Alora - Estrogen (Oral Route, Parenteral Route, Topical Application Route, Transdermal Route)

    Alora – Estrogen (Oral Route, Parenteral Route, Topical Application Route, Transdermal Route)

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    Description and Brand Names of Alora – Estrogen (Oral Route, Parenteral Route, Topical Application Route, Transdermal Route)

    US Brand Name

    1. Alora
    2. Cenestin
    3. Climara
    4. Divigel
    5. Elestrin
    6. Emcyt
    7. Enjuvia
    8. Esclim
    9. Estinyl
    10. EstroGel
    11. Evamist
    12. Femtrace
    13. Gynodiol
    14. Menest
    15. Menostar
    16. Minivelle
    17. Ogen 625
    18. Ogen 125
    19. Ogen 25
    20. Premarin
    21. Vivelle
    22. Vivelle-Dot
    23. Estraderm
    24. EstroGel

    Canadian Brand Name

    1. Estradot Transdermal
    2. Estradot Transdermal Therapeutic System
    3. Estradot Transdermal Therapeutic System
    4. Oesclim
    5. Rhoxal-Estradiol Derm 50
    6. Rhoxal-Estradiol Derm 75
    7. Roxal-Estradiol Derm 100
    8. Vivelle 100 Mcg
    9. Vivelle 25 Mcg

    Descriptions

    Estrogens are female hormones. They are produced by the body and are necessary for the normal sexual development of the female and for the regulation of the menstrual cycle during the childbearing years.

    The ovaries begin to produce less estrogen after menopause (the change of life). This medicine is prescribed to make up for the lower amount of estrogen. Estrogens help relieve signs of menopause, such as hot flashes and unusual sweating, chills, faintness, or dizziness.

    Estrogens are prescribed for several reasons:

    • To provide additional hormone when the body does not produce enough of its own, such as during menopause or when female puberty (development of female sexual organs) does not occur on time. Other conditions include a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or ovary problems (female hypogonadism or failure or removal of both ovaries).
    • To help prevent weakening of bones (osteoporosis) in women past menopause.
    • In the treatment of selected cases of breast cancer in men and women.
    • In the treatment of cancer of the prostate in men.

    Estrogens may also be used for other conditions as determined by your doctor.

    There is no medical evidence to support the belief that the use of estrogens will keep the patient feeling young, keep the skin soft, or delay the appearance of wrinkles. Nor has it been proven that the use of estrogens during menopause will relieve emotional and nervous symptoms, unless these symptoms are caused by other menopausal symptoms, such as hot flashes or hot flushes.

    Estrogens are available only with your doctor’s prescription.

    Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, estrogen is used in certain patients with the following medical conditions:

    • Gender identity disorder, male-to-female transsexualism (person who is born as a man but adapts to a woman’s lifestyle, sees himself as a woman, and feels like a woman instead of a man.
    • Osteoporosis caused by lack of estrogen before menopause.
    • Turner’s syndrome (a genetic disorder).

    This product is available in the following dosage forms:

    • Tablet
    • Patch, Extended Release
    • Gel/Jelly
    • Spray
    • Emulsion
    • Tablet, Enteric Coated
    • Capsule

    Before Using Alora – Estrogen (Oral Route, Parenteral Route, Topical Application Route, Transdermal Route)

    Allergies

    Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

    Pediatric

    Use of this medicine before puberty is not recommended. Growth of bones can be stopped early. Girls and boys may develop growth of breasts. Girls may have vaginal changes, including vaginal bleeding.

    This medicine may be used to start puberty in teenagers with some types of delayed puberty.

    Geriatric

    Elderly people are especially sensitive to the effects of estrogens. This may increase the chance of side effects during treatment, especially stroke, invasive breast cancer, and memory problems.

    Pregnancy

    Estrogens are not recommended for use during pregnancy or right after giving birth. Becoming pregnant or maintaining a pregnancy is not likely to occur around the time of menopause.

    Certain estrogens have been shown to cause serious birth defects in humans and animals. Some daughters of women who took diethylstilbestrol (DES) during pregnancy have developed reproductive (genital) tract problems and, rarely, cancer of the vagina or cervix (opening to the uterus) when they reached childbearing age. Some sons of women who took DES during pregnancy have developed urinary-genital tract problems.

