Buy Estrace Online

Estrace (estradiol)

BOXED WARNING

Estrogens increase the risk of endometrial cancer. Perform adequate diagnostic measures, including endometrial sampling, to rule out malignancy w/ undiagnosed persistent or recurrent abnormal vaginal bleeding. Should not be used for the prevention of cardiovascular disease. Increased risk of MI, stroke, invasive breast cancer, pulmonary embolism (PE), and DVT in postmenopausal women (50-79 yrs of age) reported. Increased risk of developing probable dementia in postmenopausal women ≥65 yrs of age reported. Should be prescribed at the lowest effective dose and for the shortest duration consistent w/ treatment goals and risks.

THERAPEUTIC CLASS

Estrogen

DEA CLASS

RX

INDICATIONS

(Cre) Treatment of vulvar and vaginal atrophy. (Tab) Treatment of moderate to severe vasomotor symptoms associated w/ menopause. Treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated w/ menopause. Treatment of hypoestrogenism due to hypogonadism, castration, or primary ovarian failure. Palliative treatment of breast cancer in appropriately selected women and men w/ metastatic disease, and advanced androgen-dependent prostate carcinoma. Prevention of osteoporosis.

ADULT DOSAGE

Menopausal Vasomotor Symptoms

Moderate to Severe:
Tab:
Initial: 1-2mg/day
Maint: Minimal effective dose should be determined by titration; Administer cyclically (eg, 3 weeks on and 1 week off)

Use the lowest effective dose for the shortest duration; reevaluate at 3- to 6-month intervals

Menopausal Vulvar/Vaginal Atrophy

Cre:
Usual: 2-4g/day for 1-2 weeks; then gradually reduce to 1/2 initial dose for a similar period
Maint: 1g 1-3X/week

Tab:
Moderate to Severe:
Initial: 1-2mg/day
Maint: Minimal effective dose should be determined by titration; Administer cyclically (eg, 3 weeks on and 1 week off)

Use the lowest effective dose for the shortest duration; reevaluate at 3- to 6-month intervals

Hypoestrogenism

Due to Hypogonadism, Castration, or Primary Ovarian Failure:
Tab:
Initial: 1-2mg/day
Titrate: Adjust as necessary to control presenting symptoms
Maint: Minimal effective dose should be determined by titration

Breast Cancer

Palliative Treatment in Appropriately Selected Women and Men w/ Metastatic Disease:
Tab:
10mg tid for at least 3 months

Prostate Carcinoma

Palliative Treatment of Advanced Androgen-Dependent Carcinoma:
Tab:
1-2mg tid

Osteoporosis

Prevention:
Tab:
Consider therapy for women at risk of osteoporosis and for whom non-estrogen medications are not appropriate, when used solely for prevention of postmenopausal osteoporosis

ADMINISTRATION

Cre
Intravaginal route

Tab
Oral route

HOW SUPPLIED

Cre: 0.01% [42.5g]; Tab: 0.5mg*, 1mg*, 2mg* *scored

CONTRAINDICATIONS

Undiagnosed abnormal genital bleeding, known/suspected/history of breast cancer, known/suspected estrogen-dependent neoplasia, active/history of DVT/PE, active or recent arterial thromboembolic disease (eg, stroke, MI), liver dysfunction or disease, known/suspected pregnancy.

WARNINGS/PRECAUTIONS

D/C immediately if stroke, DVT, PE, or MI occur or is suspected. Caution in patients w/ risk factors for arterial vascular disease and/or venous thromboembolism. If feasible, d/c at least 4-6 weeks before surgery of the type associated w/ an increased risk of thromboembolism, or during periods of prolonged immobilization. May increase the risk of gallbladder disease and ovarian cancer. May lead to severe hypercalcemia in patients w/ breast cancer and bone metastases; d/c and take appropriate measures if hypercalcemia occurs. Retinal vascular thrombosis reported; d/c pending exam if sudden partial/complete loss of vision, or sudden onset of proptosis, diplopia, or migraine occurs. D/C permanently if exam reveals papilledema or retinal vascular lesions. Consider addition of progestin for women w/ a uterus or w/ residual endometriosis post-hysterectomy. May elevate BP and thyroid-binding globulin levels. May elevate plasma TGs leading to pancreatitis in patients w/ preexisting hypertriglyceridemia. Caution w/ impaired liver function, and history of cholestatic jaundice associated w/ past estrogen use or w/ pregnancy; d/c in case of recurrence. May cause fluid retention; caution w/ cardiac/renal impairment. Caution w/ severe hypocalcemia. May exacerbate endometriosis, asthma, diabetes mellitus, epilepsy, migraine, porphyria, systemic lupus erythematosus, and hepatic hemangiomas; use w/ caution. May affect certain endocrine and blood components in lab tests. (Tab) 2mg tab contains tartrazine, which may cause allergic-type reactions (eg, bronchial asthma) in certain susceptible individuals.

