Premarin Cream

✔️ Premarin Cream is used to treat:

• Atrophic vaginitis (vaginal itching, inflammation, dryness, and vaginal thinning)
• Kraurosis vulvae (itching and inflammation of the vulva and other parts of the genital area)
• Moderate to severe dyspareunia (genital pain during sexual intercourse)

✔️ How does Premarin Cream work?

Conjugated Estrogen, a blend of female sex hormones, prevents menopause-related symptoms like hot flashes, night sweats, and mood swings, and guards against osteoporosis.

✔️ Side Effects of Premarin Cream

Less serious, but common side effects include headache, breast pain, irregular vaginal bleeding or spotting, stomach/abdominal cramps/bloating, nausea and vomiting, hair loss, fluid retention, vaginal yeast infection, reactions from Premarin Vaginal Cream such as vaginal burning, irritation, and itching.

✔️ Quick Suggestions:

• You have been prescribed Conjugated estrogen as a part of hormone replacement therapy to relieve symptoms of menopause.
• It may also be used for preventing osteoporosis in postmenopausal women who are at high risk of fractures.
• Take it at the same time every day to help you remember to take it.
• Inform your doctor if you experience any unusual vaginal bleeding or spotting, abnormal vaginal discharge, or vaginal discomfort while taking Conjugated Estrogen.
• It may increase the risk of breast cancer. Have regular breast examinations.
• Stop taking this medicine and inform your doctor immediately if you notice unexplained swelling and pain in your limbs, shortness of breath, chest pain, or changes in vision. These could be symptoms of a blood clot in a vein.

✔️ Indication of Premarin Cream

Vaginal Atrophy

• This medicine is used in the treatment of atrophic vaginitis, or vaginal atrophy, which is the thinning of the walls of the vagina caused by decreased estrogen levels.

Post-menopausal symptoms

• This medicine is used to relieve and treat the symptoms experienced after menopause. The most common symptoms include hot flashes and vaginal dryness.

✔️ Pharmacology

Endogenous estrogens play a crucial role in shaping the female reproductive system and secondary sexual characteristics. While estrogen levels continually shift through metabolic processes, the most influential intracellular estrogen is estradiol, which surpasses estrone and estriol in receptor potency. In menstruating women, the primary source of estrogen—generating 70 to 500 mcg of estradiol daily—stems from the ovarian follicle, with production varying based on the menstrual phase.

Following menopause, endogenous estrogen primarily arises from the peripheral tissue conversion of adrenal cortex-secreted androstenedione into estrone. This results in the abundance of estrone and its sulfate-conjugated form, estrone sulfate, in postmenopausal women.

Estrogens function by binding to nuclear receptors within estrogen-responsive tissues, with two types of estrogen receptors recognized, their presence varying among tissues. Circulating estrogens regulate the secretion of pituitary gonadotropins—luteinizing hormone (LH) and follicle-stimulating hormone (FSH)—via negative feedback. In postmenopausal women, estrogens act to reduce elevated gonadotropin levels.

✔️ Dosage & Administration of Premarin Cream

Menopausal Vasomotor Symptoms, Atrophic Vaginitis/Kraurosis Vulvae:

• Start with 0.3 mg PO once daily.
• Use a continuous daily regimen or cyclic regimen (25 days on, 5 days off).
• Adjust dose PRN; use the lowest effective dose.
• If needed, daily use may be warranted based on medical assessment.

Female Hypogonadism:

• Begin with 0.3-0.625 mg PO once daily.
• Use a cyclic regimen (3 weeks on, 1 week off).
• Titrate every 6-12 months as necessary.
• Add progestin for bone mineral density maintenance after skeletal maturity.

Osteoporosis Prophylaxis:

• Initiate with 0.3 mg PO once daily.
• Cyclic regimen (25 days on, 5 days off).
• Adjust dose PRN based on clinical response.
• Daily use may be considered per medical assessment.
• May combine with medroxyprogesterone acetate.

Prostate Cancer Palliation:

• Use 1.25-2.5 mg PO q8hr.

Female Castration/Primary Ovarian Failure:

• Start with 1.25 mg PO once daily.
• Cyclic regimen (25 days on, 5 days off).
• Adjust dose PRN; use the lowest effective dose.

Breast Cancer Palliation:

• Metastatic disease: 10 mg PO q8hr for >3 months.

