Estradiol (es-tra-DYE-ole)

Treats hot flashes and other symptoms of menopause or lack of estrogen.

Brand Name(s):

When This Medicine Should Not Be Used:

How to Use This Medicine:

Liquid Mixture, Gel/Jelly

• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• This medicine is for use on the skin only. Do not get it in your eyes, nose, or mouth. Do not use it on skin areas that have cuts or scrapes. If it does get on these areas, rinse it off right away.
• This medicine comes with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.
• Wash your hands with soap and water before and after using this medicine.
• Apply the emulsion to your legs and it will be absorbed through your skin. The usual daily dose is two foil pouches, one for each leg. Cut or tear open the first pouch at the notches near the top. Squeeze out all of the medicine from the pouch onto the top of your left thigh. Rub the medicine thoroughly into your thigh and calf, for about three minutes. Repeat these steps to apply the medicine in the second pouch to the right thigh and calf.
• The gel form of this medicine comes in a pump that delivers the correct dose of estradiol each time you press the pump. When using the pump for the first time, you may need to prime it by pumping two or three times. Follow the patient instructions for the container you use. After priming the pump, do not press the pump more than one time every time you use it or you may be getting too much.
• Apply the gel to clean, dry, and unbroken skin. Spread the gel as thinly as possible over the entire area on the inside and outside of your arm from the wrist up to the shoulder area. Do not apply the medicine directly to your breasts or in or around your vagina. Do not allow others to come in contact with the area of skin where you applied the gel for at least two hours after you use the medicine. Do not allow others to apply the gel for you.
• Do not apply sunscreen to the area where you applied the gel for 7 or more consecutive days. For each application, wait at least 25 minutes before you put on a sunscreen.
• This medicine is usually applied once daily, at the same time each day.
• Allow the medicine to dry completely before you put clothing on.
• Estradiol gel is flammable. Avoid using the medicine near open flame or while smoking.

If a dose is missed:

• If you miss a dose or forget to use your medicine, apply it as soon as you can. If it is almost time for your next dose, wait until then to apply the medicine and skip the missed dose. Do not apply extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine:

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of the used medicine container and any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are also using a blood thinner such as warfarin (Coumadin®), St. John's wort, phenobarbital (Luminal®), carbamazepine (Tegretol®), rifampin (Rifadin®, Rifater®), erythromycin (E.E.S.®, Ery-tab®), clarithromycin (Biaxin®), itraconazole (Sporanox®), ketoconazole (Nizoral®), ritonavir (Norvir®), or thyroid medicine (levothyroxine, Synthroid®).
• Do not use cosmetics or other skin care products on the treated skin areas.
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:

• It is unlikely that a postmenopausal woman may become pregnant. But, you should know that using this medicine while you are pregnant could harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.
• Make sure your doctor knows if you are breastfeeding, or if you have endometriosis, a history of cancer, asthma, diabetes, epilepsy, gallbladder disease, kidney disease, lupus, migraine headaches, porphyria, thyroid problems, high or low calcium in your blood (hypercalcemia or hypocalcemia), heart disease, blood clotting problems, high blood pressure, high blood cholesterol, or a family history of high cholesterol. Tell your doctor if you have ever had liver problems caused by pregnancy or estrogen.
• Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments.
• This medicine should not be used to treat or prevent heart disease or stroke. In fact, using large doses of this medicine over a long period of time may increase your risk of heart attack, stroke, dementia, breast cancer, or uterine cancer. Talk with your doctor about this risk. If you still have your uterus (womb), ask your doctor if you should also use a progestin medicine.
• Your risk of heart disease or stroke from this medicine is higher if you smoke. Your risk is also increased if you have diabetes or high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.
• This medicine may also increase your risk of certain types of cancer. Talk to your doctor if you have concerns about this risk.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.
• Check with your eye doctor if you wear contact lenses and you have vision problems or eye discomfort.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing.
• Chest pain, shortness of breath, or coughing up blood.
• Fever, chills, cough, sore throat, and body aches.
• Lumps in your breast, or nipple discharge.
• Numbness or weakness in your arm or leg, or on one side of your body.
• Pain in your lower leg (calf).
• Rapid weight gain.
• Sudden or severe headache, problems with vision, speech, or walking.
• Swelling in your hands, ankles, or feet.
• Unusual vaginal bleeding, discharge, or itching.
• Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

• Back or joint pain.
• Changes in weight or hair growth.
• Mild headache.
• Mild skin rash or itching.
• Nausea, vomiting, diarrhea, upset stomach, or stomach pain or cramps.
• Nervousness or anxiety.
• Runny or stuffy nose.
• Skin discoloration.
• Skin redness or itching where the medicine is applied.
• Swollen or tender breasts.