    Breastfeeding

    Use of this medicine is not recommended in nursing mothers. Estrogens pass into the breast milk and their possible effect on the baby is not known.

    Drug Interactions

    Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

    Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

    • Rotavirus Vaccine, Live
    • Tranexamic Acid

    Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

    • Adenovirus Vaccine Type 4, Live
    • Adenovirus Vaccine Type 7, Live
    • Bacillus of Calmette and Guerin Vaccine, Live
    • Boceprevir
    • Clozapine
    • Crizotinib
    • Dabrafenib
    • Eslicarbazepine Acetate
    • Felbamate
    • Fentanyl
    • Influenza Virus Vaccine, Live
    • Isotretinoin
    • Measles Virus Vaccine, Live
    • Mumps Virus Vaccine, Live
    • Paclitaxel
    • Paclitaxel Protein-Bound
    • Piperaquine
    • Pixantrone
    • Primidone
    • Rubella Virus Vaccine, Live
    • Smallpox Vaccine
    • St John’s Wort
    • Theophylline
    • Tizanidine
    • Typhoid Vaccine
    • Varicella Virus Vaccine
    • Yellow Fever Vaccine

    Other Interactions

    Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

    Other Medical Problems

    The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

    For all patients

    • Asthma or
    • Calcium, too much or too little in blood or
    • Diabetes or
    • Epilepsy or seizures or
    • Heart problems or
    • Kidney problems or
    • Liver tumors, benign or
    • Lupus erythematosus, systemic or
    • Migraine headaches – Estrogens may worsen these conditions.
    • Blood clotting problems, or history of during previous estrogen therapy – Estrogens usually are not used until blood clotting problems stop; using estrogens is not a problem for most patients without a history of blood clotting problems due to estrogen use.
    • Breast cancer or
    • Bone cancer or
    • Cancer of the uterus or
    • Fibroid tumors of the uterus – Estrogens may interfere with the treatment of breast or bone cancer or worsen cancer of the uterus when these conditions are present.
    • Bulging eyes or
    • Double vision or
    • Migraine headache or
    • Vision changes, sudden onset including or
    • Vision loss, partial or complete – Estrogens may cause these problems. Tell your doctor if you have had any of these problems, especially while taking estrogen or oral contraceptives (“birth control pillsâ€).
    • Changes in genital or vaginal bleeding of unknown causes – Use of estrogens may delay diagnosis or worsen condition. The reason for the bleeding should be determined before estrogens are used.
    • Endometriosis or
    • Gallbladder disease or gallstones, or history of or
    • High cholesterol or triglycerides, or history of or
    • Liver disease, or history of or
    • Pancreatitis (inflammation of pancreas) or
    • Porphyria – Estrogens may worsen these conditions. Although estrogens can improve blood cholesterol, they can worsen blood triglycerides for some people.
    • Hypothyroid (too little thyroid hormone) – Dose of thyroid medicine may need to be increased.

    For males treated for breast or prostate cancer:

    • Blood clots or
    • Heart or circulation disease or
    • Stroke – Males with these medical problems may be more likely to have clotting problems while taking estrogens; the high doses of estrogens used to treat male breast or prostate cancer have been shown to increase the chances of heart attack, phlebitis (inflamed veins) caused by a blood clot, or blood clots in the lungs.

    Proper Use of Alora – Estrogen (Oral Route, Parenteral Route, Topical Application Route, Transdermal Route)

    Take this medicine only as directed by your doctor. Do not take more of it and do not take or use it for a longer time than your doctor ordered. For patients taking any of the estrogens by mouth, try to take the medicine at the same time each day to reduce the possibility of side effects and to allow it to work better.

    This medicine usually comes with patient information or directions. Read and follow the instructions in the insert carefully. Ask your doctor if you have any questions.

    For patients taking any of the estrogens by mouth or by injection:

    • Nausea may occur during the first few weeks after you start taking estrogens. This effect usually disappears with continued use. If the nausea is bothersome, it can usually be prevented or reduced by taking each dose with food or immediately after food.