Abnormal Uterine Bleeding:

• Initial dose: 25 mg IV/IM; repeated in 6-12 hours PRN or 25 mg IV q4hr for 24 hr.
• If no response after 2 doses, re-evaluate therapy.
• Alternative regimen: 10-20 mg/day PO divided q4hr.
• Consider low-dose medroxyprogesterone acetate.

Premarin Cream Application:

• Follow your physician's instructions.
• Apply in and around the vagina/genital area.
• Tube and applicator provided.
• Squeeze the correct medicine amount into the applicator.
• Insert the applicator into the vagina while lying down.
• Press plunger to release medicine.
• Cleanse applicator with mild soap and warm water.
• For external use on the genital area (vulva, labia minora, clitoris, vaginal orifice), apply the required Premarin Cream quantity.

Your doctor will determine the suitable dose and treatment duration based on your age, weight, and health condition.

✔️ Interaction

All medications can interact differently for each individual. It's crucial to discuss potential interactions with your doctor before starting any new medicine.

Interaction with Alcohol: The interaction with alcohol is unknown. Consult your doctor before consuming alcohol while on this medication.

Interaction with Specific Medicines: Certain medicines like Thalidomide, Acarbose, Lenalidomide, and Carfilzomib may interact with this medication. Your doctor should provide guidance on these interactions.

Disease Interactions:

Abnormal Vaginal Bleeding: Use with caution in cases of previous abnormal vaginal bleeding, especially for prolonged use. Diagnostic tests should be conducted to determine the cause before starting estradiol therapy.

Estrogen-Dependent Tumor: Not recommended for patients with tumors caused by abnormal estrogen levels in the body (such as endometrial or breast tumors). Diagnostic tests are advised before starting treatment.

Hypertension (High Blood Pressure): Extreme caution is required for patients with high blood pressure. The risk of heart and blood vessel complications is high. Dose adjustment and safety monitoring are necessary.

Hepatic Neoplasms (Liver Cancer): Not recommended if liver cancer is suspected. The treatment course will be determined by your doctor.

Food and Lab Interactions: Specific food and lab interactions are not available in this information.

This list may not cover all possible interactions. It's essential to consult your doctor about potential drug interactions, especially considering your current medications and medical history.

✔️ Contraindications

• Severe liver impairment
• Breast carcinoma (cancer)
• Thromboembolic disorders (history of blood clot-related conditions)
• Cardiovascular (CV) disease (heart and blood vessel issues)
• Undiagnosed vaginal bleeding
• Estrogen-dependent neoplasms (tumors influenced by estrogen)
• Hypersensitivity (allergic reactions)
• Pregnancy

✔️ Pregnancy & Lactation

In case of pregnancy during Conjugated Estrogens treatment, cease medication promptly. Most epidemiological studies conducted so far, focusing on unintentional fetal exposure to estrogens, have not revealed teratogenic or fetal toxicity effects. This medicine is not recommended for use in breastfeeding women unless absolutely necessary. All the risks and benefits should be discussed with the doctor before using this medicine.

✔️ Precautions & Warnings

• Using estrogen-alone can increase the risk of uterine cancer. Report any unusual vaginal bleeding while using the cream, as it could signal a concern. Consult your healthcare provider to investigate the cause.
• Estrogens, with or without progestins, should not be used to prevent heart disease, heart attacks, strokes, or dementia. Using estrogen-alone can heighten the risk of strokes and blood clots. Combining estrogens with progestins can increase the chances of heart attacks, strokes, breast cancer, and blood clots. A study suggests a potential link between estrogen use and dementia in older women.
• Estrogens should be used at the lowest effective dose and only for the necessary duration. Regular discussions with your healthcare provider about the ongoing need for treatment are recommended.
• Premarin Vaginal Cream should not be used if you have certain conditions, including unusual vaginal bleeding, cancer history, stroke or heart attack, blood clot or liver issues, bleeding disorder, allergy to ingredients, or suspected pregnancy. Adding progestin is usually advised for uterus-having women to lower uterine cancer risk.
• Consult your healthcare provider if you take thyroid medication, as estrogen use might affect the required dosage.
• Serious but less common side effects encompass heart attack, stroke, blood clots, dementia, various cancers, high blood pressure, high blood sugar, gallbladder disease, liver problems, fibroid enlargement, and severe allergic reactions.
• Contact your healthcare provider if you experience warning signs or unusual symptoms, including breast lumps, unusual vaginal bleeding, vision or speech changes, severe headaches, chest/leg pain with or without breathlessness, weakness, fatigue, and facial swelling.

✔️ Storage Conditions

Keep away from light and heat in a dry area. Keep out of children's reach.