applicator deeply into the vagina and press plunger downward to its original position.
To cleanse the applicator, pull the plunger to remove it from the barrel, then wash with mild soap and warm water. Do not boil or use hot water.
–If you miss a dose…
Take the forgotten dose as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Never try to “catch up” by doubling the dose.
–Storage instructions…
Store at room temperature.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor immediately. Only your doctor can determine whether it is safe to continue taking Premarin.
- Side effects of conjugated estrogens may include:
Abdominal/stomach cramps, bloating, breast pain, enlargement of benign tumors of the uterus (also called fibroids), fluid retention, hair loss, headache, high blood pressure, high blood sugar, irregular vaginal bleeding or spotting, liver problems, nausea and vomiting, vaginal yeast infections
- Other possible side effects of Cenestin may include:
Constipation, increased heartbeat, joint pain, skin tingling
Possible food and drug interactions when taking Premarin
If Premarin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Premarin with the following:
Barbiturates such as phenobarbital
Blood thinners such as Coumadin
Carbamazepine (Tegretol)
Clarithromycin (Biaxin)
Drugs used for epilepsy, such as Dilantin
Erythromycin
Grapefruit juice
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Major tranquilizers such as Thorazine
Oral diabetes drugs such as Micronase
Rifampin (Rifadin)
Ritonavir (Norvir)
St. John’s wort
Steroid medications such as Deltasone
Thyroid preparations such as Synthroid
Tricyclic antidepressants such as Elavil and Tofranil
Vitamin C
Special information if you are pregnant or breastfeeding
If you are pregnant or plan to become pregnant, notify your doctor immediately. Premarin and conjugated estrogens should not be taken during pregnancy because of the possibility of harm to the unborn child. Premarin cannot prevent a miscarriage. Estrogens can decrease the quantity and quality of breast milk, and progestins appear in breast milk. Your doctor may advise you not to breastfeed while you are taking this drug.
Recommended dosage
Your doctor will start therapy with this medication at a low dose and adjust the dosage according to your response. He or she will want to check you periodically at 3- to 6-month intervals to determine the need for continued therapy.
Hot flashes associated with menopause
The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles such as 25 days on Premarin and 5 days off.
Tissue degeneration in the vagina
The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles.
Low estrogen levels due to reduced ovary function
The usual dosage is 0.3 to 0.625 milligrams daily, taken cyclically.
Ovary removal or ovarian failure
The usual dosage is 1.25 milligrams daily, taken cyclically.
Prevention of osteoporosis (loss of bone mass)
The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles.
Advanced androgen-dependent cancer of the prostate, for relief of symptoms only
The usual dosage is 1.25 to 2.5 milligrams 3 times daily.
Breast cancer (for relief of symptoms only) in appropriately selected women and men with metastatic disease
The suggested dosage is 10 milligrams 3 times daily for a period of at least 3 months. Tell your doctor if you have any unusual bleeding.
Overdosage
Any medication taken in excess can have serious consequences. If you suspect an overdose of Premarin, seek medical attention immediately.
- Symptoms of conjugated estrogen overdose may include:
Nausea, vomiting, withdrawal bleeding
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