conjugated estrogens vaginal cream, Premarin Vaginal Cream (cont.)

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DOSING: The recommended dose is 0.5 to 2 grams administered daily for 21 days then off for 7 days. Twice weekly administration may also be used. Vaginal products work best if used at bedtime. The hands should first be washed and the applicator filled with cream from the tube. Lying on the back with the knees bent, individuals should insert the applicator into the vagina and push the applicator's plunger to deliver the cream. The applicator and plunger then should be washed with warm, soapy water and rinsed with plain water. The hands should be washed before and after use. A small amount of the cream also can be applied to the outer skin folds or "lips" of the vagina (vulvae) to relieve dryness or irritation.

DRUG INTERACTIONS: Premarin drug interaction studies have not been conducted. Estrogens are broken down in the liver by certain enzymes. Drugs that increase or decrease the activity of these enzymes may interfere with the action of Premarin. Rifampin (Rifadin), barbiturates, carbamazepine (Tegretol), griseofulvin (Grifulvin), phenytoin (Dilantin), St. John's wort, and primidone may increase the elimination of estrogen by enhancing the liver's ability to eliminate estrogens. Use of any of these medications with estrogens may result in a reduction of the beneficial effects of estrogens. Conversely, drugs such as erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), and ritonavir (Norvir) may reduce the elimination of estrogens by the liver and lead to increased levels of estrogens in the blood and increased effects. Grapefruit juice also may increase levels of estrogen by increasing the absorption of estrogens from the intestine. Increased levels of estrogens in the blood may result in more estrogen-related side effects.

PREGNANCY: Estrogens should be avoided during pregnancy since they increase the risk of fetal abnormalities.

NURSING MOTHERS: Estrogens are secreted in milk and cause unpredictable effects in the infant. In general, they should not be used by women who are breastfeeding.



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