Wednesday, November 05, 2008

A memo to those who are thinking of self-medication

[Before I get to the main piece here, thank goodness the election is over. Sadly we may have done something as a feel good measure and not one that will overall benefit the country in the longterm. If one is in the millitary, this could not ahve come at a worse time, seeing there is a promise to gut the F-35 Raptor , which is needed by the USAF seeing the F-16 is reaching the end of its usable life, 2 of 3 replacement aircraft carriers which have been planned may as well be scrapped. if you are looking for improvement in education, dream on. Currently the US spends on average $12,500 per student per grade and yet we are still far behind several Asian and Northern European countries as far as as math and science are concerned and the unions that many teaching professionals belong to have spend tons of money to place our president elect in office, which means they have some favors coming back. Like more money, with very little return. It will be nice to see those who bought into those promises end up realizing in 163 days that the new emperor has no clothes]

WARNING...SOME RATHER ADULT AND CLINICAL MATERIAL ADHEAD. IF THIS IS NOT YOUR CUP OF TEA, SKIP DOWN TO SOME OTHER POSTS ON THIS BLOG. ALSO, I AM NOT A PHYSICIAN, HAVE NO CONNECTION WITH ANY OUTSIDE OF BEING A PATIENT OF THOSE WHO WORK IN THE PROVIDENCE HEALTH SYSTEM IN PORTLAND, OREGON. HENCE WHAT IS SAID HERE CAN BE TAKEN AS OPINION WITH FACTUAL STATEMENTS AT THEIR ROOT.

Much has been made in some other corners about those folks who want to self medicate in order to to go from male to female or female to male. Trannsexuals or transgenders if you will [I will not use any of the colloqial terms due to the fact that many of those are derogatory]. Now let's be blunt here....seeing that each person on this planet in some way, shape or form is a setient being and if they feel that certain treatments will work for a particular ailment or malady, then they should go for it. With that said, this is one of the those where consulting internists and endocrinologists if only because they have a little more experience with what the medications that are used in transition. Those being estradiol, premarin, spironolactone and going from female to male, testosterone.

What is going to be posted here are is the info on each that comes from what is the best source for what these medications can do for and can do to a person, that being the Physicians Desk Reference. The names of the medications may be different from those mentioned in the last paragraph, however they are the same.

Brand name:
Estrogen Patches
Generic name: Estradiol

Brand names: Alora, Climara, Esclim, Estraderm, Vivelle, Vivelle-Dot


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Why are Estrogen Patches prescribed?
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All of these products are used to reduce symptoms of menopause, including feelings of warmth in the face, neck, and chest; the sudden intense episodes of heat and sweating known as "hot flashes"; dry, itchy external genitals; and vaginal irritation. They are also prescribed for other conditions that cause low levels of estrogen, and some doctors prescribe them for teenagers who fail to mature at the usual rate.

Along with diet, calcium supplements, and exercise, Alora, Climara, Estraderm, Vivelle, and Vivelle-Dot are prescribed to prevent osteoporosis, a condition in which the bones become brittle and easily broken.


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Most important fact about Estrogen Patches
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Because estrogens have been linked with an increased risk of breast, uterine, and endometrial cancer (cancer in the lining of the uterus), it is essential to have regular mammograms and checkups. Report any unusual vaginal bleeding to your doctor immediately.

Hormone replacement therapy using estrogens, with or without progestin, should not be used to prevent heart disease. Recent studies have confirmed an increased rate of heart attack, stroke, and dangerous blood clots among women taking estrogen or estrogen combinations for 5 years. Blood clots can lead to phlebitis, stroke, heart attack, a loss of blood supply to the lungs, a blockage in the blood vessels serving the eye, and other serious disorders. Because of these risks, hormone replacement therapy should be given at the lowest effective dose for the shortest possible time. Your doctor will determine the dosage that is best for you.


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How should you use Estrogen Patches?
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Each patch is individually sealed in a protective pouch and is applied directly to the skin.

A stiff protective liner covers the adhesive side of the patch. Remove the liner by sliding it sideways between your thumb and index finger. Holding the patch at one edge, remove the protective liner and discard it. Try to avoid touching the adhesive. Use immediately after removing the liner. If you are using Alora, Vivelle, or Vivelle-Dot peel off one side of the protective liner and discard it. Use the other half of the liner as a handle until you have applied the sticky area, then fold back the remaining side of the patch, pull off the rest of the liner, and smooth the second half of the patch onto your skin.

Apply the adhesive side to a clean, dry area of your skin on the trunk of your body (including the buttocks and abdomen). Do not apply to your breasts or waist. Firmly press the patch in place with the palm of your hand for about 10 seconds, to make sure the edges are flat against your skin. When first using Alora, start on the lower abdomen. Climara is applied only to the abdomen or upper buttock, and is pressed in place with the fingers.