ADVERSE REACTIONS

Vaginal bleeding pattern changes, vaginitis, breast tenderness, galactorrhea, N/V, thrombophlebitis, melasma, abdominal cramps, headache, mental depression, weight changes, edema, libido changes, MI, PE.

DRUG INTERACTIONS

CYP3A4 inducers (eg, St. John's wort preparations, phenobarbital, carbamazepine, rifampin) may decrease levels, which may decrease therapeutic effects and/or change uterine bleeding profile. CYP3A4 inhibitors (eg, erythromycin, ketoconazole, ritonavir, grapefruit juice) may increase levels, which may result in side effects. Patients concomitantly receiving thyroid replacement therapy and estrogens may require increased doses of thyroid replacement therapy; monitor thyroid function.

PREGNANCY AND LACTATION

(Cre) Contraindicated in pregnancy, (Tab) Category X; caution in nursing.

MECHANISM OF ACTION

Estrogen; binds to nuclear receptors in estrogen-responsive tissues. Circulating estrogens modulate pituitary secretion of gonadotropins, luteinizing hormone and follicle-stimulating hormone, through a (-) feedback mechanism. Reduces elevated levels of these hormones in postmenopausal women.

PHARMACOKINETICS

Absorption: (Cre) Absorbed through skin, mucous membranes, and GI tract. Distribution: Largely bound to sex hormone-binding globulin and albumin; found in breast milk. Metabolism: Liver to estrone (metabolite); estriol (major urinary metabolite); sulfate and glucuronide conjugation (liver); biliary secretion of conjugates into the intestine; hydrolysis (gut); reabsorption; CYP3A4 (partial metabolism). Elimination: Urine (parent compound and metabolites).

ASSESSMENT

Assess for undiagnosed abnormal genital bleeding, presence/history of breast cancer, estrogen-dependent neoplasia, active/history of DVT/PE/arterial thromboembolic disease, liver impairment/disease, history of cholestatic jaundice, drug hypersensitivity, pregnancy/nursing status, any other conditions where treatment is contraindicated or cautioned, need for progestin therapy, and possible drug interactions.

MONITORING

Monitor for signs/symptoms of CV events, malignant neoplasms, dementia, gallbladder disease, hypercalcemia, visual abnormalities, BP and serum TG elevations, pancreatitis, fluid retention, cholestatic jaundice, exacerbation of endometriosis and other conditions, and other adverse reactions. Perform annual breast exam; schedule mammography based on age, risk factors, and prior mammogram results. Monitor thyroid function in patients on thyroid hormone replacement therapy. Periodically evaluate (every 3-6 months) to determine need for therapy. In cases of undiagnosed, persistent, or recurrent abnormal vaginal bleeding, perform adequate diagnostic measures (eg, endometrial sampling) to rule out malignancy.

PATIENT COUNSELING

Inform of the risks/benefits of therapy. Inform that medication increases risk for breast/uterine cancer. Advise to contact physician if breast lumps, unusual vaginal bleeding, dizziness or faintness, changes in speech, severe headaches, chest pain, SOB, leg pain, visual changes, or vomiting occur. Advise to have yearly breast exams by a physician and perform monthly breast self-exams. Advise to notify physician if pregnant/nursing.

STORAGE

(Cre) Room temperature. Protect from temperatures in excess of 40°C (104°F). (Tab) 20-25°C (68-77°F).

