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Pronounced: PREM-uh-rin
Generic name: Conjugated estrogens
Other brand names: Cenestin, Premphase, Prempro

Why is this drug prescribed: Premarin is an estrogen replacement drug. The tablets are used to reduce symptoms of menopause, including feelings of warmth in the face, neck, and chest, and the sudden intense episodes of heat and sweating known as "hot flashes." Cenestin tablets, containing a synthetic form of conjugated estrogens, may also be prescribed for these symptoms. In addition to the symptoms of menopause, Premarin tablets are prescribed for teenagers who fail to mature at the usual rate, and to relieve the symptoms of certain types of cancer, including some forms of breast and prostate cancer. In addition, either the tablets or Premarin vaginal cream can be used for other conditions caused by lack of estrogen, such as dry, itchy external genitals and vaginal irritation. Along with diet, calcium supplements, and exercise, Premarin tablets are also prescribed to prevent osteoporosis, a condition in which the bones become brittle and easily broken. The addition of progesterone to estrogen-replacement therapy has been shown to reduce the risk of uterine cancer. Prempro combines estrogen and progesterone in a single tablet taken once daily. Premphase is a 28-day supply of tablets. The first 14 contain only estrogen. The second 14 supply both estrogen and progesterone. Both Prempro and Premphase are prescribed to reduce the symptoms of menopause, including vaginal problems, and to prevent osteoporosis.

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: Take Premarin exactly as prescribed. Do not share it with anyone else. If you are taking calcium supplements as a part of the treatment to help prevent brittle bones, check with your doctor about how much to take. You should take a few moments to read the patient package insert provided with your prescription. If you are using Premarin vaginal cream, apply it as follows: 1. Remove cap from tube. 2. Screw nozzle end of applicator onto tube. 3. Gently squeeze tube from the bottom to force sufficient cream into the barrel to provide the prescribed dose. Use the marked stopping points on the applicator as a guide. 4. Unscrew applicator from tube. 5. Lie on back with knees drawn up. Gently insert applicator deeply into the vagina and press plunger downward to its original position. To cleanse the applicator, pull the plunger to remove it from the barrel, then wash with mild soap and warm water. Do not boil or use hot water. --If you miss a dose... Take the forgotten dose as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Never try to "catch up" by doubling the dose. --Storage instructions... Store at room temperature.

What side effects may occur: Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor immediately. Only your doctor can determine whether it is safe to continue taking Premarin. Side effects of conjugated estrogens may include: Abdominal cramps, abnormal vaginal bleeding, allergic reactions, bloating, blood clots, breast swelling and tenderness, depression, dizziness, enlargement of benign tumors in the uterus, fluid retention, gallbladder disease, hair loss from the scalp, increased body hair, inflammation of the pancreas, intolerance to contact lenses, migraine headache, nausea, sex-drive changes, skin darkening, especially on the face, skin rash or redness, swelling of wrists and ankles, vaginal yeast infection, vomiting, weight gain or loss, yellow eyes and skin Other possible side effects of Premphase and Prempro may include: Appetite changes, backache, changes in blood pressure, excessive flow of breast milk, eye disorders, fatigue, fever, headache, nervousness, sleep disturbances, twitching Other possible side effects of Cenestin may include: Constipation, cough, diarrhea, gas, heavy bleeding during menstruation, increased heartbeat, increased muscle tone, indigestion, infection, joint pain, leg cramps, muscle pain, pain, painful menstruation, runny nose, skin tingling, sore throat, weakness

Why should this drug not be prescribed: Do not take Premarin if you have ever had a bad reaction to it, or have undiagnosed abnormal vaginal bleeding. Except in certain special circumstances, you should not be given Premarin if you have breast cancer or any other "estrogen-dependent" cancer. Do not take Premarin if you have had any circulation problem involving blood clots.

