GENERIC NAME: estropipate

BRAND NAME: Ogen

DRUG CLASS AND MECHANISM: Estropipate is a crystalline form of estrone, a form of estrogen. Estrogens, when taken alone or in combination with a progestin, have been shown to reduce the risk for hip fracture due to osteoporosis by 25%, the risk of heart attack (myocardial infarction) and stroke by 40-50%. Estropipate is used for numerous medical situations. Estrogens cause growth and development of female sex organs and the maintenance of sex characteristics, including growth of underarm and pubic hair and shaping of body contours and skeleton. Estrogens also increase secretions from the cervix and growth of the inner lining of the uterus (endometrium). Estrogens reduce LDL-cholesterol ("bad" cholesterol) and increase HDL-cholesterol ("good" cholesterol) concentrations in the blood.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Tablets: 0.625mg, 1.25mg, 2.5mg.

STORAGE: Tablets should be stored between 2° (36°F) and 30°C (86°F).

PRESCRIBED FOR: Estropipate is prescribed for treatment of the usual symptoms associated with menopause (hot flashes, vaginal dryness), prevention of bone fractures associated with osteoporosis, and dysfunctional (excessive and painful) uterine bleeding.

DOSING: Estropipate is generally prescribed once daily.

DRUG INTERACTIONS: Estrogens can inhibit the metabolism of cyclosporine, resulting in increased cyclosporine levels in blood. Such increased blood levels can result in kidney and/or liver damage. If this combination cannot be avoided, cyclosporine concentrations can be monitored, and the dose of cyclosporine can be adjusted to assure that its blood levels are not elevated.

Estrogens appear to increase the risk of liver disease in patients receiving dantrolene through an unknown mechanism. Women over 35 years of age and those with a history of liver disease are especially at risk. Estrogens increase the liver's ability to manufacture clotting factors. Because of this, patients receiving warfarin (Coumadin) need to be monitored for loss of the anticoagulant effect (blood thinning) of warfarin if estrogens like estropipate are added.

Rifampin, barbiturates, carbamazepine (Tegretol), griseofulvin, phenytoin (Dilantin) and primidone, all can increase the elimination of estrogens by enhancing the liver's ability to metabolize (break down) the estrogens. Thus, concurrent use of these drugs and estrogens may result in reduction of the beneficial effects of estrogens.

PREGNANCY: Estrogens are should be avoided during pregnancy due to an increased risk of fetal abnormalities.

NURSING MOTHERS: Estrogens are secreted in milk and cause unpredictable effects in the infant. They are generally avoided during breast-feeding.

SIDE EFFECTS: Among the most common endocrine side are break-through vaginal bleeding or spotting, loss of periods or excessively prolonged periods, breast pain, breast enlargement, and changes in sexuality (increase or decrease in libido). Abdominal pain may result from obstruction of the gallbladder due to gallstones or hepatitis caused by the estrogen. Migraine headaches have been associated with estrogen therapy. Estrogens can cause sodium and fluid retention leading to swelling in the legs. Melasma, tan or brown patches, may develop on the forehead, cheeks, or temples. These may persist even after the estrogen is stopped. Conjugated estrogens (estrogens attached to other chemicals) may cause an increase in the curvature of the cornea, and patients with contact lenses may develop intolerance to their lenses.

Blood clots are occasional, serious adverse reactions of estrogen therapy and are dose-related. (The higher the dose, the more likely are clots.) Cigarette smokers are at a higher risk for developing clots while taking estrogens, and patients requiring estrogen therapy are strongly encouraged to quit smoking.

Estrogens can promote a buildup of the uterine lining (endometrial hyperplasia) and increase the risk of endometrial carcinoma (cancer). At diagnosis, endometrial cancers in estrogen recipients are generally at an earlier stage and a lower grade making cure more likely. Survival is better in women exposed to estrogens than in those not exposed to estrogens. The addition of a progestin to estrogen therapy offsets the risk of endometrial carcinoma by counteracting the stimulatory effects of estrogens on the endometrium.

Conflicting data exists on the association between estrogens and breast cancer, but there may be a small increase in risk. It is unclear if concomitant estrogen and progestin therapy, as with endometrial cancer, reduces the risk of estrogen-induced breast cancer.

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From the Doctors at MedicineNet.com

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Last Editorial Review: 3/26/1998 2:30:00 PM