Drospirenone + Estradiol

Indications

Drospirenone + Estradiol is used for: Hormone replacement therapy (HRT), Climacteric syndrome in postmenopausal women including vasomotor symptoms (such as hot flushes and sweating attacks), sleep disorders, depressed moods, nervousness and atrophic, urogenital conditions caused by deficient endogenous estrogen production due to natural menopause, hypogonadism, castration or primary ovarian failure in women with an intact uterus, Prevention of postmenopausal osteoporosis

Adult Dose

Hormone Replacement Therapy Oral Tablet 1 tablet PO daily Hepatic impairment In women with mild or moderate hepatic impairment, DRSP is well tolerated. It is contraindicated in women with severe hepatic disease

Child Dose

Renal Dose

Renal Impairment In women with mild or moderate renal impairment, a slight increase of Drug Resistant Streptococcus Pneumoniae exposure was observed but is not expected to be of clinical relevance. It is contraindicated in women with severe renal disease.

Administration

Each pack covers 28 days of treatment. Treatment is continuous, which means that the next pack follows immediately without a break. The tablets are to be swallowed whole with some liquid irrespective of food intake. The tablets should preferably be taken at the same time every day. For treatment of postmenopausal symptoms, the lowest effective dose should be used. For initiation and continuation of treatment of postmenopausal symptoms, the lowest effective dose for the shortest duration should be used.

Contra Indications

Hormone replacement therapy (HRT) should not be started in the presence of any of the conditions listed below. The product should be stopped immediately, if any of the conditions appear during HRT use. Undiagnosed abnormal genital bleeding Known or suspected cancer of the breast Known or suspected premalignant conditions or malignancies, if sex steroid-influenced The excess risk disappears within a few years after stopping HRT. Endometrial cancer Prolonged exposure to unopposed estrogens increases the risk of development of endometrial hyperplasia or carcinoma. The addition of DRSP opposes the development of endometrial hyperplasia caused by estrogens. Liver tumors In rare cases benign, and even more rarely, malignant liver tumors have been observed after the use of hormonal substances such as those contained in HRT products. In isolated cases, these tumors led to life-threatening intra-abdominal hemorrhage.

Precautions

Before initiating therapy, all conditions/risk factors mentioned below should be considered when determining the individual benefit/risk of treatment for the patient. During HRT use, therapy should be discontinued immediately in case a contraindication is discovered, as well as in the following situations: 1. Migrainous or frequent and unusually severe headaches that occur for the first time or other symptoms that are possible prodromal of cerebrovascular occlusion. 2. Recurrence of cholestatic jaundice or cholestatic pruritus which occurred first during pregnancy or previous use of sex steroids. 3. Symptoms of a thrombotic event. In the event of new onset or deterioration of the following conditions or risk factors, the individual benefit/risk analysis should be re-done, taking into consideration the possible necessity of discontinuing therapy. The potential for an increased synergistic risk of thrombosis should be considered in women who possess a combination of risk factors or exhibit a greater severity of an individual risk factor. This increased risk may be greater than a simple cumulative risk of the factors. HRT should not be prescribed in case of a negative risk benefit assessment.

Pregnancy-Lactation

Pregnancy Category: contraindicated in pregnancy Lactation: enters breast milk/not recommended

Interactions

Pharmacodynamic interaction with antihypertensive medications and non-steroidal anti-inflammatory drugs (NSAID) Hypertensive women treated with this combination drugs and anti-hypertensive medications, e.g. ACE inhibitors, angiotensin II receptor antagonists, and hydrochlorothiazide may experience an additional decrease in blood pressure. Combined use of this and NSAIDs or antihypertensive medications is unlikely to increase serum potassium. Concomitant use of these three types of medications together may cause a small increase in serum potassium, more pronounced in diabetic women.

Adverse Effects

Side effects of Drospirenone + Estradiol : >10% Breast pain (19%) Upper respiratory infection (19%) Abdominal pain (11%) 1-10% Edema Peripheral edema Headache Accidental injury, back pain, pain in extremity Endometrial disorder Leukorrhea Vaginal hemorrhage Abdominal enlargement Flu syndrome Sinusitis

Mechanism of Action

Estradiol: Endogenous estrogen; reduces the release of gonadotropin-releasing hormone from hypothalamus, reduces release of luteinizing hormone (LH) and follicle stimulating hormone (FSH) from pituitary gland; increases synthesis of DNA, RNA, and various proteins in target tissues. Estrogen replacement reduces elevated levels of estrogen and progesterone LH and FSH in postmenopausal women Drospirenone: Progestin; spironolactone analog with antimineralocorticoid and antiandrogenic activity