Clinician's Pocket Drug Reference 2008

Estrogen, Conjugated 95on product; adjust PRN to control Sxs; w/intact uterus cycle 3 wk on 1 wk off oruse cyclic progestin 10–14 d Caution: [X, –] See estradiol Contra: PRG, AUB,porphyria, breast CA, estrogen-dependent tumors, Hx thrombophlebitis, thrombosisDisp: TD patches (mg/24 h) 0.025, 0.0375, 0.05, 0.06, 0.075, 0.1 SE: N, bloating,breast enlargement/tenderness, edema, HA, hypertriglyceridemia, gallbladderDz Notes: Do not apply to breasts, place on trunk, rotate sitesEstradiol/Levonorgestrel transdermal (Climara Pro) WARN-ING: Do not use in the prevention of CV Dz or dementia Uses: *Menopausal vasomotorsx; prevent postmenopausal osteoporosis* Action: Estrogen andprogesterone Dose: 1 patch 1X/wk Caution: [X, –] w/ ↓ thyroid Contra: AUB,estrogen sens tumors, hx thromboembolism, liver impair, PRG, hysterectomyDisp: Pro 0.045 mg/0.015/mg day patch SE: Site rxn, vag bleed/spotting, breastchanges, abd bloating/cramps, HA, retention fluid, edema, ↑ BP Notes: Applylower abd; for osteoporosis give Ca +2 /vit D supp; follow breast examsEstradiol/ Norethindrone Acetate (Femhrt, Activella)WARNING: Estrogens & progestins should not be used for the prevention of CVDz or dementia; the WHI study reported ↑ risks of MI, breast CA, & DVT in postmenopausalwomen during 5 y of treatment with estrogens combined with medroxyprogesteroneacetate relative to placebo Uses: *Vasomotor Sxs associated w/menopause; prevent osteoporosis* Action: Estrogen/progestin hormone replacement;plant derived Dose: 1 tab/day start w/ lowest dose combo Caution: [X, –] w/↓ Ca+2/thyroid Contra: PRG; Hx breast CA; estrogen-dependent tumor; abnormalgenital bleeding; Hx DVT, PE, or related disorders; recent (w/in past year) arterialthromboembolic Dz (CVA, MI) Disp: Femhrt tabs 2.5/0.5, 5 mcg/1 mg;Activella tabs 1.0/0.5, 0.5 mg/0.1 mg SE: Thrombosis, dizziness, HA, libidochanges, insomnia, emotional stability, breast pain Notes: Use in women w/ intactuterus; caution in heavy smokersEstramustine Phosphate (Estracyt, Emcyt) Uses: *AdvancedPCa* Action: Antimicrotubule agent; weak estrogenic & antiandrogenic activityDose: 14 mg/kg/d in 3–4 ÷ doses; on empty stomach, no dairy products Caution:[NA, not used in females] Contra: Active thrombophlebitis or thromboembolicdisorders Disp: Caps 140 mg SE: N/V, exacerbation of preexisting CHF, edema,hepatic disturbances, thrombophlebitis, MI, PE, gynecomastia in 20–100%Estrogen, Conjugated (Premarin) WARNING: Should not be usedfor the prevention of CV Dz or dementia. The WHI reported ↑ risk of MI, stroke,breast CA, PE, & DVT when combined with methoxyprogesterone over 5 y of Rx;↑ risk of endometrial CA, unopposed estrogens ↑ risk of endometrial cancer, ↑ riskof dementia in premenopausal women Uses: *Moderate–severe menopausal vasomotorSxs; atrophic vaginitis; palliative advanced CAP; prevent & Tx of estrogen-deficiencyosteoporosis* Action: Estrogen hormonal replacement Dose:0.3–1.25 mg/d PO cyclically; prostatic CA 1.25–2.5 mg PO tid; Caution: [X, –]Contra: Severe hepatic impair, genital bleeding of unknown cause, breast CA,