    For patients using the transdermal (skin patch):

    • Wash and dry your hands thoroughly before and after handling the patch.
    • Apply the patch to a clean, dry, non-oily skin area of your lower abdomen, hips below the waist, or buttocks that has little or no hair and is free of cuts or irritation. The manufacturer of the 0.025-mg patch recommends that its patch be applied to the buttocks only. Furthermore, each new patch should be applied to a new site of application. For instance, if the old patch is taken off the left buttock, then apply the new patch to the right buttock.
    • Do not apply to the breasts. Also, do not apply to the waistline or anywhere else where tight clothes may rub the patch loose.
    • Press the patch firmly in place with the palm of your hand for about 10 seconds. Make sure there is good contact, especially around the edges.
    • If a patch becomes loose or falls off, you may reapply it or discard it and apply a new patch.
    • Each dose is best applied to a different area of skin on your lower abdomen, hips below the waist, or buttocks so that at least 1 week goes by before the same area is used again. This will help prevent skin irritation.

    For patients using the topical emulsion (skin lotion):

    • Washing and drying hands thoroughly before each application.
    • Apply while you are sitting comfortably. Apply one pouch to each leg every morning.
    • Apply the entire contents of one pouch to clean, dry skin on the left thigh. Rub the emulsion into the entire thigh and calf for 3 minutes until thoroughly absorbed.
    • Apply entire contents of the second pouch to clean, dry skin on the right thigh. Rub the emulsion into the entire thigh and calf for 3 minutes until thoroughly absorbed.
    • Rub any remaining emulsion on both hands on the buttocks.
    • Washing and drying hands thoroughly after application.
    • To avoid transfer to other individuals, allow the application areas to dry completely before covering with clothing.

    If you are using the Evamist® transdermal spray:

    • Spray the medicine on your skin on the inside of your forearm, between the elbow and the wrist.
    • Do not allow your child to touch the area of the arm where the medicine was sprayed. If you cannot avoid to come nearer with your child, wear clothes with long sleeves to cover the application site.
    • If your child comes in direct contact with the arm where the medicine was sprayed, wash your child’s skin right away with soap and water.
    • Do not allow your pets to lick or touch the arm where the medicine was sprayed.

    Dosing

    The dose medicines in this class will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

    The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

    For conjugated estrogens

    • For oral dosage form (tablets):

      • For treating breast cancer in women after menopause and in men:

        • Adults – 10 milligrams (mg) three times a day for at least 3 months.
      • For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:

        • Adults – 0.3 milligram (mg) a day. Your doctor may want you to take the medicine each day or only on certain days of the month. Your doctor may change the dose based on how your body responds to the medication.
      • To prevent loss of bone (osteoporosis):

        • Adults – 0.3 milligram (mg) a day. Your doctor may want you to take the medicine each day or only on certain days of the month. Your doctor may change the dose based on how your body responds to the medication.
      • For treating ovary problems (female hypogonadism or for starting puberty):

        • Adults and teenagers – 0.3 to 0.625 milligram (mg) a day. Your doctor may want you to take the medicine only on certain days of the month.
      • For treating ovary problems (failure or removal of both ovaries):

        • Adults – 1.25 milligram (mg) a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
      • For treating prostate cancer:

        • Adults – 1.25 to 2.5 milligram (mg) three times a day.
    • For injection dosage form:

      • For controlling abnormal bleeding of the uterus:

        • Adults – 25 milligrams (mg) injected into a muscle or vein. This may be repeated in six to twelve hours if needed.

    For esterified estrogens

    • For oral dosage form (tablets):

      • For treating breast cancer in women after menopause and in men:

        • Adults – 10 milligrams (mg) three times a day for at least three months.
      • For treating a genital skin condition (vulvar atrophy) or inflammation of the vagina (atrophic vaginitis), or to prevent loss of bone (osteoporosis):

        • Adults – 0.3 to 1.25 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
      • For treating ovary problems (failure or removal of both ovaries):

        • Adults – 1.25 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
      • For treating ovary problems (female hypogonadism):

        • Adults – 2.5 to 7.5 mg a day. This dose may be divided up and taken in smaller doses. Your doctor may want you to take the medicine each day or only on certain days of the month.
      • For treating symptoms of menopause:

        • Adults – 0.625 to 1.25 mg a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
      • For treating prostate cancer:

        • Adults – 1.25 to 2.5 mg three times a day.

