Drospirenone Estradiol Brand Name– Angeliq
What is Drospirenone Estradiol
Estradiol and drospirenone products are a combination of an estrogen and progestin used together to treat vasomotor and genitourinary symptoms associated with menopause in women with an intact uterus.
Unopposed estrogen has been associated with increased risk of endometrial hyperplasia in women with an intact uterus.
The addition of a progestin, such as drospirenone, substantially reduces this risk. However, the addition of a progestin to an estrogen regimen may present additional risks for individual women.
Patients should be prescribed HRT products with the indication of use and individual risk:benefit in mind, and for the shortest duration consistent with the treatment goals of the individual. Boxed warnings for HRT relate to cardiovascular, dementia and cancer risks in the menopausal/post-menopausal population.
Drospirenone is a fourth generation progestin and an analog of spironolactone with antimineralocorticoid and antiandrogenic properties. These properties of drospirenone may minimize salt and water retention and may have beneficial effects on blood pressure in postmenopausal women.
However, due to the antimineralocorticoid activity, drospirenone has a potassium-sparing effect and has the potential to increase serum potassium concentrations; therefore, drospirenone should not be used in patients with adrenal, renal, or hepatic insufficiency and should be used with caution in patients taking potassium-elevating medications.
Estradiol drospirenone products for the treatment of symptoms related to menopause were first FDA-approved in 2005.
Indications
- atrophic vaginitis
- hot flashes
- menopause
For treatment of moderate to severe vasomotor symptoms (hot flashes) of menopause and/or related genitourinary symptoms including atrophic vaginitis, vulvar atrophy (kraurosis vulvae) in women with an intact uterus
Side Effects
- abdominal pain
- acne vulgaris
- alopecia
- amenorrhea
- anaphylactoid reactions
- angioedema
- anxiety
- arthralgia
- biliary obstruction
- bowel ischemia
- breakthrough bleeding
- breast cancer
- breast discharge
- breast enlargement
- candidiasis
- cervical dysplasia
- cervicitis
- cholecystitis
- cholelithiasis
- cholestasis
- colitis
- dementia
- depression
- diarrhea
- diplopia
- dysmenorrhea
- edema
- elevated hepatic enzymes
- emotional lability
- endometrial cancer
- endometrial hyperplasia
- erythema multiforme
- erythema nodosum
- fatigue
- fluid retention
- galactorrhea
- headache
- hepatitis
- hirsutism
- hypercalcemia
- hyperglycemia
- hyperkalemia
- hypertension
- hypocalcemia
- impaired cognition
- jaundice
- leukorrhea
- libido decrease
- libido increase
- mastalgia
- melasma
- migraine
- muscle cramps
- myocardial infarction
- nausea
- new primary malignancy
- ovarian cancer
- pancreatitis
- papilledema
- peliosis hepatis
- pelvic pain
- peripheral edema
- 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
- LFTs
- pap smear
- pelvic exam
- serum creatinine/BUN
- serum lipid profile
- serum potassium
Contraindications
- adrenal insufficiency
- asthma
- 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
- hyperkalemia
- hypertension
- hypertriglyceridemia
- hypocalcemia
- hyponatremia
- hypoparathyroidism
- hypothyroidism
- infants
- jaundice
- migraine
- myocardial infarction
- new primary malignancy
- obesity
- ovarian cancer
- pancreatitis
- porphyria
- pregnancy
- protein C deficiency
- protein S deficiency
- renal disease
- renal failure
- renal impairment
- 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; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Propoxyphene
- Acetohexamide
- Albiglutide
- Aliskiren
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Alogliptin
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alpha-glucosidase Inhibitors
- Amikacin
- Amiloride
- Amiloride; Hydrochlorothiazide, HCTZ
- Aminoglycosides
- Amiodarone
- Amobarbital
- Amoxicillin
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amoxicillin; Clavulanic Acid
- Ampicillin
- Ampicillin; Sulbactam
- Amprenavir
- Anastrozole
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Apalutamide
- Aprepitant, Fosaprepitant
- Armodafinil
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine; Fluticasone
- Azithromycin
- Aztreonam
- Bacitracin
- Barbiturates
- Beclomethasone
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Betamethasone
- Bexarotene
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Boceprevir
- Bosentan
- Bromocriptine
- Budesonide
- Budesonide; Formoterol
- Butabarbital
- Calaspargase pegol
- Calcium
- Canagliflozin
- Canagliflozin; Metformin
- Carbamazepine
- Carbapenems
- Carbenicillin
- Cefaclor
- Cefadroxil
- Cefazolin
- Cefdinir
- Cefditoren
- Cefepime
- Cefiderocol
- Cefixime
- Cefotaxime
- Cefotetan
- Cefoxitin
- Cefpodoxime
- Cefprozil
