(conjugated estrogens and medroxyprogesterone acetate)
8 USE IN SPECIFIC POPULATIONS
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Risk Summary
PREMPRO and PREMPHASE are not indicated for use during pregnancy.
There are no data with the use of PREMPRO and PREMPHASE in pregnant women; however, epidemiologic studies and meta-analyses have not found an increased risk of genital or nongenital birth defects (including cardiac anomalies and limb-reduction defects) following exposure to combined hormonal contraceptives (estrogen and progestins) before conception or during early pregnancy.
In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
8.2 Lactation
Risk Summary
Estrogens and progestins and metabolites are present in human milk. These hormones can reduce milk production in breast-feeding women. This reduction can occur at any time but is less likely to occur once breast-feeding is well established. The developmental and health benefits of breast-feeding should be considered along with the mother’s clinical need for PREMPRO or PREMPHASE and any potential adverse effects on the breast-fed child from PREMPRO or PREMPHASE or from the underlying maternal condition.
8.4 Pediatric Use
PREMPRO and PREMPHASE are not indicated in children. Clinical studies have not been conducted in the pediatric population.
8.5 Geriatric Use
There have not been sufficient numbers of geriatric women involved in clinical studies utilizing PREMPRO or PREMPHASE to determine whether those over 65 years of age differ from younger subjects in their response to PREMPRO or PREMPHASE.
The Women's Health Initiative Study
In the WHI estrogen plus progestin substudy (daily CE [0.625 mg] plus MPA [2.5 mg] versus placebo), there was a higher relative risk of nonfatal stroke and invasive breast cancer in women greater than 65 years of age [see Clinical Studies (14.6)].
In the WHI estrogen-alone substudy (daily CE [0.625 mg]-alone versus placebo), there was a higher relative risk of stroke in women greater than 65 years of age [see Clinical Studies (14.6)].
The Women's Health Initiative Memory Study
In the WHIMS ancillary studies of postmenopausal women 65 to 79 years of age, there was an increased risk of developing probable dementia in women receiving estrogen plus progestin or estrogen-alone when compared to placebo [see Warnings and Precautions (5.3), and Clinical Studies (14.7)].
Since both ancillary studies were conducted in women 65 to 79 years of age, it is unknown whether these findings apply to younger postmenopausal women8 [see Warnings and Precautions (5.3), and Clinical Studies (14.7)].
PATIENT INFORMATION
PATIENT INFORMATION
PREMPRO®
(Conjugated Estrogens/Medroxyprogesterone Acetate Tablets)
PREMPHASE®
(Conjugated Estrogens plus Medroxyprogesterone Acetate Tablets)
Read this PATIENT INFORMATION before you start taking PREMPRO or PREMPHASE and read what you get each time you refill your PREMPRO or PREMPHASE prescription. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or your treatment.
What is the most important information I should know about PREMPRO and PREMPHASE (combinations of estrogens and a progestin)?
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What is PREMPRO or PREMPHASE?
PREMPRO or PREMPHASE are medicines that contain two kinds of hormones, estrogens and a progestin.
What is PREMPRO or PREMPHASE used for?
PREMPRO or PREMPHASE is used after menopause to:
- •
- Reduce moderate to severe hot flushes
Estrogens are hormones made by a woman's ovaries. The ovaries normally stop making estrogens when a woman is between 45 and 55 years old. This drop in body estrogen levels causes the "change of life" or menopause (the end of monthly menstrual periods). Sometimes, both ovaries are removed during an operation before natural menopause takes place. The sudden drop in estrogen levels causes "surgical menopause."
When the estrogen levels begin dropping, some women get very uncomfortable symptoms, such as feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating ("hot flushes"). In some women the symptoms are mild, and they will not need to take estrogens. In other women, symptoms can be more severe. - •
- Treat menopausal changes in and around the vagina
You and your healthcare provider should talk regularly about whether you still need treatment with PREMPRO or PREMPHASE to control these problems. If you use PREMPRO or PREMPHASE only to treat your menopausal changes in and around your vagina, talk with your healthcare provider about whether a topical vaginal product would be better for you. - •
- Help reduce your chances of getting osteoporosis (thin weak bones)
Osteoporosis from menopause is a thinning of the bones that makes them weaker and easier to break. If you use PREMPRO or PREMPHASE only to prevent osteoporosis due to menopause, talk with your healthcare provider about whether a different treatment or medicine without estrogens might be better for you. Weight-bearing exercise, like walking or running, and taking calcium (1500 mg per day of elemental calcium) and vitamin D (400–800 IU per day) supplements may also lower your chances of getting postmenopausal osteoporosis. It is important to talk about exercise and supplements with your healthcare provider before starting them.
You and your healthcare provider should talk regularly about whether you still need treatment with PREMPRO or PREMPHASE.
Who should not take PREMPRO or PREMPHASE?
Do not take PREMPRO or PREMPHASE if you have had your uterus (womb) removed (hysterectomy).
