Top 300 Pharmacy Drug Cards

ESTRADIOL TRANSDERMAL PATCH: Vivelle-DOT, Estraderm, Various

Class: Estrogen

Dosage Forms. Transdermal Patch: 0.025 mg/d, 0.0375 mg/d, 0.05 mg/d, 0.075 mg/d, 0.1 mg/d

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Common FDA Label Indication, Dosing, and Titration.

1. Abnormal vasomotor function or atrophic vagina or vulva (moderate-severe), menopause: 0.0375 mg/d patch applied to the skin twice weekly

2. Postmenopausal osteoporosis, prophylaxis: 0.025 mg/d patch applied to the skin twice weekly

Off-Label Uses. None

MOA. Estradiol (17β-estradiol; E2) is the most potent of the naturally occurring estrogens and the major estrogen secreted during the reproductive years. Estradiol and other estrogens produce characteristic effects on specific tissues (such as breast), cause proliferation of vaginal and uterine mucosa, increase calcium deposition in bone, and accelerate epiphyseal closure after initial growth stimulation.

Drug Characteristics: Estradiol Transdermal Patch

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Medication Safety Issues: Estradiol Transdermal Patch

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Drug Interactions: Estradiol Transdermal Patch

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Adverse Reactions: Estradiol Transdermal Patch

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Efficacy Monitoring Parameters. Improvement in menopause symptoms; improved bone mineral density evaluation for postmenopausal osteoporosis.

Toxicity Monitoring Parameters. Annual physical examination including cervical cytology (Pap smear) and breast exam (in addition to monthly self-exam).

Key Patient Counseling Points. Report abnormal vaginal bleeding or signs/symptoms of a thromboembolic disorder. Do not smoke during therapy, as this increases the risk of thromboembolic events. Place patch on clean, dry skin, preferably on the lower abdomen, upper quadrant of the buttock, or outer aspect of the hip; do not apply to the breasts or waistline; rotate sites of application with 1 wk allowed between applications to a particular site.

Clinical Pearls. Estrogens increase the risk of endometrial cancer; monitor for abnormal vaginal bleeding. Increased risks of MI, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women have been reported. An increased risk of developing dementia in women 65 y or older has also been reported. Estrogens, with or without progestins, should be prescribed at the lowest effective doses and for the shortest duration possible. Also available in oral and vaginal formulations. Patch contains metal, remove prior to MRI.