TAGS

estrace coupons, estrace cost cream, estrace ivf birth defects, estrace and ivf pregnancy, estrace discount coupons, estrace 2mg tablets price, prometrium and estrace after ivf, estrace 0 5, buy estrace cream uk, estrace tablets ivf, estrace 1mg tablets, estrace cream side effects, estrace whithout prescrition, estrace cream coupon offers, estrace tablets cost, estrace ivf dosage, take pueraria mirifica with estrace, ordering estrace without prescription, estrace creme, estradiol (estrace) 1 mg tablet, estrace cream costco, cost of estrace without insurance, estrace canadian pharmacy, using estrace for ivf, estrace 2mg tablets ivf, estrace .5mg, low cost estrace cream, cost of estrace cream without insurance, estrace dosage for ivf, estrace ivf how long, estrace 0.5 mg tablet, buy estrace online uk, free estrace cream coupon, estrace for ivf side effects, estrace cream price comparisons, estrace cream cost, generic estrace pills, estrace price, estrace cream discount coupon, estrace cream printable coupon, estrace 2mg tabs, estrace cream coupon 2013, estrace manufacturer coupon, buy estrace uk, estrace wirkstoff, estrace 2 mg reviews, estrace 2mg tablets side effects, what is the dosage for estrace cream, medicament estrace 1 mg, estrace online, buy estrace cream canada, estrace vaginal cream buy cheap, prometrium and estrace ivf, buy estrace cream online, estrace cream reviews, side effects of estrace pills for ivf, estrace 0.01 cream price, estrace cream discount coupons, estrace 2mg tablets for ivf, estrace 1 mg daily, estrace 0.01 cream, estrace tablets prescribing information, purchase estradiol online, estrace cream price walmart, retail cost of estrace, estrace 2 mg, estrace and ivf and side effects, estrace manufacturer coupons, what is the lowest dose of estrace cream, estrace cream copay coupon, estrace estradiol 2mg, estrace ivf tablets, estrace price canada, buy estrace, where to buy estrace online, estrace cream, estrace 0.01 cream dosage, buy estrace cream, estrace tablets ivf pregnancy, estradiol online, estrace vaginal cream coupon, estrace 0.01 cream generic, buy cheap estradiol, warner chilcott estrace cream coupons, buy estrace pills online, buy generic estrace cream, canadian pharmacy estrace, estrace cost, estrace 1mg cream, estrace tablets benefits, estrace cream benefits, estrace 2mg ivf side effects, what is estrace cream made from, estrace 1 mg effets secondaires, estrace 1 mg co, purchase estrace cream online, cost of estrace vag cream, estrace cream directions, order estradiol online, estrace cream online pharmacy, estrace 2 mg for fertility, estrace ivf pregnancy, estrace o.5, estrace 2mg, buy estrace 2mg, estrace coupon warner chilcott, purchase estradiol, estrace 0.01 cream side effects, estrace tablets 2mg, is estrace and estradiol the same thing, estrace pills for ivf, estradiol buy, estrace vaginal cream dosage, estrace 2 mg and iui, estrace vag cream coupon, estrace cream no prescription, order estrace on line, estrace 0.5 mg side effects, estrace 0.01 cream coupon, buy estrace tablets, buy estrace online, warner chilcott estrace cream coupon, what is estrace cream, luteal estrace antagonist protocol for ivf, what is estrace cream prescribed for, warner chilcott estrace coupons, purchase estrace online, estrace cream price compare, average cost of estrace, canadian pharmacy estrace cream, buy estrace pills, where to buy estrace canada, estrace cream online, estrace 2 mg twice a day, estrace cream price online, what is estrace cream used for, estrace ivf missed dose, buy estrace cream cheap, estrace no perscription, estrace 0.5 mg co, generic estradiol vs estrace, difference between estrace and estradiol, do you need a prescription for estrace, buy estradiol valerate, estrace tablets reviews, estrace 0.01 cream cost, estradiol buy online, estrace cream coupons, estrace pills fast shipping, what is estrace 0.01 cream used for, buy ethinyl estradiol, where to buy estradiol, estrace .5, estrace cream price, estrace without prescription, cost of estrace cream, estrace ivf protocol, estrace tablets, estrace estradiol cream, estrace 0.5 mg tab, estrace coupon, cheapest place to buy estrace cream, estrace 1mg, estrace estradiol valerate, estrace 0.5 mg, estrace tablets during ivf, estrace tablets manufacturer, estrace cream manufacturer coupon, estrace cream 1mg, cost of estrace cream at walmart, estrace pills price, estrace ivf side effects, generic estrace cream cost, estrace o.5 mg, cost of estrace pills, estrace 1mg side effects, buy estradiol cream, estrace without prescriptions, estrace ivf, estrace and ivf, what is the cost of estrace cream, estrace vs estradiol, estrace cream generic, estrace online pharmacy, cost of estrace cream vs premarin, estrace tab 1mg, estrace .5mg pill, best price estrace cream, estrace and progesterone after ivf, order estradiol, estrace 1mg tab, estrace pills online, estrace price comparison, estrace 1 mg comp, estrace cream coupon, estrace and weight gain ivf, estrace vag cream coupons, how much does estrace cost, cheap estradiol, estrace for ivf, how much does estrace cream cost, estrace .5mg side effects, estrace cream coupon card, estrace 2mg cost, estrace on line with no prescription, estrace estradiol source, cost of estrace tablets, estrace 2mg price, purcghase estrace with paypal, estrace estradiol, estrace 01 cream cost, cost of estrace, buying estrace in canada, estrace estradiol pills, estrace tablets and ivf, is estrace a controlled substance, estrace, estrace 2 mg estradiol, estrace cream price cvs, estrace cream dosage, generic estradiol, estrace 1 mg, estrace cream coupon warner chilcott, estrace ivf fet, estrace tablets price, estrace coupon code, estrace estradiol side effects, estrace tablets dosage