Remove the patch slowly and carefully to avoid irritating your skin. If any adhesive remains, let it dry for 15 minutes then gently rub the area with an oil-based cream or lotion to remove the adhesive residue. The used patch still contains active hormone. To dispose of it properly, fold it in half so it sticks to itself before throwing it away.

Contact with water during bathing, swimming, or showering will not affect the patch.

The application site must be rotated. Allow an interval of at least 1 week between applications to a particular site.

Alora, Esclim, Estraderm, Vivelle, and Vivelle-Dot patches should be replaced twice a week; Climara once weekly.

If you miss a dose...
If you forget to apply a new patch when you are supposed to, do it as soon as you remember. If it is almost time to change patches anyway, skip the one you missed and go back to your regular schedule. Do not apply more than the prescribed number of patches at a time.
Storage instructions...
Store the patches at room temperature, in their sealed pouches.

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What side effects may occur?
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Side effects cannot be anticipated. If any develop or change in intensity, notify your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using the estrogen patch.

More common side effects may include:
Anxiety, back pain, breakthrough bleeding, breast tenderness, constipation, depression, flu-like symptoms, headache, high blood pressure, hot flushes, insomnia, indigestion, nausea, neck pain, sinus problems, skin redness and irritation at the site of the patch, upper respiratory tract infection, weight increase.

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Why should Estrogen Patches not be prescribed?
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Estrogen patches should not be used during pregnancy. You should also avoid this product if you have:

Unexplained vaginal bleeding
Known or suspected breast cancer
Any type of tumor stimulated by estrogen
Phlebitis, blood clots in the lung, or any other clotting disorder
Active or recent (within the last year) heart disease, heart attack, or stroke
Liver disease or liver problems
An allergy to any component of the patch

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Special warnings about Estrogen Patches
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Estrogen has the potential of causing clot-related disorders, including heart attack and stroke, pulmonary embolism (a clot in the lungs), and thrombophlebitis (a clot in the veins). A complete medical and family history should be taken by your doctor before starting any estrogen therapy, especially if you have a history of deep vein thrombosis (a clot in the legs) or a history of thrombosis in your family. The chance of developing a clot-related problem can be reduced by using the lowest dose of estrogen that still proves effective. If a problem surfaces anyway, you'll have to stop using the patch. Likewise, you should discontinue the patch and call your doctor immediately if you suffer a loss of vision, any other eye problems, or a migraine headache.

Some experts suspect that high doses of estrogen, with or without a progestin, may increase the risk of ovarian, breast, and endometrial cancer. The risk may increase with prolonged use.

Hormone therapy occasionally causes a rise in blood pressure. If you have a blood pressure problem, use the patch with caution and have your pressure checked regularly.

If you suffer from liver problems or liver disease you may not be able to use hormone therapy.

If you are on hormone therapy you may need to have your thyroid medication adjusted and your thyroid tested more frequently.

Hormones also tend to cause fluid retention. If you have a condition that could be aggravated by excess fluid, such as asthma, epilepsy, migraine headaches, heart disease, or kidney problems, use the patch with caution.

If you suffer from endometriosis, a condition where the endometrium (the lining of the uterus) doesn't shed properly and attaches to the outside of the uterus or other areas such as the ovaries or bowels, hormone therapy may cause a worsening of this condition.

Because estrogen can increase triglyceride levels, you'll need to be closely monitored if your triglycerides tend to be high. If you have diabetes, estrogen may also affect your blood sugar levels.

Estrogen therapy occasionally causes abnormal uterine bleeding or breast pain. In view of concerns about cancer, you should have these symptoms checked by your doctor. In general, you should not take estrogen for more than 1 year without a follow-up physical exam. Ideally, you should have a checkup every 3 to 6 months.

Women who take oral estrogen after menopause face a two- to fourfold increase in the odds of gallbladder disease.

In elderly women, estrogen therapy could increase the risk of dementia, including Alzheimer's disease. Talk with your doctor about the risks and benefits of using this drug.

For teenagers who fail to mature at the usual rate, large doses of estrogen taken for an extended period may affect growth. In girls, it may cause the early start of menstruation or early breast development.

While taking estrogen, get in touch with your doctor right away if you notice any of the following:

Abdominal pain, tenderness, or swelling

Abnormal bleeding of the vagina

Breast lumps

Coughing up blood

Difficulty with speech

Pain in your chest or calves

Severe headache, dizziness, or faintness

Skin irritation, redness, or rash

Sudden shortness of breath

Vision changes

Weakness or numbness of an arm or leg

Yellowing of the skin or eyes


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Possible food and drug interactions when using Estrogen Patches
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If you take certain other drugs while using estrogen, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before taking the following:

Alcohol

Barbiturates such as phenobarbital and secobarbital

Blood thinners such as warfarin

Cimetidine

Clarithromycin

Dantrolene

Epilepsy drugs such as carbamazepine and phenytoin

Erythromycin

Grapefruit juice

Itraconazole

Ketoconazole

Rifampin

Ritonavir

St. John's wort

Steroids such as prednisone

Tricyclic antidepressants such as amitriptyline and imipramine


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Special information if you are pregnant or breastfeeding
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Estrogens should not be used during pregnancy or immediately after childbirth. Use of estrogens during pregnancy has been linked to reproductive tract problems in the children. If you are pregnant or plan to become pregnant, notify your doctor immediately. Estrogens decrease the quantity and quality of breast milk. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.


