Premarin

Black Box Warnings .

Adult Dosing .

Dosage forms:  TAB: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg; INJ: various

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]

abnormal uterine bleeding, acute

[25 mg IM/IV q4-6h x24h]

Info: IV route preferred over IM route

uremic bleeding (off-label)

[0.6 mg/kg/dose IV qd x5 days]

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; INJ: various

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

abnormal uterine bleeding, acute (off-label)

[postmenarchal patients]

Dose: 25 mg IM/IV q4-6h x24h; Info: IV route preferred over IM route

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