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estrogens, conjugated
generic
Black Box Warnings .
Endometrial Cancer with Unopposed Estrogen in Patients with Intact Uterus
unopposed estrogen use incr. risk of endometrial CA in patients with intact uterus; adding progestogen has been shown to decr. risk of endometrial hyperplasia, a possible precursor to endometrial CA; perform adequate diagnostic measures (including directed or random endometrial sampling) to rule out malignancy in menopausal patient with abnormal genital bleeding of unknown etiology
Adult Dosing .
Dosage forms: TAB: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg
vasomotor symptoms, moderate-severe menopausal
- [0.3-1.25 mg PO qd]
- Start: 0.3 mg PO qd; Info: use lowest effective estrogen dose, shortest effective treatment duration; may cycle 25 days on, 5 days off; consider adding progestogen if intact uterus
vulvovaginal atrophy, moderate-severe menopausal
- [0.3-1.25 mg PO qd]
- Start: 0.3 mg PO qd; Info: not preferred if local symptoms only; use lowest effective estrogen dose, shortest effective treatment duration; may cycle 25 days on, 5 days off; consider adding progestogen if intact uterus
osteoporosis prevention, postmenopausal
- [0.3-0.625 mg PO qd]
- Start: 0.3 mg PO qd; Info: weigh estrogen treatment risk/benefit; may cycle 25 days on, 5 days off; consider adding progestogen if intact uterus
hypoestrogenism
- [associated with hypogonadism]
- Dose: 0.625-1.25 mg PO qd; Info: titrate to lowest effective maintenance dose; add progestogen if intact uterus
- [associated with oophorectomy or primary ovarian failure]
- Dose: 1.25 mg PO qd; Info: titrate to lowest effective maintenance dose; add progestogen if intact uterus
metastatic breast CA, palliative tx
- [10 mg PO tid for at least 3mo]
advanced prostate CA, palliative tx
- [1.25-2.5 mg PO tid]
renal dosing
- [see below]
- renal disease: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: contraindicated
Peds Dosing .
- Dosage forms: TAB: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg
puberty induction, female
- [associated with hypogonadism, 11 yo and older]
- Dose: 0.625-1.25 mg PO qd; Start: 0.15 mg PO qd, then may incr. dose q6-12mo; Info: add progesterone micronized or medroxyprogesterone after breakthrough bleeding occurs or with at least 2 years of estrogen treatment if intact uterus; after puberty induction, titrate to lowest effective maintenance dose for hypoestrogenism until menopausal age
- [associated with constitutional causes, 13 yo and older (off-label)]
- Dose: 0.15 mg PO qd x3-6mo; Info: may incr. dose after 6mo if spontaneous puberty progression not achieved; reassess need for treatment q3-6mo
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance