Menopause and HRT:
Indications for Estropipate:
Moderate to severe vasomotor symptoms or vulvar and vaginal atrophy due to menopause. Hypoestrogenism due to hypogonadism, castration or primary ovarian failure. Postmenopausal osteoporosis prevention.
Menopausal symptoms: 0.75–6mg once daily, given cyclically. Discontinue or taper at 3- to 6-month intervals. Female hypogonadism: 1.5–9mg once daily for 3 weeks, followed by 8–10 days rest period; repeat same dose if no bleeding occurs after rest period. May add progestogen during the third week of cycle if withdrawal bleeding does not occur. Female castration, ovarian failure: 1.5–9mg once daily for 3 weeks, followed by 8–10 days rest period; adjust dose based on symptom severity and response. Osteoporosis prevention: 0.75mg once daily, given cyclically (25 days of a 31-day cycle).
Undiagnosed abnormal genital bleeding. Breast or other estrogen-dependent neoplasms. Thromboembolic disorders (eg, DVT, PE, stroke, MI). Hepatic impairment or disease. Pregnancy.
Endometrial cancer. Cardiovascular disorders. Probable dementia.
Increased risk of endometrial carcinoma or hyperplasia in women with intact uterus (adding progestin is essential). Not for prevention of cardiovascular disease or dementia. Increased risk of cardiovascular events (eg, MI, stroke, VTE); discontinue if occurs. Manage risk factors for cardiovascular disease and venous thromboembolism appropriately. Discontinue at least 4–6 weeks before surgery type associated with increased risk of thromboembolism or during prolonged immobilization. Increased risk of breast or ovarian cancer. Risk of probable dementia in women >65yrs of age. Gallbladder disease. Severe hypercalcemia in breast cancer or bone metastases. Visual abnormalities. Hypertriglyceridemia. Discontinue if cholestatic jaundice, hypercalcemia, or retinal vascular lesions occur. Monitor thyroid function. Conditions aggravated by fluid retention. Severe hypocalcemia. Endometriosis. Asthma. Diabetes. Epilepsy. Migraine. Porphyria. SLE. Hepatic hemangiomas. Do initial complete physical and repeat annually (include Pap smear, mammogram, and BP). Reevaluate periodically. Nursing mothers.
May be potentiated by CYP3A4 inhibitors (eg, erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir, grapefruit juice). May be antagonized by CYP3A4 inducers (eg, phenobarbital, carbamazepine, rifampin, St. John’s wort). Concomitant thyroid replacement; may need to increase thyroid dose. May interfere with lab tests (eg, thyroid, PT, coagulation factors, glucose tolerance, HDL/LDL, triglycerides, hormone concentrations, other binding or plasma proteins).
GI upset, vaginal bleeding pattern changes, mastodynia, hypertension, chloasma, headache, weight changes, edema, intolerance to contact lenses; thromboembolism, neoplasms.
Formerly known under the brand name Ogen.