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Recommended dosage for Estrogen Patches
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If you are a postmenopausal woman with a uterus, progestin may be prescribed as well in order to reduce the risk of endometrial cancer. Your doctor will determine the dosage that is right for you. Typically, hormone replacement therapy should be started at the lowest possible dose and for the shortest duration needed to relieve your symptoms. You should be evaluated every 3 to 6 months.

ALORA AND ESTRADERM

The usual starting dose is one 0.05-milligram patch applied to the skin 2 times a week. (For osteoporosis the doctor may prescribe a 0.025-milligram patch.)

CLIMARA

The usual starting dose is one 0.025-milligram patch applied to the skin once a week. (For osteoporosis, the doctor may prescribe a 0.025-milligram patch.)

ESCLIM

The usual starting dose is one 0.025-milligram patch applied to the skin 2 times a week.

VIVELLE AND VIVELLE-DOT

The usual starting dose to relieve symptoms of menopause is one 0.0375-milligram patch applied to the skin 2 times a week. (For osteoporosis, the doctor may prescribe a 0.025-milligram patch.) The patch may be used continuously, or left off every fourth week.


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Overdosage
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Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

Symptoms of estrogen overdose may include:
Nausea, vomiting, withdrawal bleeding



Brand name:
Premarin
Generic name: Conjugated estrogens


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Why is Premarin prescribed?
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Premarin is an estrogen replacement drug. The tablets are used to reduce moderate to severe symptoms of menopause, including feelings of warmth in the face, neck, and chest, and the sudden intense episodes of heat and sweating known as "hot flashes." Cenestin tablets, containing a synthetic form of conjugated estrogens, may also be prescribed for these symptoms.

In addition to the symptoms of menopause, Premarin tablets are prescribed for teenagers who fail to mature at the usual rate, and to relieve the symptoms of certain types of cancer, including some forms of breast and prostate cancer.

In addition, either the tablets or Premarin vaginal cream can be used for other conditions caused by lack of estrogen, such as dry, itchy external genitals and vaginal irritation.

Along with diet, calcium supplements, and exercise, Premarin tablets are also prescribed to prevent postmenopausal osteoporosis, a condition in which the bones become brittle and easily broken. Before taking Premarin solely for this purpose, you should carefully consider using alternative, nonestrogen therapies.

The addition of progesterone to estrogen-replacement therapy has been shown to reduce the risk of uterine cancer. Prempro combines estrogen and progesterone in a single tablet taken once daily. Premphase is a 28-day supply of tablets. The first 14 contain only estrogen. The second 14 supply both estrogen and progesterone. Both Prempro and Premphase are prescribed to reduce the symptoms of menopause, including vaginal problems, and to prevent osteoporosis.


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Most important fact about Premarin
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Because estrogens have been linked with an increased risk of uterine and endometrial cancer (cancer in the lining of the uterus), it is essential to have regular checkups and to report any unusual vaginal bleeding to your doctor immediately.

Premarin and other estrogen drugs, with or without progesterone, should not be used to prevent heart disease. Recent studies have confirmed an increased rate of heart attack, stroke, and dangerous blood clots among women taking estrogen or estrogen combinations for 5 years. Blood clots can lead to phlebitis, stroke, heart attack, a loss of blood supply to the lungs, a blockage in the blood vessels serving the eye, and other serious disorders.


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How should you take Premarin?
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Take Premarin exactly as prescribed. Do not share it with anyone else.

If you are taking calcium supplements as a part of the treatment to help prevent brittle bones, check with your doctor about how much to take.

You should take a few moments to read the patient package insert provided with your prescription.

If you are using Premarin vaginal cream, apply it as follows:

Remove cap from tube.
Screw nozzle end of applicator onto tube.
Gently squeeze tube from the bottom to force sufficient cream into the barrel to provide the prescribed dose. Use the marked stopping points on the applicator as a guide.
Unscrew applicator from tube.
Lie on back with knees drawn up. Gently insert applicator deeply into the vagina and press plunger downward to its original position.
To cleanse the applicator, pull the plunger to remove it from the barrel, then wash with mild soap and warm water. Do not boil or use hot water.

If you miss a dose...
Take the forgotten dose as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Never try to "catch up" by doubling the dose.
Storage instructions...
Store at room temperature.

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What side effects may occur?
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Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor immediately. Only your doctor can determine whether it is safe to continue taking Premarin.