- Ceftaroline
- Ceftazidime
- Ceftazidime; Avibactam
- Ceftibuten
- Ceftizoxime
- Ceftolozane; Tazobactam
- Ceftriaxone
- Cefuroxime
- Cenobamate
- Cephalexin
- Charcoal
- Chenodiol
- Chloramphenicol
- Chlorpropamide
- Ciclesonide
- Cimetidine
- Ciprofloxacin
- Clarithromycin
- Clindamycin
- Clobazam
- Cobicistat
- Colistimethate, Colistin, Polymyxin E
- Conivaptan
- Corticosteroids
- Cortisone
- Cosyntropin
- Cyclosporine
- Dabrafenib
- Dalbavancin
- Danazol
- Dantrolene
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Daptomycin
- Daratumumab; Hyaluronidase
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Deferasirox
- Deflazacort
- Delafloxacin
- Delavirdine
- Demeclocycline
- Dexamethasone
- Dicloxacillin
- Diltiazem
- Dipeptidyl Peptidase-4 Inhibitors
- Doripenem
- Doxycycline
- Dulaglutide
- Duloxetine
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix
- Elagolix; Estradiol; Norethindrone acetate
- Elvitegravir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Enasidenib
- Encorafenib
- Enzalutamide
- Eplerenone
- Eravacycline
- Ertapenem
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Eslicarbazepine
- Ethotoin
- Exemestane
- Exenatide
- Felbamate
- Fidaxomicin
- Flibanserin
- Fluconazole
- Fludrocortisone
- Flunisolide
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Fluvoxamine
- Formoterol; Mometasone
- Fosamprenavir
- Fosphenytoin
- Gemifloxacin
- Gentamicin
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Glycylcyclines
- grapefruit juice
- Griseofulvin
- Hemin
- Heparin
- Hyaluronidase
- Hyaluronidase, Recombinant; Immune Globulin
- Hydantoins
- Hydralazine
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydralazine; Isosorbide Dinitrate, ISDN
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrocortisone
- Icosapent ethyl
- Idelalisib
- Imatinib
- Imipenem; Cilastatin
- Imipenem; Cilastatin; Relebactam
- Incretin Mimetics
- Indinavir
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Isotretinoin
- Itraconazole
- Ivosidenib
- Kanamycin
- Ketoconazole
- Lamotrigine
- Lefamulin
- Leflunomide
- Lenalidomide
- Lesinurad
- Lesinurad; Allopurinol
- Letrozole
- Levofloxacin
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linagliptin
- Linagliptin; Metformin
- Lincomycin
- Lincosamides
- Linezolid
- Liothyronine
- Liraglutide
- Lixisenatide
- Lomitapide
- Lopinavir; Ritonavir
- Lorlatinib
- Lumacaftor; Ivacaftor
- Meglitinides
- Melatonin
- Mephobarbital
- Meropenem
- Meropenem; Vaborbactam
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methohexital
- Methylprednisolone
- Metreleptin
- Metronidazole
- Metyrapone
- Midazolam
- Mifepristone
- Miglitol
- Miltefosine
- Mineral Oil
- Minocycline
- Minoxidil
- Mitotane
- Mivacurium
- Modafinil
- Mometasone
- Morphine
- Morphine; Naltrexone
- Moxifloxacin
- Nafcillin
- Nefazodone
- Nelfinavir
- Neomycin
- Nevirapine
- Nilotinib
- Nitrofurantoin
- Nitroprusside
- Nonsteroidal antiinflammatory drugs
- Norfloxacin
- Ofloxacin
- Omadacycline
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Oritavancin
- Ospemifene
- Oxacillin
- Oxcarbazepine
- Paromomycin
- Pegaspargase
- Penicillin G
- Penicillin G Benzathine
- Penicillin G Benzathine; Penicillin G Procaine
- Penicillin G Procaine
- Penicillin V
- Pentobarbital
- Pexidartinib
- Phenobarbital
- Phentermine; Topiramate
- Phenytoin
- Piperacillin
- Piperacillin; Tazobactam
- Pitolisant
- Plazomicin
- Polymyxin B
- Polymyxins
- Posaconazole
- Potassium
- Potassium-sparing diuretics
- Pramlintide
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Prednisolone
- Prednisone
- Primidone
- Propoxyphene
- Pyrimethamine; Sulfadoxine
- Raloxifene
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Rifamycins
- Rifapentine
- Riluzole
- Ritonavir
- Rituximab; Hyaluronidase
- Roflumilast
- Ropinirole
- Rufinamide
- Saquinavir
- Sarilumab
- Saxagliptin
- Secobarbital
- Semaglutide
- SGLT2 Inhibitors
- Siltuximab
- Simvastatin; Sitagliptin
- Sitagliptin
- Somatropin, rh-GH
- Spironolactone
- St. John’s Wort, Hypericum perforatum
- Streptogramins
- Streptomycin
- Succinylcholine
- Sugammadex
- Sulfadiazine
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulfasalazine
- Sulfisoxazole
- Sulfonamides
- Sulfonylureas
- Tacrine
- Tazemetostat
- Tedizolid
- Telavancin
- Telithromycin
- Telotristat Ethyl
- Teriflunomide
- Testolactone
- Tetracycline
- Thalidomide
- Thiazolidinediones
- Thiopental
- Thyroid hormones
- Ticarcillin
- Ticarcillin; Clavulanic Acid
- Tigecycline
- Tinidazole
- Tipranavir
- Tizanidine
- Tobramycin
- Tocilizumab
- Tolazamide
- Tolbutamide
- Topiramate
- Toremifene
- Trandolapril; Verapamil
- Tranexamic Acid
- Trastuzumab; Hyaluronidase
- Triamcinolone
- Triamterene
- Tricyclic antidepressants
- Trimethoprim
- Tucatinib
- Ulipristal
- Ursodeoxycholic Acid, Ursodiol
- Vancomycin
- Verapamil
- Voriconazole
- Warfarin
- Zafirlukast
