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conjugated estrogens/medroxyprogesterone (Prempro, Premphase)

Premarin & Provera combination. Indications: -> hot flashes Contraindications: pregnancy-category X safety in lactation - Dosage: 1 tab PO QD 0.625 mg of Premarin & 2.5 mg Provera 0.625 mg of Premarin & 5.0 mg Provera 0.45 mg of Premarin & 1.5 mg Provera [3] 0.3 mg of Premarin & 1.5 mg Provera [5] Pharmacokinetics: elimination: liver Adverse effects: 1) may increase risk of dementia in women > 65 [3] a) relative risk is small; additional 23 cases/10,000/year b) mechanism may be via increase in ischemic stroke 2) increased risk of urinary incontinence > 65 [3] a) 3 fold increased risk urge incontinence b) 5-fold increased risk of stress incontinence 3) increased risk of breast cancer in older women [4] a) breast cancer developing in women taking Prempro more difficult to detect by mammography due to increase in breast tissue radiographic density [4] b) continuous Progestin appears to be culprit Mechanism of action: 1) estrogen & progestin 2) tends to lower LDL & increase HDL Also see hormone replacement therapy.

Related

hormone replacement therapy (HRT); estrogen replacement therapy; postmenopausal hormone replacement therapy

General

pharmacologic combination

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Prescriber's Letter 7(7):40 2000
  3. Prescriber's Letter 10(6):33,34 2003
  4. Prescriber's Letter 10(8):47 2003
  5. Prescriber's Letter 11(2):suppl 2004
  6. Department of Veterans Affairs, VA National Formulary

Components

conjugated estrogens (Premarin, Enjuvia, Cenestin) medroxyprogesterone actetate; acetoxymethylprogesterone (Provera, Cycrin, Amen)