estrogens conjugated synthetic, Cenestin (cont.)

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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.

PREGNANCY: Estrogens such as Cenestin should not be used during pregnancy because they increase the risk of birth defects in the fetus.

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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