estrogens conjugated synthetic, Cenestin
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: conjugated estrogens, synthetic
BRAND NAME: Cenestin
DRUG CLASS AND MECHANISM: Cenestin is a combination of nine estrogens. Estrogens are hormones produced by the ovaries that are necessary for the proper development of the female reproductive system and sexual characteristics. After menopause, there is a decrease in the amount of estrogen that is produced by the ovaries. This decrease in estrogen production is responsible for hot flashes, mood changes, sleep disturbance, decreased sexual function and other symptoms associated with menopause. Estrogen deficiency also has been linked to heart disease and bone loss (osteoporosis). Cenestin is similar to conjugated estrogens (Premarin), the other drug used for treating hot flashes. Unlike the estrogens in Premarin which are obtained from natural sources and blended to approximate the composition of estrogens found in urine of pregnant horses, the estrogens in Cenestin are synthetic (man- made) and are produced from plant material. Therefore, the estrogens in Cenestin are different from the estrogens found in Premarin. The FDA approved Cenestin in March 1999.
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 0.3, 0.45, 0.625, 0.9, and 1.25 mg
STORAGE: Tablets should be stored at room temperature, 15 C to 30 C (59 F to 86 F).
PRESCRIBED FOR: Cenestin is used for the relief of moderate to severe hot flashes and vulvar and vaginal atrophy due to estrogen deficiency resulting from menopause.
DOSING: The lowest effective dose should be used, starting with 0.45 mg and gradually increasing to 1.25 mg a day for treatment of hot flashes and 0.3 mg for treatment of vulvar and vaginal atrophy.
DRUG INTERACTIONS: Rifampin, carbamazepine (Tegretol), barbiturates, and St. John's Wort increase the ability of the liver to convert estrogens into inactive compounds. Therefore, use of these drugs with Cenestin may decrease the effectiveness of Cenestin. Conversely, breakdown of estrogens by the liver is reduced by erythromycin, clarithromycin (Biaxin), ketoconazole, itraconazole (Sporanox), ritonavir (Norvir), and grapefruit juice. This increases blood levels of estrogens and may result in increased side effects.
NURSING MOTHERS: Estrogens such as Cenestin may decrease the quantity and quality of breast milk and produce unpredictable effects in the infant. Nursing mothers should avoid taking estrogens.
SIDE EFFECTS: Common side effects of conjugated estrogens include headache, abdominal pain, nervousness, nausea, back pain, joint pain and vaginal bleeding. Patients also may experience vaginal spotting, loss of periods or excessively prolonged periods, breast pain, breast enlargement, and an increase or decrease in sexual drive.
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