Conjugated Estrogens

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Conjugated Estrogens Brand Names

Cenestin | Enjuvia | Premarin

What is Conjugated Estrogens

Conjugated estrogens are traditionally a mixture of the water soluble salts of sulfate esters from estrone, equilin, 17 alpha-dihydroequilin, and other related steroids. Traditionally conjugated estrogens are derived from pregnant equine urine (e.g., Premarin).

The estrogens include the sodium salts of estrone sulfate, equilin sulfate, 17alpha- and 17beta-dihydroequilin sulfate, 17alpha- and 17beta-estradiol sulfate, 17alpha- and 17beta-dihydroequilenin sulfate, and equilenin sulfate; the exact composition of the equine urine-derived mixture is uncertain.

The synthetic conjugated estrogens, A product (e.g., Cenestin) is derived from yam and soy plants and contains 9 synthetic estrogenic substances.

The synthetic conjugated estrogens, B product (e.g., Enjuvia), is plant-derived, and includes the active estrogenic component delta 8,9-dyhydroestrone sulfate. The different conjugated estrogens products are not considered to be bioequivalent at this time.

However, there is no evidence that ‘natural’ estrogens are more or less efficacious or safe than ‘synthetic’ estrogens given at equiestrogenic doses.

Conjugated estrogens are used primarily as hormone replacement therapy (HRT) to treat moderate to severe vasomotor symptoms and genitourinary symptoms associated with menopause, and for the prevention of osteoporosis.

Conjugated estrogens are also used for numerous abnormalities related to gonadotropin hormone dysfunction.

Conjugated estrogens were first marketed in 1938; parenteral, oral and vaginal dose forms are available.

Conjugated estrogens, A was approved by the FDA in March 1999.

Conjugated estrogens, B was approved by the FDA in May 2004.

In December 2008, the FDA approved synthetic conjugated estrogens A vaginal cream.

Indications

  1. atrophic vaginitis
  2. dysfunctional uterine bleeding
  3. dyspareunia
  4. hot flashes
  5. hypogonadism
  6. menopause
  7. oophorectomy
  8. osteoporosis prophylaxis
  9. ovarian failure
  10. palliative treatment of breast cancer
  11. prostate cancer

Side Effects

  1. abdominal pain
  2. acne vulgaris
  3. acneiform rash
  4. alopecia
  5. amenorrhea
  6. anaphylactoid reactions
  7. angioedema
  8. anxiety
  9. arthralgia
  10. asthenia
  11. back pain
  12. biliary obstruction
  13. bowel ischemia
  14. breakthrough bleeding
  15. breast cancer
  16. breast discharge
  17. breast enlargement
  18. bronchospasm
  19. candidiasis
  20. cervical dysplasia
  21. cholecystitis
  22. cholelithiasis
  23. cholestasis
  24. colitis
  25. dementia
  26. depression
  27. diarrhea
  28. diplopia
  29. dizziness
  30. dysmenorrhea
  31. dyspepsia
  32. edema
  33. elevated hepatic enzymes
  34. emotional lability
  35. endometrial cancer
  36. endometrial hyperplasia
  37. erythema multiforme
  38. erythema nodosum
  39. fatigue
  40. flatulence
  41. fluid retention
  42. galactorrhea
  43. gingivitis
  44. gynecomastia
  45. headache
  46. hepatitis
  47. hirsutism
  48. hypercalcemia
  49. hyperglycemia
  50. hypertension
  51. hypertriglyceridemia
  52. hypocalcemia
  53. impaired cognition
  54. injection site reaction
  55. insomnia
  56. irritability
  57. jaundice
  58. leukorrhea
  59. libido decrease
  60. libido increase
  61. mastalgia
  62. melasma
  63. migraine
  64. muscle cramps
  65. myalgia
  66. myocardial infarction
  67. nausea
  68. new primary malignancy
  69. ovarian cancer
  70. pancreatitis
  71. papilledema
  72. paresthesias
  73. peliosis hepatis
  74. pelvic pain
  75. peripheral vasodilation
  76. porphyria
  77. pruritus
  78. pulmonary embolism
  79. rash
  80. retinal thrombosis
  81. stroke
  82. teratogenesis
  83. thromboembolism
  84. thrombosis
  85. urinary incontinence
  86. urticaria
  87. vaginal bleeding
  88. vaginal discharge
  89. vaginal irritation
  90. vaginitis
  91. visual impairment
  92. vomiting
  93. weight gain

