Conjugated Oestrogens

Registered South African indications: 

• Dysfunctional uterine bleeding

Contraindications

• Hypersensitivity to the active ingredient or any of the excipients 
• Hepatic impairment
• Breast cancer
• Estrogen-dependent malignant tumours
• Undiagnosed genital bleeding
• Untreated endometrial hyperplasia
• Venous thromboembolism 
• Thrombophilic disorders
• Arterial thromboembolic disease 
• Porphyria

Cautions

• Breastfeeding
• Renal impairment
• Intact uterus
• Endometriosis
• Inherited thrombophilia
• Preexisting hypertriglyceridemia
• Risk factors for ovarian cancer
• Asthma
• Diabetes
• Cardiovascular disease
• Hypercholesterolemia
• Hypertension
• Systemic lupus erythematosis
• Obesity
• Tobacco use
• Epilepsy
• Gallbladder disease
• Hepatic hemangiomas
• Hereditary angioedema
• Hypoparathyroidism
• Migraine
• Osteoporosis

Forms avail. in SA and covered in this monograph: inj

Dysfunctional uterine bleeding
-When all organic causes have been ruled out as possible aetiologic factors

• IM/IV: 25mg

Emergency to control spontaneous capillary bleeding

• IM/IV: 25mg; Repeated at 1hr intervals; Max: 3 doses

IV route is preferred since a more rapid response can be expected

Compatible with normal saline, dextrose and invert sugar solutions. Not compatible with protein hydrolysate, ascorbic acid or any solution with an acid pH

Not established for use in children

Pregnancy

• Not indicated during pregnancy
• If pregnancy occurs during medication with conjugated oestrogens treatment should be withdrawn immediately. The results of most epidemiological studies to date relevant to inadvertent foetal exposure to estrogens indicate no teratogenic or foetotoxic effects

Breastfeeding

• Caution; not recommended
• Conjugated oestrogens are not indicated during breastfeeding

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• Contraindicated

Elderly

• No dose adjustment recommended
  The lowest effective dose should be used

Porphyria Information

• Probably porphyrinogenic (PRP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Dizziness
• Headache
• Migraine
• Nervousness

Cardiovascular Disorders

• Pulmonary embolism
• Venous thrombosis
• Superficial thrombophlebitis
• Hypotension
• Phlebitis

Gastrointestinal Disorders

• Bloating
• Abdominal pain
• Nausea and vomiting

Genitourinary Disorders

• Breast pain

Skin and Subcutaneous Tissue Disorders

• Injection site pain
• Injection site oedema
• Oedema
• Rash

Immune, Blood and Lymphatic System Disorders

• Anaphylactic reactions

• Benzyl alcohol
• Thyroid replacement therapy
• Anastrozole
• Anticoagulants
• CYP3A4 inducers 
• Dehydroepiandrosterone
• Exemestane
• Hyaluronidase
• Pomalidomide
• Somatropin
• St John's wort
• Tipranavir
• Tizanidine

• Blood pressure
• Papanicolaou smear
• Breast examination
• Mammogram

Specific cases may require

• Endometrial sampling
• Blood glucose
• Lipid profiles
• Thyroid function

The pharmacologic effects of conjugated oestrogens are similar to those of endogenous oestrogens.

Injection (per vial) 25mg

• Premarin (Pfizer) originator

Also available in the following forms: Tablet and vaginal cream.