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. Also, if you have endometriosis (uterine tissue growing outside the uterus), estrogen therapy may make the condition worse. If you've ever had endometriosis, make sure the doctor is aware of it. Some studies have shown that women taking estrogen for prolonged periods of time face a slightly increased risk of breast cancer, and a study by the National Heart, Lung and Blood Institute has confirmed an increased risk among women taking the estrogen/progesterone combination product Prempro. Use combination products (and estrogen-only preparations, too) with special caution if you have a family history of breast cancer or have ever had an abnormal mammogram. Be sure to get an annual breast exam from your doctor, and do your own self-examination each month. Women who take Premarin after menopause are more likely to develop gallbladder disease. Women taking Premarin face an increased--though still slight--risk of blood clots. These clots can cause phlebitis, stroke, heart attack, a loss of blood supply to the lungs, a blockage in the blood vessels serving the eye, and other serious disorders. Recent studies have confirmed an increased rate of heart attack, stroke, and dangerous clots among women taking estrogen or an estrogen/progesterone combination. While taking Premarin, get in touch with your doctor right away if you notice any of the following: Abdominal pain, tenderness, or swelling Abnormal bleeding from the vagina Breast lumps Coughing up blood Pain in your chest or calves Severe headache, dizziness, or faintness Sudden shortness of breath Vision changes Yellowing of the skin Estrogen therapy has also been known to cause an increase in blood pressure. Ask your doctor to check your blood pressure regularly. If you have high levels of fat in your blood, specifically a high triglyceride level, conjugated estrogens are likely to cause side effects in the pancreas. If you are using Premarin vaginal cream, you should be aware that this product can weaken latex condoms, diaphragms, and cervical caps.

Possible food and drug interactions when taking this medication: If Premarin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Premarin with the following: Barbiturates such as phenobarbital Blood thinners such as Coumadin Drugs used for epilepsy, such as Dilantin Major tranquilizers such as Thorazine Oral diabetes drugs such as Micronase Rifampin (Rifadin) Steroid medications such as Deltasone Thyroid preparations such as Synthroid Tricyclic antidepressants such as Elavil and Tofranil Vitamin C

Special information if you are pregnant or breastfeeding: If you are pregnant or plan to become pregnant, notify your doctor immediately. Premarin and conjugated estrogens in general, should not be taken during pregnancy because of the possibility of harm to the unborn child. Premarin cannot prevent a miscarriage. Estrogens can decrease the quantity and quality of breast milk, and progestins appear in breast milk. Your doctor may advise you not to breastfeed while you are taking this drug.

Recommended dosage: Your doctor will start therapy with this medication at a low dose and adjust the dosage according to your response. He or she will want to check you periodically at 3- to 6-month intervals to determine the need for continued therapy. PREMARIN TABLETS: Hot flashes associated with menopause The usual dosage is 0.625 milligrams daily, taken continuously or in cycles such as 25 days on Premarin and 5 days off. Tissue degeneration in the vagina The usual dosage is 0.3 to 1.25 milligrams or more daily, taken continuously or in cycles. Low estrogen levels due to reduced ovary function The usual dosage is 0.3 to 0.625 milligrams daily, taken cyclically. Ovary removal or ovarian failure The usual dosage is 1.25 milligrams daily, cyclically. Prevention of osteoporosis (loss of bone mass) The usual dosage is 0.625 milligram daily, taken continuously or in cycles. Advanced androgen-dependent cancer of the prostate, for relief of symptoms only The usual dosage is 1.25 to 2.5 milligrams 3 times daily. Breast cancer (for relief of symptoms only) in appropriately selected women and men with metastatic disease The suggested dosage is 10 milligrams 3 times daily for a period of at least 3 months. Tell your doctor if you have any unusual bleeding. PREMARIN VAGINAL CREAM: Given cyclically for short-term use only. Degeneration of genital tissue or severe itching in the genital area The recommended dosage is one-half to 2 grams daily, inserted into the vagina, depending on the severity of the condition. You will use the cream for 3 weeks, then stop for 1 week. Tell your doctor if you notice any unusual bleeding. PREMPHASE TABLETS: Follow a 28-day cycle. Take 1 maroon Premarin tablet every day for the first 14 days; on the 15th day, begin taking 1 light-blue tablet daily. PREMPRO TABLETS: The usual starting dose is one 0.625-milligram/2.5-milligram tablet once a day. If this dose proves insufficient, your doctor may increase the dose to one 0.625-milligram/5-milligram tablet once a day. CENESTIN TABLETS: The usual starting dose is 0.625 milligrams a day. If this proves insufficient, the doctor may gradually increase the dose up to a maximum of 1.25 milligrams daily.

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

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