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Estradiol Norethindrone Brand Names
Activella | Amabelz | CombiPatch | Lopreeza | Mimvey | Mimvey Lo
What is Estradiol Norethindrone
Estradiol and norethindrone are combined in oral and transdermal products.
Estradiol is the principal intracellular human estrogen and is substantially more active than its metabolites, estrone and estriol, at the cellular level.
Norethindrone is a first generation oral progestin with moderate androgenic and slight estrogenic activity relative to newer progestins.
The combination products are primarily used in women with an intact uterus to treat moderate to severe vasomotor and genitourinary symptoms associated with menopause; the oral product is additionally indicated for the prevention of osteoporosis in postmenopausal women.
The transdermal system is also used for hormone replacement in women with an intact uterus who have had an oophorectomy, or who have hypogonadism or primary ovarian failure.
The addition of a progestin to the estrogen replacement therapy substantially reduces, but does not eliminate, the risk for endometrial hyperplasia.
However, combination HRT may add additional health risks for some women, and hormone replacement regimens are recommended to be used for the shortest duration consistent with the treatment goals of the individual patients.
The transdermal patch is an adhesive-based matrix designed to release 17beta-estradiol and norethindrone acetate continuously upon application to the skin.
The oral tablet contains a daily combination regimen of 17beta-estradiol and norethindrone acetate.
The combination transdermal patch and the combination oral tablets were initially FDA-approved in 1998.
Indications
- atrophic vaginitis
- hot flashes
- hypogonadism
- menopause
- oophorectomy
- osteoporosis prophylaxis
- ovarian failure
For treatment of moderate to severe vasomotor symptoms (hot flashes) of menopause and/or related genitourinary symptoms including atrophic vaginitis, vulvar atrophy (kraurosis vulvae), whether menopause is natural or surgical (e.g., due to oophorectomy)
continuous combined regimen – for women who do not want to resume menses
Side Effects
- abdominal pain
- acne vulgaris
- alopecia
- amenorrhea
- anaphylactoid reactions
- angioedema
- anxiety
- arthralgia
- asthenia
- back pain
- biliary obstruction
- bowel ischemia
- breakthrough bleeding
- breast cancer
- breast discharge
- breast enlargement
- candidiasis
- cervical dysplasia
- cervicitis
- cholecystitis
- cholelithiasis
- cholestasis
- colitis
- dementia
- depression
- diarrhea
- diplopia
- dizziness
- dysmenorrhea
- edema
- elevated hepatic enzymes
- emotional lability
- endometrial cancer
- endometrial hyperplasia
- erythema
- erythema multiforme
- erythema nodosum
- fatigue
- fluid retention
- galactorrhea
- headache
- hepatitis
- hirsutism
- hypercalcemia
- hyperglycemia
- hypertension
- hypertriglyceridemia
- hypocalcemia
- hypothyroidism
- impaired cognition
- 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
- peripheral edema
- pruritus
- pulmonary embolism
- rash
- retinal thrombosis
- skin irritation
- stroke
- teratogenesis
- thromboembolism
- thrombosis
- urinary incontinence
- urticaria
- vaginal bleeding
- vaginitis
- visual impairment
- vomiting
- 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
- 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
- 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
- Telaprevir
- 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