    For estradiol

    • For oral dosage form:

      • For treating breast cancer in women after menopause and in men:

        • Adults – 10 milligrams (mg) three times a day for at least 3 months.
      • For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), ovary problems (female hypogonadism or failure or removal of both ovaries), or symptoms of menopause:

        • Adults – At first, 1 to 2 milligrams (mg) one time per day for at least 3 months. Your doctor may want you to take the medicine each day or only on certain days of the month. Your doctor may also need to change the dose based on how your body responds to the medication.
      • For treating prostate cancer:

        • Adults – 1 to 2 milligrams (mg) three times a day.
      • To prevent loss of bone (osteoporosis):

        • Adults – 0.5 milligram (mg) a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
    • For topical emulsion dosage form (skin lotion):

      • For treating symptoms of menopause:

        • Adults – 1.74 grams (one pouch) applied to the skin of each leg (thigh and calf) once a day in the morning.
    • For transdermal dosage form (skin patches):

      • For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), symptoms of menopause, ovary problems (female hypogonadism or failure or removal of both ovaries), or to prevent loss of bone (osteoporosis):

        For the Climara patches

        • Adults – 0.025 to 0.1 milligram (mg) (one patch) applied to the skin and worn for one week. Then, remove that patch and apply a new one. A new patch should be applied once a week for three weeks. During the fourth week, you may or may not wear a patch. Your health care professional will tell you what you should do for this fourth week. After the fourth week, you will repeat the cycle.

        For the Alora, Estraderm, Estradot, Vivelle, or Vivelle-Dot patches

        • Adults – 0.025 to 0.1 mg (one patch) applied to the skin and worn for one half of a week. Then, remove that patch and apply and wear a new patch for the rest of the week. A new patch should be applied two times a week for three weeks. During the fourth week, you may or may not apply new patches. Your health care professional will tell you what you should do for this fourth week. After the fourth week, you will repeat the cycle.

    For estradiol cypionate

    • For injection dosage form:

      • For treating ovary problems (female hypogonadism):

        • Adults – 1.5 to 2 milligrams (mg) injected into a muscle once a month.
      • For treating symptoms of menopause:

        • Adults – 1 to 5 milligrams (mg) injected into a muscle every 3 to 4 weeks.

    For estradiol valerate

    • For injection dosage form:

      • For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), symptoms of menopause, or ovary problems (female hypogonadism or failure or removal of both ovaries):

        • Adults – 10 to 20 milligrams (mg) injected into a muscle every 4 weeks as needed.
      • For treating prostate cancer:

        • Adults – 30 milligrams (mg) injected into a muscle every 1 or 2 weeks.

    For estrone

    • For injection dosage form:

      • For controlling abnormal bleeding of the uterus:

        • Adults – 2 to 5 milligrams (mg) a day, injected into a muscle for several days.
      • For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:

        • Adults – 0.1 to 0.5 milligram (mg) injected into a muscle 2 or 3 times a week. Your doctor may want you to receive the medicine each week or only during certain weeks of the month.
      • For treating ovary problems (female hypogonadism or failure or removal of both ovaries):

        • Adults – 0.1 to 1 milligram (mg) a week. This is injected into a muscle as a single dose or divided into more than one dose. Your doctor may want you to receive the medicine each week or only during certain weeks of the month.
      • For treating prostate cancer:

        • Adults – 2 to 4 milligrams (mg) injected into a muscle 2 or 3 times a week.

    For estropipate

    • For oral dosage form (tablets):

      • For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis), or symptoms of menopause:

        • Adults – 0.75 to 6 milligrams (mg) a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
      • For treating ovary problems (female hypogonadism or failure or removal of both ovaries):

        • Adults – 1.5 to 9 milligrams (mg) a day. Your doctor may want you to take the medicine each day or only on certain days of the month.
      • To prevent loss of bone (osteoporosis):

        • Adults – 0.75 milligram (mg) a day. Your doctor may want you to take the medicine each day for twenty-five days of a thirty-one–day cycle.

