Clinician's Pocket Drug Reference 2008

94 Estradiolment Action: Estrogen & androgen supl Dose: 1 tab/d × 3 wk, 1 wk off Caution:[X, –] Contra: Genital bleeding of unknown cause, breast CA, estrogen-dependenttumors, thromboembolic disorders, thrombophlebitis, recent MI, PRG Disp: Tabs(estrogen/methyltestosterone) 0.625 mg/1.25 mg, 1.25 mg/2.5 mg SE: N, HA,bloating, breast enlargement/tenderness, edema, ↑ triglycerides, venous thromboembolism,gallbladder Dz Notes: Use lowest dose for shortest time; (seeWomen’s Health Initiatives (WHI) data www.whi.org)Estradiol (Estrace, others) Uses: *Atrophic vaginitis, vasomotor Sxs associatedw/ menopause, osteoporosis* Action: Estrogen supl Dose: PO: 1–2 mg/d,adjust PRN to control Sxs. Vaginal cream: 2–4 g/d × 2 wk, then 1 g 1–3×/wk Caution:[X, –] Contra: Genital bleeding of unknown cause, breast CA, porphyria,estrogen-dependent tumors, thromboembolic disorders, thrombophlebitis; recentMI; hepatic impair Disp: Ring, 0.05, 0.1, 2 mg; gel 0.061%; Tabs 0.5, 1, 2 mg;vaginal cream 0.1 mg/g SE: N, HA, bloating, breast enlargement/tenderness,edema, ↑ triglycerides, venous thromboembolism, gallbladder DzEstradiol gel (Elestrin) WARNING: Do not use in the prevention of CVDz or dementia; ↑ risk of endometrial cancer Uses: *Postmenopausal vasomotorsymptoms * Action: Estrogenic Dose: Apply 0.87–1.7 g to skin daily; add progestinx 10–14 days/28-day cycle w/intact uterus; use lowest effective estrogen doseCaution: [C, ?] Contra: AUB, breast CA, estrogen-dependent tumors, thromboembolicdisorders, recent MI, PRG, severe hepatic Dz Disp: 0.87 g gel = 0.52mg estradiol/pump SE: Thromboembolic events, MI, stroke, ↑ BP, breast/ovarian/endometrialCA, site rxns, vag spotting, breast changes, abd bloating, cramps,HA, fluid retention Notes: Apply to upper arm, wait > 25 min before sunscreen;avoid concomitant use for > 7 d; BP, breast examsEstradiol Cypionate & Medroxyprogesterone Acetate(Lunelle) WARNING: Cigarette smoking ↑ risk of serious CV side effectsfrom contraceptives containing estrogen. This risk ↑ with age & with heavy smoking(> 15 cigarettes/d) & is quite marked in women > 35 y. Women who useLunelle should be strongly advised not to smoke Uses: *Contraceptive* Action:Estrogen & progestin Dose: 0.5 mL IM (deltoid, ant thigh, buttock) monthly, donot exceed 33 d Caution: [X, M] HTN, gallbladder Dz, ↑ lipids, migraines, suddenHA, valvular heart Dz with comps Contra: PRG, heavy smokers >35 y, DVT,PE, cerebro/CV Dz, estrogen-dependent neoplasm, undiagnosed AUB, porphyria,hepatic tumors, cholestatic jaundice Disp: Estradiol cypionate (5 mg), medroxyprogesteroneacetate (25 mg) single-dose vial or syringe (0.5 mL) SE: Arterialthromboembolism, HTN, cerebral hemorrhage, MI, amenorrhea, acne, breast tendernessNotes: Start w/in 5 d of menstruationEstradiol, Transdermal (Estraderm, Climara, Vivelle, VivelleDot) WARNING: Do not use in the prevention of CV Dz or dementia; ↑ risk ofendometrial cancer Uses: *Severe menopausal vasomotor Sxs; female hypogonadism*Action: Estrogen supl Dose: Start 0.0375–0.05 mg/d patch– 2 × wk based