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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
- atrophic vaginitis
- dysfunctional uterine bleeding
- dyspareunia
- hot flashes
- hypogonadism
- menopause
- oophorectomy
- osteoporosis prophylaxis
- ovarian failure
- palliative treatment of breast cancer
- prostate cancer
Side Effects
- abdominal pain
- acne vulgaris
- acneiform rash
- alopecia
- amenorrhea
- anaphylactoid reactions
- angioedema
- anxiety
- arthralgia
- asthenia
- back pain
- biliary obstruction
- bowel ischemia
- breakthrough bleeding
- breast cancer
- breast discharge
- breast enlargement
- bronchospasm
- candidiasis
- cervical dysplasia
- cholecystitis
- cholelithiasis
- cholestasis
- colitis
- dementia
- depression
- diarrhea
- diplopia
- dizziness
- dysmenorrhea
- dyspepsia
- edema
- elevated hepatic enzymes
- emotional lability
- endometrial cancer
- endometrial hyperplasia
- erythema multiforme
- erythema nodosum
- fatigue
- flatulence
- fluid retention
- galactorrhea
- gingivitis
- gynecomastia
- headache
- hepatitis
- hirsutism
- hypercalcemia
- hyperglycemia
- hypertension
- hypertriglyceridemia
- hypocalcemia
- impaired cognition
- injection site reaction
- insomnia
- irritability
- jaundice
- leukorrhea
- libido decrease
- libido increase
- mastalgia
- melasma
- migraine
- muscle cramps
- myalgia
- myocardial infarction
- nausea
- new primary malignancy
- ovarian cancer
- pancreatitis
- papilledema
- paresthesias
- peliosis hepatis
- pelvic pain
- peripheral vasodilation
- porphyria
- pruritus
- pulmonary embolism
- rash
- retinal thrombosis
- stroke
- teratogenesis
- thromboembolism
- thrombosis
- urinary incontinence
- urticaria
- vaginal bleeding
- vaginal discharge
- vaginal irritation
- vaginitis
- visual impairment
- vomiting
- 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
