ESTRING Dosage & Rx Info | Uses, Side Effects

Estring Generic Name & Formulations

Legal Class

General Description

Estradiol 7.5mcg/24hrs; vaginal ring.

Pharmacological Class

Estrogen.

How Supplied

Vaginal ring—1

Storage

Store at controlled room temperature 15° to 25 °C (59 °F to 77 °F).

Manufacturer

Pfizer Inc.

Generic Availability

Mechanism of Action

Endogenous estrogens are largely responsible for the development and maintenance of the female reproductive system and secondary sexual characteristics. Estrogens act through binding to nuclear receptors in estrogen-responsive tissues. Circulating estrogens modulate the pituitary secretion of the gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH), through a negative feedback mechanism. Estrogens act to reduce the elevated levels of these hormones seen in postmenopausal women.

Estring Indications

Indications

Moderate to severe symptoms of vulvar and vaginal atrophy due to menopause.

Estring Dosage and Administration

Adult

Insert 1 ring high into vagina. Replace after 90 days.

Children

Not applicable.

Estring Contraindications

Contraindications

Undiagnosed abnormal genital bleeding. Breast or other estrogen-dependent neoplasms. Active DVT, PE or history of. Active arterial thromboembolic disease (eg, stroke, MI) or history of. Protein C, protein S, or antithrombin deficiency, or other thrombophilias. Pregnancy.

Estring Boxed Warnings

Boxed Warning

Endometrial cancer. Breast cancer. Cardiovascular disorders. Probable dementia.

Estring Warnings/Precautions

Warnings/Precautions

Increased risk of endometrial carcinoma or hyperplasia in women with intact uterus (adding progestin is essential). Not for prevention of cardiovascular disease or dementia. Increased risk of cardiovascular events (eg, stroke, MI, VTE); discontinue if occurs. Manage risk factors for cardiovascular disease and venous thromboembolism appropriately. Discontinue at least 4–6 weeks before surgery type associated with increased risk of thromboembolism or during prolonged immobilization. Increased risk of breast or ovarian cancer. Risk of probable dementia in women >65yrs of age. Gallbladder disease. Severe hypercalcemia in breast cancer or bone metastases. Visual abnormalities. Permanently discontinue if papilledema or retinal vascular lesions reveals on exam. Preexisting hypertriglyceridemia. History of cholestatic jaundice. Discontinue if pancreatitis, hypercalcemia, or recurrence of cholestatic jaundice occurs. Monitor thyroid function. Conditions aggravated by fluid retention. Hypoparathyroidism. Endometriosis. Hereditary angioedema. Asthma. Diabetes. Epilepsy. Migraine. Porphyria. SLE. Hepatic hemangiomas. Narrow vagina, vaginal stenosis, prolapse, or vaginal infections increase risk of irritation or ulceration. Remove if vaginal infections occur; reinsert after resolved. Do initial complete physical and repeat yearly (include Pap smear, mammogram, BP). Reevaluate periodically. Nursing mothers: not recommended.

Estring Pharmacokinetics

Distribution

Estrogens are widely distributed in the body and are generally found in higher concentrations in the sex hormone target organs. Estrogens circulate in blood largely bound to SHBG and albumin.

Metabolism

Hepatic.

Elimination

Renal.

Estring Interactions

Interactions

Remove during treatment with other vaginally-administered preparations. Concomitant thyroid replacement; may need to increase thyroid dose. May interfere with lab tests (eg, thyroid, PT, coagulation factors, glucose tolerance, HDL/LDL, triglycerides, hormone concentrations, other binding or plasma proteins).

Estring Adverse Reactions

Adverse Reactions

Vaginal discomfort/pain, abdominal pain, nausea, back pain, arthritis, headache, insomnia, upper respiratory tract infection, leukorrhea, vaginitis; thromboembolism, neoplasms.

Estring Clinical Trials

See Literature

Estring Note

Not Applicable

Estring Patient Counseling