Estradiol Levonorgestrel Brand Name– Climara Pro
What is Estradiol Levonorgestrel
Estradiol and levonorgestrel are an estrogen and progestin, respectively, that are used together in a transdermal system to treat moderate to severe vasomotor symptoms and genitourinary symptoms associated with menopause in women with an intact uterus.
Estradiol is the primary human estrogen, and levonorgestrel is a progestin of relatively high progestational and androgenic activity.
The addition of a progestin, such as levonorgestrel, substantially reduces, but does not eliminate, the risk for endometrial hyperplasia during estrogen therapy. Combination estrogen-progestin products were primarily developed to enhance patient compliance with combination hormone replacement therapy (HRT) regimens; however, the addition of a progestin to an estrogen regimen may present additional risks for individual women.
The estradiol levonorgestrel transdermal patch was first approved by the FDA in November 2003. The patch received approval for the prevention of osteoporosis in postmenopausal women in December 2005.
Indications
- atrophic vaginitis
- hot flashes
- menopause
- osteoporosis prophylaxis
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
- back pain
- biliary obstruction
- bowel ischemia
- breakthrough bleeding
- breast cancer
- breast discharge
- breast enlargement
- candidiasis
- cervical dysplasia
- cervicitis
- cholecystitis
- cholelithiasis
- cholestasis
- colitis
- dementia
- depression
- diplopia
- dysmenorrhea
- edema
- elevated hepatic enzymes
- emotional lability
- endometrial cancer
- endometrial hyperplasia
- erythema
- erythema multiforme
- erythema nodosum
- fatigue
- flatulence
- fluid retention
- galactorrhea
- gingivitis
- headache
- hepatitis
- hirsutism
- hypercalcemia
- hyperglycemia
- hypertension
- hypocalcemia
- impaired cognition
- infection
- insomnia
- irritability
- jaundice
- libido decrease
- libido increase
- mastalgia
- melasma
- menorrhagia
- migraine
- muscle cramps
- myocardial infarction
- nausea
- new primary malignancy
- ovarian cancer
- pancreatitis
- papilledema
- peliosis hepatis
- pruritus
- pulmonary embolism
- rash
- retinal thrombosis
- skin irritation
- stroke
- teratogenesis
- thromboembolism
- thrombosis
- urinary incontinence
- urticaria
- vaginal bleeding
- vaginitis
- visual impairment
- weight gain
Monitoring Parameters
- pap smear
- pelvic exam
Contraindications
- 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
- hypertension
- hypertriglyceridemia
- hypocalcemia
- hypoparathyroidism
- hypothyroidism
- infants
- jaundice
- migraine
- myocardial infarction
- 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; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Propoxyphene
- Acetohexamide
- Acitretin
- Albiglutide
- Alogliptin
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alpha-glucosidase Inhibitors
- Amikacin
- Aminoglycosides
- Amiodarone
- Amobarbital
- Amoxicillin
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amoxicillin; Clavulanic Acid
- Ampicillin
- Ampicillin; Sulbactam
- Amprenavir
- Anastrozole
- Apalutamide
- Aprepitant, Fosaprepitant
- Armodafinil
- Artemether; Lumefantrine
- 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
- Brigatinib
- 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
- 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
- Formoterol; Mometasone
- Fosamprenavir
- Fosphenytoin
- Gemifloxacin
- Gentamicin
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Glycylcyclines
- grapefruit juice
- Griseofulvin
- Hemin
- Hyaluronidase
- Hyaluronidase, Recombinant; Immune Globulin
- Hydantoins
- Hydralazine
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydralazine; Isosorbide Dinitrate, ISDN
- 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
- Mivacurium
- Modafinil
- Mometasone
- Morphine
- Morphine; Naltrexone
- Moxifloxacin
- Nafcillin
- Nefazodone
- Nelfinavir
- Neomycin
- Nevirapine
- Nilotinib
- Nitrofurantoin
- Nitroprusside
- 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
- Perampanel
- Pexidartinib
- Phenobarbital
- Phentermine; Topiramate
- Phenytoin
- Piperacillin
- Piperacillin; Tazobactam
- Pitolisant
- Plazomicin
- Polymyxin B
- Polymyxins
- Posaconazole
- 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
- St. John’s Wort, Hypericum perforatum
- Streptogramins
- Streptomycin
- Succinylcholine
- Sugammadex
- Sulfadiazine
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulfasalazine
- Sulfisoxazole
- Sulfonamides
- Sulfonylureas
- Sunscreens
- Tacrine
- Tazemetostat
- Tedizolid
- Telavancin
- Telithromycin
- 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
- Tricyclic antidepressants
- Trimethoprim
- Ulipristal
- Ursodeoxycholic Acid, Ursodiol
- Vancomycin
- Verapamil
- Voriconazole
- Warfarin
- Zafirlukast
