estradiol transdermal

Black Box Warnings .

Adult Dosing .

Dosage forms:  PATCH (weekly): 0.025 mg per day, 0.0375 mg per day, 0.05 mg per day, 0.06 mg per day, 0.075 mg per day, 0.1 mg per day; PATCH (twice-weekly): 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; GEL (0.06%): 0.75 mg per pump; GEL (0.1%): 0.25 mg per packet, 0.5 mg per packet, 0.75 mg per packet, 1 mg per packet, 1.25 mg per packet

vasomotor symptoms, moderate-severe menopausal

[weekly patch]

Dose: apply 1 patch qwk; Start: apply 0.025 mg patch qwk; Info: use lowest effective estrogen dose, shortest effective tx duration; consider adding progestogen if intact uterus

[twice-weekly patch]

Dose: apply 1 patch 2x/wk; Start: apply 0.0375 mg patch 2x/wk; Info: use lowest effective estrogen dose, shortest effective tx duration; may cycle 3wk on, 1wk off; consider adding progestogen if intact uterus

[0.06% gel]

Dose; apply 0.75 mg qd; Info: use lowest effective estrogen dose, shortest effective tx duration; consider adding progestogen if intact uterus

[0.1% gel]

Dose: apply 0.25-1.25 mg qd; Start: apply 0.25 mg qd; Max: 1.25 mg/day; Info: use lowest effective estrogen dose, shortest effective tx duration; consider adding progestogen if intact uterus

vulvovaginal atrophy, menopausal

[weekly patch]

Dose: apply 1 patch qwk; Start: apply 0.025 mg patch qwk; Info: not preferred if local symptoms only; use lowest effective estrogen dose, shortest effective tx duration; consider adding progestogen if intact uterus

[twice-weekly patch]

Dose: apply 1 patch 2x/wk; Start: apply 0.0375 mg patch 2x/wk; Info: not preferred if local symptoms only; use lowest effective estrogen dose, shortest effective tx duration; may cycle 3wk on, 1wk off; consider adding progestogen if intact uterus

[0.06% gel]

Dose: apply 0.75 mg qd; Info: not preferred if local symptoms only; use lowest effective estrogen dose, shortest effective tx duration; consider adding progestogen if intact uterus

hypoestrogenism

[weekly patch]

Dose: apply 1-2 patches (0.1-0.2 mg) qwk; Info: for hypogonadism, oophorectomy, or primary ovarian failure; titrate to lowest effective maintenance dose; add progestogen if intact uterus

[twice-weekly patch (off-label)]

Dose: 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

osteoporosis prevention, postmenopausal

[weekly patch]

Dose: apply 1 patch qwk; Start: apply 0.025 mg patch qwk; Info: weigh estrogen tx risk/benefit; consider adding progestogen if intact uterus

[twice-weekly patch]

Dose: apply 1 patch 2x/wk; Start: apply 0.025 mg patch 2x/wk; Info: weigh estrogen tx risk/benefit; may cycle 3wk on, 1wk off; consider adding progestogen if intact uterus

abnormal uterine bleeding (off-label)

[weekly patch]

Dose: apply 1 patch qwk; Start: apply 0.025 mg patch qwk; Info: use lowest effective estrogen dose, shortest effective tx duration; may cycle 3wk on, 1wk off; add progestogen x10-14 days/cycle if intact uterus

[twice-weekly patch]

Dose: apply 1 patch 2x/wk; Start: apply 0.025 mg patch 2x/wk; Info: use lowest effective estrogen dose, shortest effective tx duration; may cycle 3wk on, 1wk off; add progestogen x10-14 days/cycle if intact uterus

transgender hormone therapy, feminizing (off-label)

[weekly patch]

Dose: apply 1-2 patches (0.025-0.2 mg) qwk; Info: adjust dose based on patient tx goals, clinical response, and estradiol levels; refer to WPATH or Endocrine Society guidelines

[twice-weekly patch]

Dose: 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

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 (weekly): 0.025 mg per day, 0.0375 mg per day, 0.05 mg per day, 0.06 mg per day, 0.075 mg per day, 0.1 mg per day; PATCH (twice-weekly): 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, weekly patch, 11 yo and older]

Dose: apply 1-2 patches (0.1-0.2 mg) qwk; Start: cut patch to appropriate dose; start 3-7 mcg dose qwk x6-12mo, then incr. to 14 mcg dose qwk x6-12mo, then incr. to 25 mcg dose qwk x6-12mo, then incr. by 25 mcg per dose qwk 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 hypogonadism, twice-weekly patch, 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, weekly patch, 13 yo and older]

Dose: apply partial patch (0.014 mg) qwk x3-6mo; Info: cut patch to appropriate dose; may incr. dose after 6mo if spontaneous puberty progression not achieved; reassess tx need q3-6mo

[associated with constitutional causes, twice-weekly patch, 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