PREMPRO and PREMPHASE contain a progestin to decrease the chance of getting cancer of the uterus. If you do not have a uterus, you do not need a progestin and you should not take PREMPRO or PREMPHASE.
Do not take PREMPRO or PREMPHASE if you:
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- Have unusual vaginal bleeding
- •
- Currently have or have had certain cancers
Estrogens may increase the chance of getting certain types of cancers, including cancer of the breast or uterus. If you have or have had cancer, talk with your healthcare provider about whether you should use PREMPRO or PREMPHASE. - •
- Had a stroke or heart attack
- •
- Currently have or have had blood clots
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- Currently have or have had liver problems
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- Have been diagnosed with a bleeding disorder
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- Are allergic to PREMPRO or PREMPHASE or any of their ingredients
See the list of ingredients in PREMPRO and PREMPHASE at the end of this leaflet.
Tell your healthcare provider
- •
- If you have any unusual vaginal bleeding
Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause. - •
- About all of your medical problems
Your healthcare provider may need to check you more carefully if you have certain conditions, such as asthma (wheezing), epilepsy (seizures), diabetes, migraine, endometriosis, lupus, problems with your heart, liver, thyroid, kidneys, or have high calcium levels in your blood. - •
- About all the medicines you take
This includes prescription and nonprescription medicines, vitamins, and herbal supplements. Some medicines may affect how PREMPRO or PREMPHASE works. PREMPRO or PREMPHASE may also affect how your other medicines work. - •
- If you are going to have surgery or will be on bedrest
You may need to stop taking PREMPRO or PREMPHASE. - •
- If you are pregnant or think you may be pregnant
PREMPRO and PREMPHASE are not for pregnant women.
- •
- If you are breastfeeding
The hormones in PREMPRO and PREMPHASE can pass into your breast milk.
How should I take PREMPRO or PREMPHASE?
- •
- Take one PREMPRO or PREMPHASE tablet at the same time each day
- •
- If you miss a dose, take it as soon as possible
If it is almost time for your next dose, skip the missed dose and go back to your normal schedule. Do not take 2 doses at the same time. - •
- Estrogens should be used at the lowest dose possible for your treatment only as long as needed
You and your healthcare provider should talk regularly (for example, every 3 to 6 months) about the dose you are taking and whether you still need treatment with PREMPRO or PREMPHASE.
What are the possible side effects of PREMPRO or PREMPHASE?
Side effects are grouped by how serious they are and how often they happen when you are treated.
Serious, but less common side effects include:
- •
- Heart attack
- •
- Stroke
- •
- Blood clots
- •
- Breast cancer
- •
- Cancer of the lining of the uterus (womb)
- •
- Cancer of the ovary
- •
- Dementia
- •
- High or low blood calcium
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- Gallbladder disease
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- Visual abnormalities
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- High blood pressure
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- High levels of fat (triglycerides) in your blood
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- Liver problems
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- Changes in your thyroid hormone levels
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- Fluid retention
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- Cancer changes of endometriosis
- •
- Enlargement of benign tumors of the uterus ("fibroids")
- •
- Severe allergic reactions
- •
- Changes in certain laboratory test results, such as high blood sugar
Call your healthcare provider right away if you get any of the following warning signs or any other unusual symptoms that concern you:
- •
- New breast lumps
- •
- Unusual vaginal bleeding
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- Changes in vision or speech
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- Sudden new severe headaches
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- Severe pains in your chest or legs with or without shortness of breath, weakness and fatigue
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- Swelling of the face, lips, and tongue with or without red itchy bumps
Common side effects of PREMPRO or PREMPHASE include:
- •
- Headache
- •
- Breast pain
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- Irregular vaginal bleeding or spotting
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- Stomach or abdominal cramps, bloating
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- Nausea and vomiting
- •
- Hair loss
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- Fluid retention
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- Vaginal yeast infection
These are not all the possible side effects of PREMPRO or PREMPHASE. For more information, ask your healthcare provider or pharmacist for advice about side effects. You may report side effects to Pfizer Inc. at 1-800-438-1985 or to FDA at 1-800-FDA-1088.
What can I do to lower my chances of getting a serious side effect with PREMPRO or PREMPHASE?
- •
- Talk with your healthcare provider regularly about whether you should continue taking PREMPRO or PREMPHASE
- •
- See your healthcare provider right away if you get vaginal bleeding while taking PREMPRO or PREMPHASE
- •
- Have a pelvic exam, breast exam and mammogram (breast X-ray) every year unless your healthcare provider tells you something else
If members of your family have had breast cancer or if you have ever had breast lumps or an abnormal mammogram, you may need to have breast exams more often. - •
- If you have high blood pressure, high cholesterol (fat in the blood), diabetes, are overweight, or if you use tobacco, you may have higher chances for getting heart disease
Ask your healthcare provider for ways to lower your chances of getting heart disease.
General Information about the safe and effective use of PREMPRO and PREMPHASE
Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not take PREMPRO or PREMPHASE for conditions for which it was not prescribed. Do not give PREMPRO or PREMPHASE to other people, even if they have the same symptoms you have. It may harm them.
