Premarin (Conjugated Estrogens)

Premarin is a type of estrogen medicine made from compounds found in the urine of pregnant mares. It contains water-soluble estrogen sulfate salts. This treatment helps replace estrogen that the body no longer makes in sufficient amounts, especially during and after menopause. Premarin is used to treat moderate to severe hot flashes, vaginal dryness, and other symptoms caused by low estrogen.

Directions

Premarin tablets are taken by mouth, usually once daily. The dosage depends on the condition being treated and how a person responds to treatment.

For moderate to severe hot flashes and night sweats, the typical starting dose is 0.3 mg daily. Some patients may need higher doses like 0.625 mg or 1.25 mg per day. For example, the dosage for the prevention of osteoporosis in postmenopausal women is typically 0.3 mg taken once daily. When treating vulvar and vaginal atrophy, doctors may prescribe 0.3 mg to 1.25 mg daily depending on symptom severity.

Patients should take Premarin at the same time each day to maintain steady hormone levels. The medication can be taken with or without food. Doctors typically prescribe the lowest effective dose for the shortest duration needed. Women with an intact uterus usually need to take a progestin medication along with Premarin to reduce certain risks. A doctor will provide specific instructions about when and how to take both medications together.

Ingredients

The active ingredients in this drug are a mixture of conjugated estrogens.

Cautions

• Before using this medication, you may want to consult a healthcare provider about the following:
  • Any existing health conditions
  • Any allergies
  • A list of all medications currently being taken
• Taking Premarin may increase the risk of blood clots, stroke, and sometimes heart attack, especially when estrogen is used with a progestin. Your doctor may advise you to stop treatment right away if you develop symptoms like sudden numbness, chest pain, shortness of breath, or leg swelling.
• Some women have a higher chance of blood clots because of factors like age, smoking, obesity, lupus, or a personal or family history of clots. If you need surgery or expect long periods of immobility, your doctor may have you stop the medication for a short time.
• Using estrogen alone in women with a uterus can increase the risk of cancer of the uterine lining, especially with long-term use. Unusual vaginal bleeding should be checked promptly so your doctor can rule out serious causes.
• Breast cancer risk can increase with estrogen combined with a progestin and may appear earlier in some women. Regular breast exams and mammograms are important while using hormone therapy.
• There may also be a small increase in ovarian cancer with hormone therapy. This risk may be higher with longer use, so your doctor will consider your personal and family history when deciding if treatment is right for you.
• Older women (typically over 65) using estrogen with or without progestin have shown a higher risk of developing dementia. It's not known if this applies to younger postmenopausal women.
• Estrogen can worsen gallbladder problems and may increase the chances of needing gallbladder surgery. Tell your doctor if you have sudden abdominal pain, nausea, or fever.
• In women with breast cancer that has spread to the bone, estrogen can sometimes cause severely high calcium levels. Treatment should be stopped if this occurs.
• Estrogen can rarely cause sudden vision changes due to blood vessel problems in the eye. If you have sudden vision loss, severe headaches, or double vision, stop the medication and get medical care right away.
• Some women may experience serious allergic reactions like swelling of the face, lips, or throat and trouble breathing. Anyone who has this type of reaction should not take Premarin again.
• Women who still have a uterus may need a progestin added to lower the chance of overgrowth of the uterine lining. However, adding a progestin may slightly increase breast cancer risk, so your doctor will weigh the pros and cons.
• Estrogen may cause fluid retention, which can worsen heart or kidney problems. Let your doctor know if you notice swelling in your legs, sudden weight gain, or shortness of breath.
• Women using thyroid replacement may need dose adjustments because estrogen can change thyroid hormone levels. Thyroid function may need to be checked more often.
• Women with very high triglycerides may have a higher chance of pancreatitis while using estrogen. Your doctor may monitor your levels and stop treatment if they become too high.
• Estrogen therapy can worsen certain conditions like asthma, migraines, diabetes, epilepsy, lupus, and liver growths. Your doctor will help decide if treatment is safe based on your medical history.

Contraindications

Avoid taking or using this medication if any of the following apply:

• Undiagnosed abnormal genital bleeding
• Known, suspected, or history of breast cancer
• Known or suspected estrogen-dependent cancer
• Active deep vein thrombosis, pulmonary embolism, or history of these conditions
• Active arterial thromboembolic disease (such as stroke or heart attack) or history of these conditions
• Known anaphylactic reaction or angioedema to Premarin
• Known liver dysfunction or disease
• Known protein C, protein S, or antithrombin deficiency, or other known thrombophilic disorders
  Pregnancy (known or suspected)

Side Effects

Common side effects of Premarin include:

• Headache
• Breast pain
• Irregular vaginal bleeding or spotting
• Stomach or abdominal cramps and bloating
• Nausea or vomiting
• Hair loss
• Fluid retention
• Vaginal yeast infections

These effects are usually mild and tend to improve as your body adjusts to treatment. Some women may notice changes in their cycle, breast tenderness, or digestive discomfort during the first few months. Let your healthcare provider know if any symptoms persist or worsen.

More serious but less common risks include heart attack, stroke, blood clots, and certain cancers such as breast, ovarian, or uterine cancer. Premarin can also affect blood pressure, thyroid levels, liver function, and calcium levels. It may also cause fluid retention or severe allergic reactions. Seek immediate medical care for new breast lumps, unusual vaginal bleeding, chest or leg pain, sudden severe headaches, changes in vision or speech, or swelling of the face, lips, or tongue.