Monitoring Parameters

  • pap smear
  • pelvic exam

Contraindications

  • asthma
  • benzyl alcohol hypersensitivity
  • breast cancer
  • breast-feeding
  • cardiac disease
  • cerebrovascular disease
  • cervical cancer
  • children
  • contact lenses
  • coronary artery disease
  • dementia
  • depression
  • diabetes mellitus
  • endometrial cancer
  • endometrial hyperplasia
  • endometriosis
  • gallbladder disease
  • geriatric
  • hepatic disease
  • hepatocellular cancer
  • hereditary angioedema
  • history of angioedema
  • hypercalcemia
  • hypercholesterolemia
  • hypertension
  • hypertriglyceridemia
  • hypocalcemia
  • hypoparathyroidism
  • hypothyroidism
  • infants
  • jaundice
  • migraine
  • myocardial infarction
  • neonates
  • new primary malignancy
  • obesity
  • ovarian cancer
  • pancreatitis
  • porphyria
  • pregnancy
  • protein C deficiency
  • protein S deficiency
  • renal disease
  • seizure disorder
  • stroke
  • surgery
  • systemic lupus erythematosus (SLE)
  • thromboembolic disease
  • thromboembolism
  • thrombophlebitis
  • thyroid disease
  • tobacco smoking
  • uterine cancer
  • uterine leiomyomata
  • vaginal bleeding
  • vaginal cancer
  • visual disturbance

Interactions

  • Acarbose
  • Acetaminophen; Propoxyphene
  • Albiglutide
  • Alogliptin; Metformin
  • Alpha-glucosidase Inhibitors
  • Amiodarone
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amprenavir
  • Anastrozole
  • Aprepitant, Fosaprepitant
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atracurium
  • Azelastine; Fluticasone
  • Barbiturates
  • Beclomethasone
  • Betamethasone
  • Bexarotene
  • Bosentan
  • Bromocriptine
  • Budesonide
  • Budesonide; Formoterol
  • Calcium
  • Canagliflozin
  • Canagliflozin; Metformin
  • Carbamazepine
  • Cenobamate
  • Chenodiol
  • Chloramphenicol
  • Ciclesonide
  • Cimetidine
  • Cisatracurium
  • Clarithromycin
  • Clobazam
  • Conivaptan
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Cosyntropin
  • Cyclosporine
  • Dalfopristin; Quinupristin
  • Danazol
  • Dantrolene
  • Dapagliflozin
  • Dapagliflozin; Metformin
  • Dapagliflozin; Saxagliptin
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Deflazacort
  • Delavirdine
  • Dexamethasone
  • Diltiazem
  • Dipeptidyl Peptidase-4 Inhibitors
  • Doxacurium
  • Dulaglutide
  • Duloxetine
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Ertugliflozin
  • Ertugliflozin; Metformin
  • Ertugliflozin; Sitagliptin
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Exemestane
  • Exenatide
  • Felbamate
  • Fludrocortisone
  • Flunisolide
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Fosamprenavir
  • Glipizide; Metformin
  • Glyburide; Metformin
  • grapefruit juice
  • Griseofulvin
  • Hemin
  • Hyaluronidase
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydantoins
  • Hydralazine
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrocortisone
  • Icosapent ethyl
  • Imatinib
  • Incretin Mimetics
  • Indinavir
  • Insulin Degludec; Liraglutide
  • Insulin Glargine; Lixisenatide
  • Insulins
  • Itraconazole
  • Ketoconazole
  • Lenalidomide
  • Letrozole
  • Levothyroxine
  • Levothyroxine; Liothyronine (Porcine)
  • Levothyroxine; Liothyronine (Synthetic)
  • Linagliptin; Metformin
  • Liothyronine
  • Liraglutide
  • Lixisenatide
  • Lopinavir; Ritonavir
  • Lorlatinib
  • Meglitinides
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methylprednisolone
  • Metreleptin
  • Metyrapone
  • Mifepristone
  • Miglitol
  • Mineral Oil
  • Minoxidil
  • Mivacurium
  • Modafinil
  • Mometasone
  • Nefazodone
  • Nelfinavir
  • Neuromuscular blockers
  • Nevirapine
  • Nitroprusside
  • Ombitasvir; Paritaprevir; Ritonavir
  • Ospemifene
  • Oxcarbazepine
  • Pancuronium
  • Phentermine; Topiramate
  • Pramlintide
  • Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
  • Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
  • Prednisolone
  • Prednisone
  • Propoxyphene
  • Raloxifene
  • Rapacuronium
  • Ribociclib; Letrozole
  • Rifamycins
  • Ritonavir
  • Rituximab; Hyaluronidase
  • Rocuronium
  • Ropinirole
  • Saquinavir
  • Semaglutide
  • SGLT2 Inhibitors
  • Somatropin, rh-GH
  • St. John’s Wort, Hypericum perforatum
  • Streptogramins
  • Succinylcholine
  • Sulfonylureas
  • Tacrine
  • Tazemetostat
  • Testolactone
  • Thiazolidinediones
  • Thyroid hormones
  • Tipranavir
  • Topiramate
  • Toremifene
  • Trandolapril; Verapamil
  • Tranexamic Acid
  • Trastuzumab; Hyaluronidase
  • Triamcinolone
  • Tricyclic antidepressants
  • Tubocurarine
  • Ursodeoxycholic Acid, Ursodiol
  • Valproic Acid, Divalproex Sodium
  • Vecuronium
  • Verapamil
  • Warfarin
  • Zafirlukast

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