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Estrogen Patches

Generic name: Estradiol
Brand names: Alora, Climara, Esclim, Estraderm, Vivelle, Vivelle-Dot

Why is this drug prescribed: All of these products are used to reduce symptoms of menopause, including feelings of warmth in the face, neck, and chest; the sudden intense episodes of heat and sweating known as "hot flashes"; dry, itchy external genitals; and vaginal irritation. They are also prescribed for other conditions that cause low levels of estrogen, and some doctors prescribe them for teenagers who fail to mature at the usual rate. Along with diet, calcium supplements, and exercise, Estraderm, Climara, Vivelle, and Vivelle-Dot are prescribed to prevent osteoporosis, a condition in which the bones become brittle and easily broken.

Most important fact about this drug: Because estrogens have been linked with increased risk of endometrial cancer (cancer in the lining of the uterus), it is essential to have regular checkups and to report any unusual vaginal bleeding to your doctor immediately.

How should you take this medication: Each patch is individually sealed in a protective pouch and is applied directly to the skin. A stiff protective liner covers the adhesive side of the patch. Remove the liner by sliding it sideways between your thumb and index finger. Holding the patch at one edge, remove the protective liner and discard it. Try to avoid touching the adhesive. Use immediately after removing the liner. If you are using Alora, Vivelle, or Vivelle-Dot peel off one side of the protective liner and discard it. Use the other half of the liner as a handle until you have applied the sticky area, then fold back the remaining side of the patch, pull off the rest of the liner, and smooth the second half of the patch onto your skin. Apply the adhesive side to a clean, dry area of your skin on the trunk of your body (including the buttocks and abdomen). Do not apply to your breasts or waist. Firmly press the patch in place with the palm of your hand for about 10 seconds, to make sure the edges are flat against your skin. When first using Alora, start on the lower abdomen. Climara is applied only to the abdomen or upper buttock, and is pressed in place with the fingers. Contact with water during bathing, swimming, or showering will not affect the patch. The application site must be rotated. Allow an interval of at least 1 week between applications to a particular site. Alora, Esclim, Estraderm, Vivelle, and Vivelle-Dot patches should be replaced twice a week; Climara once weekly. --If you miss a dose... If you forget to apply a new patch when you are supposed to, do it as soon as you remember. If it is almost time to change patches anyway, skip the one you missed and go back to your regular schedule. Do not apply more than the prescribed number of patches at a time. --Storage instructions... Store the patches at room temperature, in their sealed pouches.

What side effects may occur: Side effects cannot be anticipated. If any develop or change in intensity, notify your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using the estrogen patch. More common side effects may include: Back pain, headache, skin redness and irritation at the site of the patch Less common or rare side effects may include: Abdominal cramps, bloating, breakthrough bleeding, breast enlargement, breast tenderness, change in cervical secretions, change in menstrual flow, change in sex drive, change in weight, darkening of skin, dizziness, fluid retention, growth of benign fibroid tumors in the uterus, intolerance to contact lenses, migraine, nausea, rash, severe allergic reaction, vaginal bleeding (more common at higher doses), vomiting, yellowing of eyes and skin Other side effects reported with estradiol include: Abnormal withdrawal bleeding, certain cancers, cardiovascular disease, depression, excessive growth of hair, gallbladder disease, hair loss, high blood pressure, reddened skin, twitching, vaginal yeast infection

Why should this drug not be prescribed: These products should not be used if you are sensitive to or have ever had an allergic reaction to any of their components. Estrogens should not be used if you have ever had breast or uterine cancer or a tumor promoted by estrogen. Also avoid estrogens if you are pregnant or think you are pregnant, if you have abnormal, undiagnosed genital bleeding, or if you have blood clots or a blood clotting disorder.

Special warnings about this medication: The risk of cancer of the uterus increases when estrogen is used for a long time or taken in large doses. There also may be a slightly increased risk of breast cancer in women who take estrogen. (Combination products that also contain progestin pose less risk of uterine cancer, but increase the risk of breast cancer.) Although many experts suspect that estrogen may protect against heart disease, this theory remains unproven. In a major study of hormone therapy in women who already had heart disease, the researchers failed to note any improvement. Women who take estrogen after menopause are more likely to develop gallbladder disease. Tell your doctor if you have any problems with your circulation. Estrogen also increases the risk of blood clots. These blood clots can cause stroke, heart attack, or other serious disorders. While taking estrogen, get in touch with your doctor right away if you notice any of the following: Abdominal pain, tenderness, or swelling Abnormal bleeding of the vagina Breast lumps Coughing up blood Difficulty with speech Pain in your chest or calves Severe headache, dizziness, or faintness Skin irritation, redness, or rash Sudden shortness of breath Vision changes Weakness or numbness of an arm or leg Yellowing of the skin or eyes A complete medical and family history should be taken by your doctor before starting any estrogen therapy. In general, you should not take estrogen for more than 1 year without another physical examination by your doctor. Estrogen may cause fluid retention in some people. If you have asthma, epilepsy, migraine, or heart or kidney disease, use this medication cautiously. Estrogen therapy may cause uterine bleeding or breast pain.

Possible food and drug interactions when taking this medication: If you take certain other drugs while using estrogen, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before taking the following: Alcohol Barbiturates such as phenobarbital and Seconal Blood thinners such as Coumadin Cimetidine (Tagamet) Dantrolene (Dantrium) Epilepsy drugs such as Tegretol and Dilantin Rifampin (Rifadin) Steroids such as Deltasone Tricyclic antidepressants such as Elavil and Tofranil

Special information if you are pregnant or breastfeeding: Estrogens should not be used during pregnancy or immediately after childbirth. Use of estrogens during pregnancy has been linked to reproductive tract problems in the children. If you are pregnant or plan to become pregnant, notify your doctor immediately. Estrogens decrease the quantity and quality of breast milk. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.

Recommended dosage: After starting your therapy, the doctor will prescribe a higher dose if necessary, but should try decreasing the dose or discontinuing the medication every 3 to 6 months. ALORA AND ESTRADERM: The usual starting dose is one 0.05 milligram patch applied to the skin 2 times a week. CLIMARA: The usual starting dose is one 0.5 milligram patch applied to the skin once a week. (For osteoporosis, the doctor may prescribe a 0.025 milligram patch.) ESCLIM: The usual starting dose is one 0.025 milligram patch applied to the skin 2 times a week. VIVELLE AND VIVELLE-DOT: The usual starting dose to relieve symptoms of menopause is one 0.0375 patch applied to the skin 2 times a week. (For osteoporosis, the doctor may prescribe a 0.025 patch.) The patch may be used continuously, or left off every fourth week.

Overdosage: Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately. Symptoms of estrogen overdose may include: Nausea, vomiting, withdrawal bleeding

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