    For ethinyl estradiol

    • For oral dosage form (tablets):

      • For treating breast cancer in women after menopause and in men:

        • Adults – 1 milligram (mg) three times a day.
      • For treating ovary problems (female hypogonadism or failure or removal of both ovaries):

        • Adults – 0.05 milligram (mg) one to three times a day for 3 to 6 months. Your doctor may want you to take the medicine each day or only on certain days of the month.
      • For treating prostate cancer:

        • Adults – 0.15 to 3 milligrams (mg) a day.
      • For treating symptoms of menopause:

        • Adults – 0.02 to 0.05 milligram (mg) a day. Your doctor may want you to take the medicine each day or only on certain days of the month.

    For ethinyl estradiol and norethindrone

    • For oral dosage form (tablets):

      • For treating symptoms of menopause:

        • Adults – 1 tablet (5 mcg ethinyl estradiol and 1 mg of norethindrone) each day.
      • To prevent loss of bone (osteoporosis):

        • Adults – 1 tablet (5 mcg ethinyl estradiol and 1 mg of norethindrone) each day.

    Missed Dose

    If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

    If you miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

    If you forget to wear or change a patch, put one on as soon as you can. If it is almost time to put on your next patch, wait until then to apply a new patch and skip the one you missed. Do not apply extra patches to make up for a missed dose.

    Storage

    Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

    Keep out of the reach of children.

    Do not keep outdated medicine or medicine no longer needed.

    Ask your healthcare professional how you should dispose of any medicine you do not use.

    Precautions

    It is very important that your doctor check your progress at regular visits to make sure this medicine does not cause unwanted effects. These visits will usually be every year, but some doctors require them more often.

    In some patients using estrogens, tenderness, swelling, or bleeding of the gums may occur. Brushing and flossing your teeth carefully and regularly and massaging your gums may help prevent this. See your dentist regularly to have your teeth cleaned. Check with your medical doctor or dentist if you have any questions about how to take care of your teeth and gums, or if you notice any tenderness, swelling, or bleeding of your gums.

    Although the incidence is low, the use of estrogens may increase you chance of getting cancer of the breast, ovaries, or uterus (womb). Therefore, it is very important that you regularly check your breasts for any unusual lumps or discharge. Report any problems to your doctor. You should also have a mammogram (x-ray pictures of the breasts) done if your doctor recommends it. Because breast cancer has occurred in men taking estrogens, regular breast self-exams and exams by your doctor for any unusual lumps or discharge should be done.

    If your menstrual periods have stopped, they may start again. This effect will continue for as long as the medicine is taken. However, if taking the continuous treatment (0.625 mg conjugated estrogens and 2.5 mg medroxyprogesterone once a day), monthly bleeding usually stops within 10 months.

    Also, vaginal bleeding between your regular menstrual periods may occur during the first 3 months of use. Do not stop taking your medicine. Check with your doctor if bleeding continues for an unusually long time, if your period has not started within 45 days of your last period, or if you think you are pregnant.

    Tell the doctor in charge that you are using this medicine before having any laboratory test because some results may be affected.

    Check with your child’s doctor right away if your child starts to have the following symptoms: nipple or breast swelling or tenderness in females, or enlargement of the breasts in males. Your child may have been exposed to Evamist® transdermal spray.

    Do not allow your pets to lick or touch the arm where Evamist® transdermal spray was applied. Small pets may be sensitive to this medicine. Call your pet’s veterinarian if your pet starts to have the following symptoms: nipple or breast enlargement, swelling of the vulva, or any signs of illness.

    Side Effects of Alora – Estrogen (Oral Route, Parenteral Route, Topical Application Route, Transdermal Route)

    Women rarely have severe side effects from taking estrogens to replace estrogen. Discuss these possible effects with your doctor:

    The prolonged use of estrogens has been reported to increase the risk of endometrial cancer (cancer of the lining of the uterus) in women after menopause. This risk seems to increase as the dose and the length of use increase. When estrogens are used in low doses for less than 1 year, there is less risk. The risk is also reduced if a progestin (another female hormone) is added to, or replaces part of, your estrogen dose. If the uterus has been removed by surgery (total hysterectomy), there is no risk of endometrial cancer.

