IMPORTANT PREMARIN WARNING:

Why is Premarin prescribed?

Estrogen (Premarin) is a hormone, a substance produced by the body. Premarin is needed for normal growth and development of female sex organs and for functions such as bearing children. During menopause, the bodys production of Estrogen (Premarin) is decreased. Estrogen (Premarin) replacement is used for symptoms associated with menopause: hot flashes (feelings of warmth in the face, neck, and chest), sweating, sleep disturbance, vaginal discomfort (dryness and itchiness), poor concentration, and irritability. Premarin also is used in the treatment of breast cancer in postmenopausal women and breast and prostate cancer in men.

Estrogen (Premarin) is also used with diet, calcium supplements, and exercise to slow the progression of osteoporosis, a disease common in women after menopause resulting in bones that break easily.

How should Premarin be used?

Estrogen (Premarin) comes as a tablet to take by mouth, patches to apply externally to the skin, and as a cream to be inserted into the vagina.

Oral Estrogen (Premarin) is usually taken by mouth with food or milk either every day or on a cyclical basis: once a day for 21 days and then no Premarin for 7 days; then the Premarin cycle is repeated. However, for treating cancer Premarin usually is taken three times a day every day for at least 3 months.

Premarin Skin patches are usually applied either once or twice weekly for three weeks (on the same days each week), followed by 1 week without Premarin (patch); then the Premarin cycle is repeated. The Premarin package is designed to help you remember when to apply fresh skin patches.

To apply a Premarin skin patch, follow the Premarin directions provided and these steps:

• Remove the Premarin skin patch from its protective pouch and peel off the protective strip, exposing the adhesive surface.
• Place the adhesive side against a clean, dry, and not excessively hairy area of skin on the trunk of your body, preferably your abdomen (not your waistline or breasts, since tight clothing may rub the patch). Do not apply the Premarin patch to oily, broken, or irritated skin.
• Press the Premarin patch on the selected site firmly with the palm of your hand for about 10 seconds, making sure that the edges adhere to your skin. If the Premarin patch accidentally comes off, you can either reapply it or apply a fresh Premarin patch, but follow your regular Premarin dosing schedule.

Remove and discard the Premarin patch and apply a fresh Premarin patch according to the schedule prescribed by your doctor. To prevent skin irritation, use a different site for each Premarin application and wait at least 1 week before using a particular area again. Used Premarin patches should be cut up and disposed in a way that keeps them out of reach of children and pets.

To use the vaginal cream, your doctor will set up a Premarin dosage schedule for you. If you are to use Premarin once a day, it is best to use Premarin at bedtime. Follow the Premarin directions that come with the Premarin vaginal cream and these steps:

• Fill the special Premarin applicator that comes with the Premarin cream to the level indicated.
• Lie on your back with your knees drawn upward and spread apart.
• Gently insert the Premarin applicator into the vagina; then push the plunger to release the Premarin medication.
• Withdraw the Premarin applicator.
• Discard the Premarin applicator if it is disposable. If the Premarin applicator is reusable, pull it apart and clean it with soap and warm water after each use.
• Wash your hands promptly.

Ask your pharmacist or doctor any questions you have about using the Premarin vaginal cream. You may wish to wear a sanitary napkin after inserting the Premarin cream to keep your clothes clean.

Follow the Premarin directions on your Premarin prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take Estrogen (Premarin) exactly as directed. Do not take more or less Premarin or take Premarin more often than prescribed by your doctor. Do not stop taking Estrogen (Premarin) without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturers Premarin information for the patient.

Other uses for Premarin

Premarin may be prescribed for other uses; ask your doctor or pharmacist for more Premarin information.

What special Premarin precautions should I follow?

Before taking Estrogen (Premarin),

• tell your doctor and pharmacist if you are allergic to Estrogen (Premarin), aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially antibiotics or anti-infectives, anticoagulants (blood thinners) such as warfarin (Coumadin), carbamazepine (Tegretol), phenobarbital, phenylbutazone, phenytoin (Dilantin), primidone (Mysoline), rifampin, steroids (Decadron, Medrol, Prednisone), and vitamins.
• tell your doctor if you have or have ever had asthma; epilepsy (seizures); migraine headaches; history of depression; liver, heart, gallbladder, or kidney disease; jaundice (yellowing of the skin or eyes); genital bleeding; and excessive weight gain and fluid retention (bloating) during the menstrual cycle.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking Estrogen (Premarin), call your doctor immediately.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking Estrogen (Premarin).
• tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of Premarin.
• tell your doctor and pharmacist if you wear contact lenses.

What special Premarin dietary instructions should I follow?

Follow all Premarin dietary and exercise recommendations, including those regarding calcium supplements, if you are taking Estrogen (Premarin) to treat osteoporosis.

What should I do if I forget a Premarin dose?

If you forget to apply a Premarin skin patch, apply it as soon as you remember; note the date on the package, and adjust your schedule. If you miss a Premarin dose of tablets or Premarin vaginal cream, take it (or apply it) as soon as you remember. However, if it is almost time for the next Premarin dose, skip the missed Premarin dose and continue your regular Premarin dosing schedule. Do not take a double Premarin dose to make up for a missed one.

What side effects can Premarin cause?

Estrogen (Premarin) may cause side effects. Tell your doctor if any of these Premarin symptoms are severe or do not go away:

• upset stomach
• stomach cramps
• bloating
• diarrhea
• appetite and weight changes
• glucose intolerance (increased blood sugar)
• brown or black skin patches
• acne
• swelling of the hands, feet, or lower legs (fluid retention)
• increased blood pressure
• bleeding or spotting between menstrual periods
• changes in menstrual flow
• painful or missed periods
• breast tenderness, enlargement, or secretion
• intolerance to contact lenses

Some Premarin side effects may be serious. The following Premarin symptoms are uncommon, but if you experience any of them or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• severe stomach pain
• yellowing of the skin or eyes
• severe mental depression
• unusual bleeding
• loss of appetite

Estrogen (Premarin) may cause other side effects. Call your doctor if you have any unusual problems while taking Premarin.

What storage conditions are needed for Premarin?

Keep Premarin in the container it came in, tightly closed, and out of reach of children. Store Premarin at room temperature and away from excess heat and moisture (not in the bathroom). Do not remove Premarin skin patches from their protective pouches until just before applying them. Discard Premarin patches by cutting them into pieces and disposing of them in a way that keeps them out of reach of children and pets. Throw away any Premarin that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your Premarin.

In case of Premarin emergency/overdose

In case of Premarin overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

What other Premarin information should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination, including blood pressure measurements, breast and pelvic exams, and a Pap test at least yearly. Follow your doctors directions for examining your breasts; report any lumps immediately.

Before you have any laboratory tests, tell the laboratory personnel that you take Estrogen (Premarin), because Premarin may interfere with some laboratory tests.

Do not let anyone else take your Premarin. Ask your pharmacist any Premarin questions you have about refilling your Premarin prescription.