Tablets
Chemical Name: ESTROPIPATE (ess-troe-PI-pate)

Common uses
This medicine is a female hormone and is usually given to women who no longer produce the proper amount. It is used to reduce menopause symptoms (e.g., hot flashes, vaginal dryness), to prevent bone loss (osteoporosis) in people at high risk, or to treat certain cancers in men and women (e.g., certain types of metastatic breast cancer). It may be used to treat other conditions as determined by your doctor. If you are only being treated for vaginal menopause symptoms, products applied locally such as vaginal creams, tablets, or rings should be considered before products taken by mouth or absorbed through the skin. There are several medicines (e.g., raloxifene or bisphosphonates) that are safe and effective to prevent or treat bone loss. These medicines should be considered for use before estrogen therapy for osteoporosis. If you have other medical conditions as well, and are prescribed estrogens for more than one condition, consult your doctor about your treatment plan and its options. Estrogen-containing products should not be used to prevent heart disease.

Before using
WARNING: Estrogens have been reported to increase the chance of womb (endometrial) cancer in women who have been through menopause, especially in women with a uterus who receive estrogen-only hormone therapy. Estrogens may also increase the risk of cancer of the ovary or breast. Estrogen-containing products should not be used to prevent heart disease. Estrogen given in combination with another hormone (progestin) for replacement therapy can infrequently cause heart disease (e.g., heart attacks), stroke, serious blood clots (pulmonary embolism and deep venous thrombosis), dementia, and cancer of the breast. These risks appear to depend on the length of time this medicine is used and the amount of estrogen per dose. Therefore, this medicine should be used for the shortest possible length of time at the lowest effective dose, so you obtain the benefits and minimize the chance of serious side effects from long-term treatment. Consult your doctor/pharmacist for details. If you use this medicine for an extended period, you should be evaluated at least once a year (see CAUTIONS section). This medicine is not effective in preventing or treating a tendency toward miscarriages nor the threat of miscarriage. This medicine must not be used during pregnancy because its use may result in birth defects or cancer later in the child's life (see CAUTIONS section). Some medicines or medical conditions may interact with this medicine. INFORM YOUR DOCTOR OR PHARMACIST of all prescription and over-the-counter medicine that you are taking. ADDITIONAL MONITORING OF YOU DOSE OR CONDITION may be needed if you are taking corticosteroids (e.g., prednisone); hydantoins (e.g., phenytoin); warfarin; or any medicines that affect certain liver enzymes (CYP450-3A4), such as azole antifungals (e.g., ketoconazole, itraconazole), carbamazepine, macrolide antibiotics (e.g., clarithromycin, erythromycin), phenobarbital, rifamycins (e.g., rifampin), ritonavir, cimetidine, or St. John's wort. DO NOT START OR STOP any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions including a family medical history (especially breast lumps/cancer), asthma, diabetes, seizures, migraine headaches, heart disease (e.g., high blood pressure, heart attacks, congestive heart failure), kidney disease, low thyroid hormone (hypothyroidism), abnormal calcium level in the blood, depression, high blood pressure during pregnancy (toxemia), yellowing of eyes/skin (cholestatic jaundice) during pregnancy or with past estrogen use, womb problems (e.g., uterine fibroids, endometriosis), cholesterol/lipid problems, gallbladder disease, excessive weight gain, certain blood disorder (porphyria), any allergies, pregnancy, or breast-feeding. USE OF THIS MEDICINE IS NOT RECOMMENDED if you have undiagnosed abnormal vaginal bleeding, cancer (e.g., breast cancer - also see COMMON USES section), blood clots, liver disease, or active/recent stroke or heart attack.

