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Lyllana
estradiol transdermal
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: PATCH: 0.025 mg per day, 0.0375 mg per day, 0.05 mg per day, 0.075 mg per day, 0.1 mg per day
vasomotor symptoms, moderate-severe menopausal
- [apply 1 patch 2x/wk]
- Start: apply 0.0375 mg patch 2x/wk; Info: use lowest effective estrogen dose, shortest effective tx duration; consider adding progestogen if intact uterus
osteoporosis prevention, postmenopausal
- [apply 1 patch 2x/wk]
- Start: apply 0.025 mg patch 2x/wk; Info: weigh estrogen tx risk/benefit; consider adding progestogen if intact uterus
transgender hormone therapy, feminizing (off-label)
- [apply 1-2 patches (0.025-0.2 mg) 2x/wk]
- Info: adjust dose based on patient tx goals, clinical response, and estradiol levels; refer to WPATH or Endocrine Society guidelines
hypoestrogenism (off-label)
- [apply 1-2 patches (0.1-0.2 mg) 2x/wk]
- Info: for hypogonadism, oophorectomy, or primary ovarian failure; titrate to lowest effective maintenance dose; add progestogen if intact uterus
renal dosing
- [see below]
- renal disease: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment/disease: contraindicated
Peds Dosing .
- Dosage forms: PATCH: 0.025 mg per day, 0.0375 mg per day, 0.05 mg per day, 0.075 mg per day, 0.1 mg per day
puberty induction, female (off-label)
- [associated with hypogonadism, 11 yo and older]
- Dose: apply 1-2 patches (0.1-0.2 mg) 2x/wk; Start: cut patch to appropriate dose; start 3-7 mcg dose 2x/wk x6-12mo, then incr. to 14 mcg dose 2x/wk x6-12mo, then incr. to 25 mcg dose 2x/wk x6-12mo, then incr. by 25 mcg per dose 2x/wk x6-12mo; Info: add progesterone micronized or medroxyprogesterone after breakthrough bleeding occurs with at least 2y of estrogen tx 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]
- Dose: apply partial patch (0.014 mg) 2x/wk x3-6mo; Info: cut patch to appropriate dose; may incr. dose after 6mo if spontaneous puberty progression not achieved; reassess tx need 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