Side effects of conjugated estrogens may include:
Abdominal/stomach cramps, bloating, breast pain, enlargement of benign tumors of the uterus (also called fibroids), fluid retention, hair loss, headache, high blood pressure, high blood sugar, irregular vaginal bleeding or spotting, liver problems, nausea and vomiting, vaginal yeast infections
Other possible side effects of Cenestin may include:
Constipation, increased heartbeat, joint pain, skin tingling

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Why should Premarin not be prescribed?
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Do not take Premarin if you have ever had a bad reaction to it, or have undiagnosed abnormal vaginal bleeding.

Except in certain special circumstances, you should not be given Premarin if you have ever had breast cancer, uterine cancer, or any other "estrogen-dependent" cancer.

Do not take Premarin if you have had any circulation problem involving blood clots, or have had a stroke or heart attack in the past year.

Do not take Premarin if you have liver disease or your liver is not working properly.

Do not use Premarin if you are pregnant or trying to become pregnant.


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Special warnings about Premarin
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For women who have not had a hysterectomy, the risk of endometrial and uterine cancer increases when estrogen-only drugs are used for a long time or taken in large doses. Estrogen therapy can also worsen endometriosis (uterine tissue growing outside the uterus). If you've ever had endometriosis, make sure the doctor is aware of it. If you've had a hysterectomy but still have residual endometriosis, your doctor may want you to use an estrogen/progesterone combination.

Certain studies have shown that women taking estrogen for prolonged periods of time (4 years or more) face an increased risk of breast cancer, and a study by the National Heart, Lung and Blood Institute (NHLBI) has confirmed an increased risk among women taking estrogen/progesterone combinations. Use combination products (and estrogen-only preparations, too) with special caution if you have a family history of breast cancer or have ever had an abnormal mammogram. Be sure to get an annual breast exam from your doctor, and do your own self-examination each month.

The NHLBI study also found an increased risk of dementia for women taking estrogen/progesterone combinations. It's unknown whether this applies to estrogen-only drugs.

Because Premarin can increase the risk of heart attack, stroke, blood clots, and certain estrogen-dependent cancers, contact your doctor right away if you notice any of the following:

Abdominal pain, tenderness, or swelling

Abnormal bleeding from the vagina

Breast lumps

Coughing up blood

Pain in your chest or calves

Severe headache, dizziness, or faintness

Sudden shortness of breath

Vision changes

Women who take Premarin after menopause are more likely to develop gallbladder disease.

Estrogens such as Premarin can cause hypercalcemia, a severe increase of calcium levels in the blood. Women with breast or bone cancer are especially at risk and should stop taking Premarin immediately if they develop hypercalcemia. In addition, women with the opposite problem—hypocalcemia, or a severe decrease of calcium in the blood—should use Premarin with caution.

Women who have not had a hysterectomy and take estrogen along with progesterone have a lower risk of precancerous endometrial changes. However, you should be aware that estrogen/progesterone combinations could increase "bad" LDL cholesterol and blood sugar levels as well as increase the risk of breast cancer.

There is a slight chance that estrogen therapy could cause an increase in blood pressure. Ask your doctor to check your blood pressure regularly.

If you have high levels of fat in your blood, specifically a high triglyceride level, conjugated estrogens such as Premarin are likely to cause side effects in the pancreas.

Use Premarin with caution if you have a history of liver problems, including jaundice. Call your doctor right away if you develop abdominal pain or yellowing of the skin.

Premarin can alter thyroid function. If you're taking thyroid medication, you may need your dosage adjusted.

Premarin can also cause fluid retention. Use the drug with caution if you have heart or kidney problems, or any other condition that's affected by excess fluid in the body.

Some studies have shown that using estrogen-only drugs, especially for 10 years or more, could increase the risk of ovarian cancer. It's unknown whether this also applies to estrogen/progesterone combinations. Another study showed that certain estrogen/progesterone combinations increased the risk of dementia (e.g., Alzheimer's disease).

Estrogens such as Premarin have been known to make certain conditions worse, including asthma, diabetes, epilepsy, migraine, porphyria (a genetic enzyme deficiency), lupus, and liver tumors.

If you are using Premarin vaginal cream, you should be aware that this product can weaken latex condoms, diaphragms, and cervical caps.


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Possible food and drug interactions when taking Premarin
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If Premarin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Premarin with the following:

Barbiturates such as phenobarbital

Blood thinners

Carbamazepine

Clarithromycin

Drugs used for epilepsy

Erythromycin

Grapefruit juice

Itraconazole

Ketoconazole

Major tranquilizers

Oral diabetes drugs

Rifampin

Ritonavir

St. John's wort

Steroid medications

Thyroid preparations

Tricyclic antidepressants

Vitamin C


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Special information if you are pregnant or breastfeeding
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If you are pregnant or plan to become pregnant, notify your doctor immediately. Premarin and conjugated estrogens should not be taken during pregnancy because of the possibility of harm to the unborn child. Premarin cannot prevent a miscarriage. Estrogens can decrease the quantity and quality of breast milk, and progestins appear in breast milk. Your doctor may advise you not to breastfeed while you are taking this drug.


