• Ethinyl Estradiol and Norelgestromin Transdermal

    (eth' in il) (es tra dye' ole) (nor el jes' troe min)

    IMPORTANT WARNING:

    Cigarette smoking increases the risk of serious side effects from the contraceptive patch, including heart attacks, blood clots, and strokes. This risk is higher for women over 35 years old and heavy smokers (15 or more cigarettes per day). If you use the contraceptive patch, you should not smoke.

    WHY is this medicine prescribed?

    Ethinyl estradiol and norelgestromin transdermal system (patch) is used to prevent pregnancy. Norelgestromin is a progestin and ethinyl estradiol is an estrogen. Estrogen and progestin are two female sex hormones. Ethinyl estradiol and norelgestromin contraceptive patch works by preventing ovulation (the release of eggs from the ovaries) and by changing the cervical mucus and the lining of the uterus. The contraceptive patch is a very effective method of birth control, but it does not prevent the spread of human immunodeficiency virus (HIV; the virus that causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases.

    HOW should this medicine be used?

    Ethinyl estradiol and norelgestromin transdermal system comes as a patch to apply to the skin. One patch is applied once a week for 3 weeks, followed by a patch-free week. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use the contraceptive patch exactly as directed.
    If you are just starting to use the contraceptive patch, you may apply your first patch on the first day of your menstrual period or the first Sunday after your period begins. If you apply your first patch after the first day of your menstrual period, you must use a backup method of birth control (such as a condom and/or a spermicide) for the first 7 days of the first cycle.
    Always apply your new patch on the same day of the week (the Patch Change Day). Apply a new patch once a week for 3 weeks. During Week 4, remove the old patch but do not apply a new patch, and expect to begin your menstrual period. On the day after Week 4 ends, apply a new patch to start a new 4-week cycle even if your menstrual period has not started or has not ended. You should not go more than 7 days without a patch.
    Apply the contraceptive patch to a clean, dry, intact, healthy area of skin on the buttock, abdomen, upper outer arm, or upper torso, in a place where it will not be rubbed by tight clothing. Do not place the contraceptive patch on the breasts or on skin that is red, irritated, or cut. Do not apply makeup, creams, lotions, powders, or other topical products to the skin area where the contraceptive patch is placed. Each new patch should be applied to a new spot on the skin to help avoid irritation.
    Do not cut, decorate, or change the patch in any way. Do not use extra tape, glue, or wraps to hold the patch in place.
    To use the contraceptive patch, follow these steps:
    1. Open the foil pouch by tearing it along the edge.
    2. Peel apart the foil pouch and open it flat.
    3. Use your fingernail to lift one corner of the patch and peel the patch and its clear plastic liner off the foil liner. Sometimes patches can stick to the inside of the pouch; be careful not to remove the clear liner as you remove the patch.
    4. Peel away half of the plastic liner. Avoid touching the sticky surface of the patch.
    5. Apply the sticky surface of the patch to the skin and remove the other half of the plastic liner. Press down firmly on the patch with the palm of your hand for 10 seconds, making sure that the edges stick well.
    6. After one week, remove the patch from your skin. Fold the used patch in half so that it sticks to itself and throw it away in a trash can that is out of the reach of children and pets. Do not flush the used patch down the toilet.
    Check your patch every day to make sure it is sticking. If the patch has been partially or completely detached for less than one day, try to reapply it in the same place immediately. Do not try to reapply a patch that is no longer sticky, that has stuck to itself or another surface, that has any material stuck to its surface or that has loosened or fallen off before. Apply a new patch instead. Your Patch Change Day will stay the same. If the patch has been partially or completely detached for more than one day, or if you do not know how long the patch has been detached, you may not be protected from pregnancy. You must start a new cycle by applying a new patch immediately; the day that you apply the new patch becomes your new Patch Change Day. Use backup birth control for the first week of the new cycle.
    If the skin under your patch becomes irritated, you may remove the patch and apply a new patch to a different spot on the skin. Leave the new patch in place until your regular Patch Change Day. Be sure to remove the old patch because you should never wear more than one patch at a time.
    Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

    Are there OTHER USES for this medicine?