    Although the incidence is low, the use of estrogens may increase you chance of getting cancer of the breast. Breast cancer has been reported in men taking estrogens.

    Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

    The following side effects may be caused by blood clots, which could lead to stroke, heart attack, or death. These side effects occur rarely, and, when they do occur, they occur in men treated for cancer using high doses of estrogens.

    Check with your doctor immediately if any of the following side effects occur:

    More common

    1. Breast pain (in females and males)
    2. fast heartbeat
    3. fever
    4. hives
    5. hoarseness
    6. increased breast size (in females and males)
    7. irritation of the skin
    8. itching of the skin
    9. joint pain, stiffness, or swelling
    10. rash
    11. redness of the skin
    12. shortness of breath
    13. swelling of the eyelids, face, lips, hands, or feet
    14. swelling of the feet and lower legs
    15. tightness in the chest
    16. troubled breathing or swallowing
    17. weight gain (rapid)
    18. wheezing

    Less common or rare

    1. Changes in vaginal bleeding (spotting, breakthrough bleeding, prolonged or heavier bleeding, or complete stoppage of bleeding)
    2. chest pain
    3. chills
    4. cough
    5. heavy non-menstrual vaginal bleeding
    6. lumps in, or discharge from, breast (in females and males)
    7. pains in the stomach, side, or abdomen
    8. yellow eyes or skin

    Rare

    1. Headache (sudden or severe)
    2. loss of coordination (sudden)
    3. loss of vision or change of vision (sudden)
    4. pains in the chest, groin, or leg, especially in the calf of leg
    5. shortness of breath (sudden and unexplained)
    6. slurring of speech (sudden)
    7. weakness or numbness in the arm or leg

    Incidence not known

    1. Abdominal or stomach bloating
    2. abdominal or stomach cramps
    3. acid or sour stomach
    4. anxiety
    5. backache
    6. belching
    7. blindness
    8. blistering, peeling, or loosening of the skin
    9. blue-yellow color blindness
    10. blurred vision
    11. change in vaginal discharge
    12. changes in skin color
    13. changes in vision
    14. chest discomfort
    15. clay-colored stools
    16. clear or bloody discharge from nipple
    17. confusion
    18. constipation
    19. convulsions
    20. dark urine
    21. decrease in the amount of urine
    22. decreased vision
    23. depression
    24. diarrhea
    25. difficulty with breathing
    26. difficulty with speaking
    27. dimpling of the breast skin
    28. dizziness
    29. double vision
    30. dry mouth
    31. eye pain
    32. fainting
    33. fluid-filled skin blisters
    34. full feeling in upper abdomen or stomach
    35. full or bloated feeling or pressure in the stomach
    36. headache
    37. heartburn
    38. inability to move the arms, legs, or facial muscles
    39. inability to speak
    40. incoherent speech
    41. increased urination
    42. indigestion
    43. inverted nipple
    44. irregular heartbeats
    45. light-colored stools
    46. lightheadedness
    47. loss of appetite
    48. loss of bladder control
    49. lump under the arm
    50. metallic taste
    51. migraine headache
    52. mood or mental changes
    53. muscle cramps in the hands, arms, feet, legs, or face
    54. muscle pain
    55. muscle spasm or jerking of all extremities
    56. muscle weakness
    57. nausea
    58. noisy breathing
    59. numbness or tingling of the hands, feet, or face
    60. pain in the ankles or knees
    61. pain or discomfort in the arms, jaw, back or neck
    62. pain or feeling of pressure in the pelvis
    63. pain, tenderness, swelling of the foot or leg
    64. painful or tender cysts in the breasts
    65. painful, red lumps under the skin, mostly on the legs
    66. pains in the chest, groin, or legs, especially calves of the legs
    67. partial or complete loss of vision in the eye
    68. pelvic pain
    69. persistent crusting or scaling of nipple
    70. pinpoint red or purple spots on the skin
    71. prominent superficial veins over affected area
    72. red, irritated eyes
    73. redness or swelling of the breast
    74. sensitivity to the sun
    75. severe headaches of sudden onset
    76. skin thinness
    77. skin warmth
    78. slow speech
    79. sore on the skin of the breast that does not heal
    80. sore throat
    81. sores, ulcers, or white spots in the mouth or on the lips
    82. stomach discomfort, upset, or pain
    83. sudden loss of consciousness
    84. sudden loss of coordination
    85. sudden onset of shortness of breath for no apparent reason
    86. sudden onset of slurred speech
    87. sudden vision changes
    88. swelling of the abdominal or stomach area
    89. swelling of the fingers or hands
    90. thirst
    91. tremor
    92. unpleasant breath odor
    93. unusual tiredness or weakness
    94. vomiting
    95. vomiting of blood
    96. weight loss

    Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

    More common

    1. Abnormal growth filled with fluid or semisolid material
    2. accidental injury
    3. bladder pain
    4. bloated full feeling
    5. bloody or cloudy urine
    6. body aches or pain
    7. coating or white patches on tongue
    8. congestion
    9. cough producing mucus
    10. decrease in amount of urine
    11. difficult, burning, or painful urination
    12. discouragement
    13. dryness of the throat
    14. ear congestion or pain
    15. excess air or gas in the stomach or intestines
    16. fear
    17. feeling of warmth
    18. feeling sad or empty
    19. frequent urge to urinate
    20. general feeling of discomfort or illness
    21. headache, severe and throbbing
    22. increased clear or white vaginal discharge
    23. irritability
    24. itching of the vaginal, rectal or genital areas
    25. lack of appetite
    26. lack or loss of strength
    27. loss of interest or pleasure
    28. mild dizziness
    29. neck pain
    30. nervousness
    31. pain
    32. pain during sexual intercourse
    33. painful or difficult urination
    34. pain or tenderness around the eyes and cheekbones
    35. passing gas
    36. redness of the face, neck, arms, and occasionally, upper chest
    37. runny nose
    38. skin irritation or redness where skin patch was worn
    39. shivering
    40. sleeplessness
    41. sneezing
    42. sore mouth or tongue
    43. stuffy nose
    44. sudden sweating
    45. tender, swollen glands in the neck
    46. thick, white vaginal discharge with no odor or with a mild odor
    47. tiredness
    48. trouble concentrating
    49. trouble sleeping
    50. unable to sleep
    51. voice changes

    Less common

    1. Blemishes on the skin
    2. burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
    3. burning or stinging of the skin
    4. diarrhea (mild)
    5. difficulty with moving
    6. dizziness (mild)
    7. increased hair growth, especially on the face
    8. lower abdominal or stomach pain or pressure
    9. mood or mental changes
    10. muscle stiffness
    11. painful cold sores or blisters on the lips, nose, eyes, or genitals
    12. pimples
    13. pounding in the ears
    14. problems in wearing contact lenses
    15. slow heartbeat
    16. tooth or gum pain
    17. unusual decrease in sexual desire (in males)
    18. unusual increase in sexual desire (in females)
    19. white or brownish vaginal discharge

    Incidence not known

    1. Abnormal turning out of cervix
    2. changes in appetite
    3. dull ache or feeling of pressure or heaviness in the legs
    4. flushed, dry skin
    5. fruit-like breath odor
    6. increased hunger
    7. irritability
    8. large amount of triglyceride in the blood
    9. leg cramps
    10. patchy brown or dark brown discoloration of the skin
    11. poor insight and judgment
    12. problems with memory or speech
    13. trouble recognizing objects
    14. trouble thinking and planning
    15. trouble walking
    16. twitching, uncontrolled movements of the tongue, lips, face, arms, or legs
    17. unexpected or excess milk flow from the breasts

    Also, many women who are taking estrogens with a progestin (another female hormone) will start having monthly vaginal bleeding, similar to menstrual periods, again. This effect will continue for as long as the medicine is taken. However, monthly bleeding will not occur in women who have had the uterus removed by surgery (total hysterectomy).

    This medicine may cause loss or thinning of the scalp hair in some people.

    Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

    Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.