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Recommended dosage for Premarin
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Your doctor will start therapy with this medication at a low dose and adjust the dosage according to your response. He or she will want to check you periodically at 3- to 6-month intervals to determine the need for continued therapy.

PREMARIN TABLETS

Hot flashes associated with menopause

The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles such as 25 days on Premarin and 5 days off.

Tissue degeneration in the vagina

The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles.

Low estrogen levels due to reduced ovary function

The usual dosage is 0.3 to 0.625 milligrams daily, taken cyclically.

Ovary removal or ovarian failure

The usual dosage is 1.25 milligrams daily, taken cyclically.

Prevention of osteoporosis (loss of bone mass)

The usual starting dosage is 0.3 milligrams daily, taken continuously or in cycles.

Advanced androgen-dependent cancer of the prostate, for relief of symptoms only

The usual dosage is 1.25 to 2.5 milligrams 3 times daily.

Breast cancer (for relief of symptoms only) in appropriately selected women and men with metastatic disease

The suggested dosage is 10 milligrams 3 times daily for a period of at least 3 months. Tell your doctor if you have any unusual bleeding.

PREMARIN VAGINAL CREAM

Given cyclically for short-term use only.

Degeneration of genital tissue or severe itching in the genital area

The recommended dosage is one-half to 2 grams daily, inserted into the vagina, depending on the severity of the condition. You will use the cream for 3 weeks, then stop for 1 week. Tell your doctor if you notice any unusual bleeding.

PREMPRO TABLETS/PREMPHASE THERAPY

Symptoms associated with menopause (hot flashes, night sweats, and vaginal tissue degeneration) or for the prevention of osteoporosis (loss of bone mass)

The usual starting dose for Prempro is one 0.3-milligram/1.5-milligram tablet once a day. If this dose proves insufficient, your doctor may increase the dose to one 0.625-milligram/0.25- or 0.5-milligram tablet once a day.

For Premphase therapy, follow a 28-day cycle. Take 1 maroon Premarin tablet (equal to 0.625 milligrams estrogen) every day for the first 14 days; on the 15th day, begin taking 1 light-blue tablet (equal to 0.625 milligrams estrogen/5 milligrams progesterone) daily.

CENESTIN TABLETS

The usual starting dose is 0.45 milligrams a day. If this proves insufficient, the doctor may gradually increase the dose up to a maximum of 1.25 milligrams daily.


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Overdosage
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Any medication taken in excess can have serious consequences. If you suspect an overdose of Premarin, seek medical attention immediately.

Symptoms of conjugated estrogen overdose may include:
Nausea, vomiting, withdrawal bleeding



Brand name:
Aldactazide
Generic ingredients: Spironolactone, Hydrochlorothiazide


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Why is Aldactazide prescribed?
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Aldactazide is used in the treatment of high blood pressure and other conditions that require the elimination of excess fluid from the body. These conditions include congestive heart failure, cirrhosis of the liver, and kidney disease. Aldactazide combines two diuretic drugs that help your body produce and eliminate more urine. Spironolactone, one of the ingredients, helps to minimize the potassium loss that can be caused by the hydrochlorothiazide component.


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Most important fact about Aldactazide
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If you have high blood pressure, you must take Aldactazide regularly for it to be effective. Since blood pressure declines gradually, it may be several weeks before you get the full benefit of Aldactazide; and you must continue taking it even if you are feeling well. Aldactazide does not cure high blood pressure; it merely keeps it under control.


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How should you take Aldactazide?
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Take Aldactazide exactly as prescribed. Stopping Aldactazide suddenly could cause your condition to worsen.

If you miss a dose...
Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.
Storage instructions...
Store at room temperature.

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What side effects may occur?
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Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Aldactazide.

Side effects may include:
Abdominal cramps, breast development in males, change in potassium levels (leading to such symptoms as dry mouth, excessive thirst, weak or irregular heartbeat, and muscle pain or cramps), deepening of the voice, diarrhea, dizziness, dizziness on rising, drowsiness, excessive hairiness, fever, headache, hives, inflammation of blood vessels or lymph vessels, inflammation of the pancreas, irregular menstruation, kidney problems, lack of coordination, liver problems, loss of appetite, mental confusion, muscle spasms, nausea, postmenopausal bleeding, rash, red or purple spots on skin, restlessness, sensitivity to light, severe allergic reaction, sexual dysfunction, sluggishness, stomach bleeding, stomach inflammation, stomach ulcers, tingling or pins and needles, vertigo, vomiting, weakness, yellow eyes and skin, yellow vision

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Why should Aldactazide not be prescribed?
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Aldactazide should not be used if you have acute kidney disease or liver failure, have difficulty urinating or are unable to urinate, or have high potassium levels in your blood.