Keep PREMPRO and PREMPHASE out of the reach of children.
This leaflet provides a summary of the most important information about PREMPRO and PREMPHASE. If you would like more information, talk with your healthcare provider or pharmacist. You can ask for information about PREMPRO and PREMPHASE that is written for health professionals.
What are the ingredients in PREMPRO and PREMPHASE?
PREMPRO contains the same conjugated estrogens found in Premarin, which are a mixture of sodium estrone sulfate and sodium equilin sulfate and other components, including sodium sulfate conjugates, 17α-dihydroequilin, 17α-estradiol and 17β-dihydroequilin. PREMPRO also contains either 1.5, 2.5, or 5 mg of medroxyprogesterone acetate.
PREMPRO 0.3 mg/1.5 mg and 0.45 mg/1.5 mg tablets also contain calcium phosphate tribasic, microcrystalline cellulose, lactose monohydrate, carnauba wax, hypromellose, magnesium stearate, polyethylene glycol, sucrose, hydroxypropyl cellulose, Eudragit NE 30D, titanium dioxide, yellow iron oxide, propylene glycol and black iron oxide.
PREMPRO 0.625 mg/2.5 mg tablets also contain calcium phosphate tribasic, microcrystalline cellulose, carnauba wax, lactose monohydrate, hypromellose, magnesium stearate, polyethylene glycol, sucrose, hydroxypropyl cellulose, Eudragit NE 30D, propylene glycol, titanium dioxide, red iron oxide, yellow iron oxide, and black iron oxide.
PREMPRO 0.625 mg/5 mg tablets also contain calcium phosphate tribasic, carnauba wax, Eudragit NE 30D, hydroxypropyl cellulose, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, sucrose, titanium dioxide, triethyl citrate, FD&C Blue No. 2, black iron oxide, and propylene glycol.
PREMPHASE is two separate tablets. One tablet (maroon color) is 0.625 mg of Premarin, which is a mixture of sodium estrone sulfate and sodium equilin sulfate and other components, including sodium sulfate conjugates, 17 α-dihydroequilin, 17 α-estradiol and 17 β-dihydroequilin. The maroon tablet also contains calcium phosphate tribasic, carnauba wax, hydroxypropyl cellulose, microcrystalline cellulose, powdered cellulose, hypromellose, lactose monohydrate, magnesium stearate, polyethylene glycol, sucrose, titanium dioxide, propylene glycol, FD&C Blue No. 2, FD&C Red No. 40. The second tablet (light-blue color) contains 0.625 mg of the same ingredients as the maroon color tablet plus 5 mg of medroxyprogesterone acetate. The light-blue tablet also contains calcium phosphate tribasic, carnauba wax, Eudragit NE 30D, hydroxypropyl cellulose, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol, sucrose, titanium dioxide, triethyl citrate, FD&C Blue No. 2, black iron oxide, and propylene glycol.
PREMPRO therapy consists of a single tablet to be taken once daily.
PREMPRO 0.3 mg/1.5 mg
Blister Card - Each carton includes 1 blister card containing 28 oval, cream tablets. Each tablet contains 0.3 mg of the conjugated estrogens found in Premarin tablets and 1.5 mg of medroxyprogesterone acetate for oral administration.
PREMPRO 0.45 mg/1.5 mg
Blister Card - Each carton includes 1 blister card containing 28 oval, gold tablets. Each tablet contains 0.45 mg of the conjugated estrogens found in Premarin tablets and 1.5 mg of medroxyprogesterone acetate for oral administration.
PREMPRO 0.625 mg/2.5 mg
Blister Card - Each carton includes 1 blister card containing 28 oval, peach tablets. Each tablet contains 0.625 mg of the conjugated estrogens found in Premarin tablets and 2.5 mg of medroxyprogesterone acetate for oral administration.
PREMPRO 0.625 mg/5 mg
Blister Card - Each carton includes 1 blister card containing 28 oval, light-blue tablets. Each tablet contains 0.625 mg of the conjugated estrogens found in Premarin tablets and 5 mg of medroxyprogesterone acetate for oral administration.
PREMPHASE therapy consists of two separate tablets; one maroon Premarin tablet taken daily on days 1 through 14 and one light-blue tablet taken on days 15 through 28.
Each carton includes 1 blister pack containing 28 tablets. One blister pack contains 14 oval, maroon Premarin tablets containing 0.625 mg of conjugated estrogens and 14 oval, light-blue tablets that contain 0.625 mg of the conjugated estrogens found in Premarin tablets and 5 mg of medroxyprogesterone acetate for oral administration.
The appearance of PREMPRO tablets is a trademark of Pfizer Inc.
The appearance of PREMARIN tablets is a trademark of Pfizer Inc. The appearance of the conjugated estrogens/medroxyprogesterone acetate combination tablets is a trademark.
Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature].
This product's labeling may have been updated. For the most recent prescribing information, please visit www.pfizer.com. |
LAB-0504-11.0
Revised 04/2025
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