Directions
Follow the directions for using this medicine provided by your doctor. Your dosage is based on your medical condition and response to therapy. Follow the dosing schedule carefully. This medicine may come with a patient information leaflet. Read it carefully. Ask your doctor, nurse, or pharmacist any questions that you may have about this medicine. THIS MEDICINE MAY BE TAKEN with food or immediately after a meal to prevent stomach upset. STORE THIS MEDICINE at room temperature between 59 and 86 degrees F (15-30 degrees C) in a tightly-closed container, away from heat, moisture, and light. IF YOU MISS A DOSE OF THIS MEDICINE, take is as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Cautions
IT IS IMPORTANT that you keep all doctor and laboratory appointments while you are using this medicine. You should have a complete physical examination, including blood pressure measurements, breast and pelvic examinations, and a PAP test (for vaginal cancer), at least once a year. You should also have periodic mammograms as determined by your doctor. Follow your doctor's instructions for examining your own breasts, and report any lumps immediately. This medicine may affect certain lab test results. Make sure laboratory personnel and your doctors know you use this medicine. If you will be having surgery or will be confined to a chair or bed for a long period of time (e.g., a long plane flight), notify your doctor beforehand. Special precautions may need to be taken in these circumstances while you are taking this medicine. THIS MEDICINE MAY CAUSE DIZZINESS. DO NOT DRIVE, OPERATE MACHINERY, OR DO ANYTHING ELSE THAT COULD BE DANGEROUS until you know how you react to this medicine. Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive, or to perform other potentially dangerous tasks. LIMIT ALCOHOLIC BEVERAGES. THIS MEDICINE MAY CAUSE dark skin patches on your face (melasma). Exposure to the sun may make these patches darker and you may need to avoid prolonged sun exposure and sunlamps. Consult your doctor regarding the use of sunscreens and protective clothing. SMOKING WHILE USING THIS MEDICINE may increase your risk of blood clots (especially in women over the age of 35). BEFORE YOU BEGIN TAKING ANY NEW MEDICINE, either prescription or over-the-counter, check with your doctor or pharmacist. IF YOU WEAR CONTACT LENSES and you develop problems with them, contact your doctor. CAUTION IS ADVISED WHEN USING THIS MEDICINE IN CHILDREN. Their growth pattern should be monitored as this medicine might stunt their growth. DO NOT USE THIS MEDICINE if you are pregnant. IF YOU SUSPECT THAT YOU COULD BE PREGNANT, contact your doctor immediately. THIS MEDICINE MAY BE EXCRETED IN BREAST MILK. IF YOU ARE OR WILL BE BREAST-FEEDING while you are taking this medicine, check with your doctor or pharmacist to discuss the risks to your baby.

Possible side effects
SIDE EFFECTS, that may go away during treatment, include dizziness, lightheadedness, headache, stomach upset, bloating, nausea, weight changes, increased/decreased interest in sex, or breast tenderness. If they continue or are bothersome, check with your doctor. CONTACT YOUR DOCTOR IMMEDIATELY if you experience mental/mood changes (e.g., severe depression, memory loss), calf pain/swelling, sudden severe headache, chest pain, trouble breathing, one-sided weakness, slurred speech, vision changes (e.g., change in contact lens fit, loss of vision) breast lumps, swelling of hands or feet, changes in vaginal bleeding (e.g., spotting, breakthrough bleeding, or prolonged bleeding), unusual vaginal discharge/itching/odor, or yellowing of eyes or skin. AN ALLERGIC REACTION to this medicine is unlikely but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, or trouble breathing. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist.

Drug interactions
Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Use our drug interaction checker to find out if your medicines interact with each other.

If you take too much
If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include severe nausea/vomiting, or excessive or unusual vaginal bleeding.

Additional information
It is important that you and your physician regularly re-evaluate your need for this medicine. Non-drug therapy to help prevent bone loss includes a weight-bearing exercise plan, as well as adequate daily calcium and vitamin D intake. Consult your doctor or pharmacist for more details. DO NOT SHARE THIS MEDICINE with others for whom it was not prescribed. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS MEDICINE out of the reach of children and pets. IF USING THIS MEDICINE FOR AN EXTENDED PERIOD OF TIME, obtain refills before your supply runs out.