If you are sensitive to or have ever had an allergic reaction to spironolactone, hydrochlorothiazide, or similar drugs, or if you are sensitive to sulfa drugs, you should not take this medication. Make sure your doctor is aware of any drug reactions you may have experienced.


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Special warnings about Aldactazide
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This medication should be used only if your doctor has determined that the precise amount of each ingredient in Aldactazide meets your specific needs.

Drugs such as the hydrochlorothiazide component of Aldactazide have been known to trigger gout and allergic reactions. They can also raise your blood sugar levels.

Potassium supplements (including salt substitutes) or diuretics that leave high levels of potassium in your body should not be used while taking Aldactazide, unless specifically recommended by your doctor. Symptoms of excess potassium include tingling sensations, fatigue, muscle weakness or paralysis, and a slow heartbeat. If you develop these problems, call your doctor immediately.

If you are taking an ACE-inhibitor type of blood pressure medication such as enalapril maleate, this drug should be used with extreme caution.

If you have liver or kidney disease or lupus erythematosus (a disease that causes skin eruptions), Aldactazide should be used with caution.

Excessive sweating, severe diarrhea, or vomiting could cause you to lose too much water and cause your blood pressure to become too low. Signs of dehydration include thirst, dry mouth, weakness, drowsiness, muscle fatigue, muscle cramps, restlessness, reduced urination, and a rapid heartbeat. Be sure to drink plenty of fluids whenever dehydration threatens, and be careful when exercising in hot weather.

Notify your doctor or dentist that you are taking Aldactazide if you have a medical emergency, and before you have surgery or dental treatment.


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Possible food and drug interactions when taking Aldactazide
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If Aldactazide is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Aldactazide with the following:

ACE-inhibitor blood pressure drugs such as enalapril maleate

Alcohol

Antigout medications such as allopurinol

Barbiturates such as phenobarbital and secobarbital

Digoxin

Diuretics such as furosemide

Insulin or oral antidiabetic drugs such as glyburide

Lithium

Narcotic drugs such as those containing codeine

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium

Norepinephrine

Potassium supplements such as potassium chloride

Steroids such as prednisone


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Special information if you are pregnant or breastfeeding
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The effects of Aldactazide during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Aldactazide appears in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished.


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Recommended dosage for Aldactazide
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ADULTS


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Congestive Heart Failure, Cirrhosis, Nephrotic Syndrome (kidney disorder)

The usual dosage is 100 milligrams each of spironolactone and hydrochlorothiazide daily, taken as a single dose or in divided doses. Dosage may range from 25 milligrams to 200 milligrams of each ingredient daily, depending on your individual needs.

High Blood Pressure

The usual dose is 50 milligrams to 100 milligrams each of spironolactone and hydrochlorothiazide daily, in a single dose or divided into smaller doses.

CHILDREN


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The usual dose of Aldactazide should provide 0.75 milligram to 1.5 milligrams of spironolactone per pound of body weight.


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Overdosage
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Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

Symptoms of Aldactazide overdose may include:
Confusion, diarrhea, dizziness, drowsiness, nausea, patchy raised skin rash, vomiting


Brand name:
Testosterone Patches
Brand names: Androderm, Testoderm


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Why are Testosterone Patches prescribed?
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These patches are prescribed for men with low levels of the male hormone, testosterone. Lack of testosterone can lead to declining interest in sex, impotence, fatigue, depression, and loss of masculine characteristics.


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Most important fact about Testosterone Patches
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If you have prostate problems, make sure your doctor is aware of them. Supplementary testosterone may increase the risk of prostate cancer.


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How should you use Testosterone Patches?
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The patches deliver steady doses of testosterone through the skin.

TESTODERM

Testoderm patches are applied daily to the skin of the scrotum. They should not be applied elsewhere. Scrotal skin is much thinner than other skin, so you will not get the full dosage if you apply the patch to another part of the body.

For best results, the scrotal skin should be shaved, clean, and dry. Dry-shave the skin; avoid wet-shaving or chemical hair-removal products. The patch should be worn for 22 to 24 hours per day, every day for up to 8 weeks.

ANDRODERM

Androderm patches are applied to the skin of the back, abdomen, upper arms, or thigh, but NOT to the scrotum. It's also best to avoid bony areas such as the shoulders and hips as well as areas that get the greatest pressure while you are sleeping or sitting. You should change sites each day of the week, waiting 7 days before re-using a site.

Apply the prescribed number of patches every night. Press each patch firmly in place immediately after opening its pouch. Leave the patches in place for a full 24 hours. The application sites should be clean, dry, and free of irritation.

If you miss a dose...
Apply it as soon as you remember. If it is almost time for the next application, skip the one you missed and go back to your regular schedule. Do not apply two doses at the same time.
Storage instructions...
Store at room temperature.

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What side effects may occur?
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Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using the patch.

Among younger men being treated for delayed sexual development, supplementary testosterone can cause breast enlargement; among older men, it increases the odds of prostate cancer. Among men with heart, kidney, or liver disease, it can lead to fluid retention and congestive heart failure. The Testoderm patch sometimes causes itching, discomfort, or irritation. The Androderm patch occasionally causes itching, blisters, burning, or hardening or reddening of the skin.


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Why should Testosterone Patches not be prescribed?
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Do not use these patches if you have prostate cancer (or breast cancer). Avoid them if they give you an allergic reaction. The patches are not for use by women.


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Special warnings about Testosterone Patches
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Some testosterone may be left on the skin after a patch is removed. Particularly with Testoderm, there is a possibility that your partner could absorb some of the hormone during sex and suffer unwanted changes. If she experiences increased hair growth or an aggravation of acne, inform your doctor.

Also check with your doctor if you have frequent or persistent erections, nausea, vomiting, changes in skin color, or ankle swelling.

Testosterone patches have not been tested in boys under 15 years of age.


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Possible food and drug interactions when using Testosterone Patches
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Extra testosterone can decrease the need for blood-thinning drugs and insulin. While using the patch, you should also check with your doctor before taking the anti-inflammatory drug oxyphenbutazone.


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Special information if you are pregnant or breastfeeding
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Testosterone is intended for use only by males and must not be used by women. If used during pregnancy, it can cause serious harm to the developing baby.


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Recommended dosage for Testosterone Patches
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TESTODERM

The usual dose is 1 patch per day. The larger patch delivers 6 milligrams of testosterone. The smaller patch delivers 4 milligrams.

ANDRODERM

The usual starting dose is one 5-milligram patch or two 2.5-milligram patches per day. Depending on results, your doctor may increase the dosage to 1 large and 1 small patch (or 3 small patches) daily, or reduce it to 1 small patch per day of testosterone.


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Overdosage
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Testosterone overdose is very rare, but has been implicated in one case of stroke. Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.




Now if you are wondering why I would say this and publish this information, it is the fact I have experience with these three of these due to wanting to use them for transition, but also one other which did more damage to me than anything else in my youth. That being prednisone, which while it and several other steroids took care of an inflamation called pulmonary sarcoidosis [which also attacked the eyes]it did more damage to the system overall, which I have been dealing with over the better part of the past 20+ years...in addition to the congestive heart failure and other illnesses mentioned in a previous post. Sadly, the illness that this was used against could ahve been prevented, however some rather blatant shortsightedness on the part of one of the parental units, who at the time was a registered nurse caused the damage which did occur to be more or less a lifetime issue. In case you are wondering what prednisone can do for and do to a person:


Prednisone

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Why is Prednisone prescribed?
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Prednisone, a steroid drug, is used to reduce inflammation and alleviate symptoms in a variety of disorders, including rheumatoid arthritis and severe cases of asthma. It may be given to treat primary or secondary adrenal cortex insufficiency (lack of sufficient adrenal hormone in the body). It is used in treating all of the following:

Abnormal adrenal gland development

Allergic conditions (severe)

Blood disorders

Certain cancers (along with other drugs)

Diseases of the connective tissue including systemic lupus erythematosus

Eye diseases of various kinds

Flare-ups of multiple sclerosis

Fluid retention due to "nephrotic syndrome" (a condition in which damage to the kidneys causes protein to be lost in the urine)

Lung diseases, including tuberculosis

Meningitis (inflamed membranes around the brain)

Prevention of organ rejection

Rheumatoid arthritis and related disorders

Severe flare-ups of ulcerative colitis or enteritis (inflammation of the intestines)

Skin diseases

Thyroid gland inflammation

Trichinosis (with complications)


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Most important fact about Prednisone
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Prednisone lowers your resistance to infections and can make them harder to treat. Prednisone may also mask some of the signs of an infection, making it difficult for your doctor to diagnose the actual problem.


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How should you take Prednisone?
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Take prednisone exactly as prescribed. Dosages are kept to an absolute minimum.

If you need long-term prednisone treatment, your doctor may prescribe alternate-day therapy, in which you take the medication only every other morning. The "resting day" gives your adrenal glands a chance to produce some hormone naturally so they will not lose the ability.

If you have been taking prednisone for a period of time, you will probably need an increased dosage of the medication before, during, and after any stressful situation. Always consult your doctor if you are anticipating stress and think you may need a temporary dosage increase.

When stopping prednisone treatment, tapering off is better than quitting abruptly. Your doctor will probably have you decrease the dosage very gradually over a period of days or weeks.

You should take prednisone with food to avoid stomach upset.

If you are on alternate-day therapy or have been prescribed a single daily dose, take prednisone in the morning with breakfast (about 8 a.m.). If you have been prescribed several doses per day, take them at evenly spaced intervals around the clock.

Patients on long-term Prednisone therapy should wear or carry identification.

If you miss a dose...
If you take your dose once a day, take it as soon as you remember. If you don't remember until the next day, skip the one you missed.
If you take several doses a day, take the forgotten dose as soon as you remember and then go back to your regular schedule. If you don't remember until your next dose, double the dose you take.

If you take your dose every other day, and you remember it the same morning, take it as soon as you remember, then go back to your regular schedule. If you don't remember until the afternoon, do not take a dose until the following morning, then skip a day.

Storage instructions...
Store at room temperature.

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What side effects may occur?
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Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking prednisone.

Prednisone may cause euphoria, insomnia, mood changes, personality changes, psychotic behavior, or severe depression. It may worsen any existing emotional instability.

At a high dosage, prednisone may cause fluid retention and high blood pressure. If this happens, you may need a low-salt diet and a potassium supplement.

With prolonged prednisone treatment, eye problems may develop (e.g., a viral or fungal eye infection, cataracts, or glaucoma).

If you take prednisone over the long term, the buildup of adrenal hormones in your body may cause a condition called Cushing's syndrome, marked by weight gain, a "moon-faced" appearance, thin, fragile skin, muscle weakness, brittle bones, and purplish stripe marks on the skin. Women are more vulnerable to this problem than men. Alternate-day therapy may help prevent its development.


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Why should Prednisone not be prescribed?
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Do not take prednisone if you have ever had an allergic reaction to it.

You should not be treated with prednisone if you have a body-wide fungus infection, such as candidiasis or cryptococcosis.


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Special warnings about Prednisone
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Do not get a smallpox vaccination or any other immunization while you are taking prednisone. The vaccination might not "take," and could do harm to the nervous system.

Prednisone may reactivate a dormant case of tuberculosis. If you have inactive TB and must take prednisone for an extended time, you should be given anti-TB medication as well.

If you have an underactive thyroid gland or cirrhosis of the liver, your doctor will probably need to prescribe prednisone for you at a lower-than-average dosage.

If you have an eye infection caused by the herpes simplex virus, prednisone should be used with great caution; there is a potential danger that the cornea will become perforated.

A few people taking prednisone develop Kaposi's sarcoma, a form of cancer; it may disappear when the drug is stopped.

Prednisone should also be taken with caution if you have any of the following conditions:

Diverticulitis or other disorder of the intestine

High blood pressure

Kidney disorder

Myasthenia gravis (a muscle-weakness disorder)

Osteoporosis (brittle bones)

Peptic ulcer

Ulcerative colitis (inflammation of the bowel)

Long-term treatment with prednisone may stunt growth. If this medication is given to a child, the youngster's growth should be monitored carefully.

Diseases such as chickenpox or measles can be very serious or even fatal in both children and adults who are taking this drug. Try to avoid exposure to these diseases.


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Possible food and drug interactions when taking Prednisone
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Prednisone may decrease your carbohydrate tolerance or activate a latent case of diabetes. If you are already taking insulin or oral medication for diabetes, make sure your doctor knows this; you may need an increased dosage while you are being treated with prednisone.

If you have a blood-clotting disorder caused by a vitamin K deficiency and are taking prednisone, check with your doctor before you use aspirin.

You may be at risk of convulsions if you take the immunosuppressant drug cyclosporine while being treated with prednisone.

If prednisone is taken with certain other drugs, the effects of either could be increased, decreased, or altered. Check with your doctor before combining prednisone with any of the following:

Amphotericin B

Blood thinners such as warfarin

Carbamazepine

Estrogen drugs

Ketoconazole

Oral contraceptives

Phenobarbital

Phenytoin

Potent diuretics such as furosemide

Rifampin

Troleandomycin


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Special information if you are pregnant or breastfeeding
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If you are pregnant or plan to become pregnant, inform your doctor immediately. Prednisone should be taken during pregnancy or while breastfeeding only if clearly needed and only if the benefit outweighs the potential risks to the child.


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Recommended dosage for Prednisone
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Dosage is determined by the condition being treated and your response to the drug. Typical starting doses can range from 5 milligrams to 60 milligrams a day. Once you respond to the drug, your doctor will lower the dose gradually to the minimum effective amount. For treatment of acute attacks of multiple sclerosis, doses of as much as 200 milligrams per day may be given for a week, followed by 80 mg every other day for a month.


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Overdosage
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Long-term high doses of prednisone may produce Cushing's syndrome (see "Side Effects" section). Although no specific information is available regarding short-term overdosage, any medication taken in excess can have serious consequences. If you suspect an overdose of prednisone, seek medical attention immediately.



And with the above, you have now the facts. Just the facts...AGAIN.....I am not a doctor, but I do know where to find this information sans the filters that come through gender groups, doctors, shrinks and others whose only vested interest is making a quick or long lasting buck off of a potential patient. In this case it was the Physicians Desk Reference, which is the bible for doctors in re: their medications. This is done without that bias, just in the name of keeping people safe. If one is armed with the correct information, they can make the decisions that will benefit them longterm.

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