    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before using ethinyl estradiol and norelgestromin contraceptive patch,
    • tell your doctor and pharmacist if you are allergic to estrogens, progestins, or any other medications.
    • tell your doctor if you are using any other type of hormonal birth control, such as pills, rings, injections, or implants. Your doctor will tell you how and when you should stop using the other type of birth control and start using the contraceptive patch. Do not use any other type of hormonal birth control while you are using the contraceptive patch.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics such as ampicillin; anticoagulants ('blood thinners') such as warfarin (Coumadin); antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral); ascorbic acid (vitamin C); atorvastatin (Lipitor); clofibrate ; cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), felbamate (Felbatol), phenobarbital (Luminal, Solfoton), oxcarbazepine (Trileptal), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor what herbal products you are taking, especially products containing St. John's wort.
    • tell your doctor if you have recently had surgery or if you are on bedrest. Also tell your doctor if you have or have ever had a heart attack; a stroke; blood clots in your legs, lungs, or eyes; chest pain due to heart disease; cancer of the breasts, lining of the uterus, cervix, or vagina; vaginal bleeding between menstrual periods; hepatitis (swelling of the liver); yellowing of the skin or eyes, especially while you were pregnant or using hormonal contraceptives; a liver tumor; headaches that happen with other symptoms such as weakness or difficulty seeing or moving; high blood pressure; diabetes that has caused problems with your kidneys, eyes, nerves, or blood vessels; or heart valve disease. Your doctor will probably tell you that you should not use the contraceptive patch.
    • tell your doctor if you have recently given birth or had a miscarriage or abortion and if you weigh 198 lbs or more. Also tell your doctor if anyone in your family has ever had breast cancer and if you have or have ever had breast lumps, fibrocystic disease of the breast (condition in which lumps or masses that are not cancer form in the breasts) or an abnormal mammogram (x-ray of the breasts). Also tell your doctor if you have or have ever had high blood cholesterol and fats; diabetes; asthma; migraines or other types of headaches; depression; seizures; scanty or irregular menstrual periods; or liver, heart, gallbladder, or kidney disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using ethinyl estradiol and norelgestromin contraceptive patch, call your doctor immediately. You should suspect that you are pregnant and call your doctor if you have used the contraceptive patch correctly and you have missed two periods in a row, or if you have not used the contraceptive patch correctly and you have missed one period.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are using ethinyl estradiol and norelgestromin contraceptive patch. Talk to your doctor about this as soon as your surgery is scheduled because your doctor may want you to stop using the contraceptive patch several weeks before your surgery.
    • tell your doctor if you wear contact lenses. If you notice changes in your vision or ability to wear your lenses while using ethinyl estradiol and norelgestromin contraceptive patch, see an eye doctor.
    • you should know that when you use the contraceptive patch, the average amount of estrogen in your blood will be higher than it would be if you used an oral contraceptive (birth control pill), and this may increase the risk of serious side effects such as blood clots in the legs or lungs. Three studies were done to learn more about this risk. Two studies found that women who used contraceptive patches were more likely to develop blood clots than women who used oral contraceptives. The other study found that women who used contraceptive patches were no more likely to develop blood clots than women who used oral contraceptives. Talk to your doctor about the risks of using the contraceptive patch.

    What SPECIAL DIETARY instructions should I follow?

    Unless your doctor tells you otherwise, continue your normal diet.

    What should I do IF I FORGET to take a dose?

    If you forget to apply your patch at the start of any patch cycle (Week 1, Day 1), you may not be protected from pregnancy. Apply the first patch of the new cycle as soon as you remember. There is now a new Patch Change Day and a new Day 1. Use a backup method of birth control for one week.
    If you forget to change your patch in the middle of the patch cycle (Week 2 or Week 3) for 1 or 2 days, apply a new patch immediately and apply the next patch on your usual Patch Change Day. If you forget to change your patch in the middle of the cycle for more than 2 days, you may not be protected from pregnancy. Stop the current cycle and start a new cycle immediately by applying a new patch. There is now a new Patch Change Day and a new Day 1. Use a backup method of birth control for 1 week.
    If you forget to remove your patch at the end of the patch cycle (Week 4), take it off as soon as you remember. Start the next cycle on the usual Patch Change Day, the day after Day 28.

    What SIDE EFFECTS can this medicine cause?

    Ethinyl estradiol and norelgestromin contraceptive patch may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • irritation, redness, or rash in the place where you applied the patch
    • breast tenderness, enlargement, or discharge
    • nausea
    • vomiting
    • stomach cramps or bloating
    • weight gain or weight loss
    • change in appetite
    • brown or black skin patches
    • acne
    • swelling of the hands, feet, ankles, or lower legs
    • hair loss
    • bleeding or spotting between menstrual periods
    • changes in menstrual flow
    • painful or missed periods
    • vaginal itching or irritation
    • white vaginal discharge
    • difficulty wearing contact lenses
    Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
    • sudden severe headache or vomiting
    • speech problems
    • dizziness or faintness
    • weakness or numbness of an arm or leg
    • sudden partial or complete loss of vision
    • double vision
    • bulging eyes
    • sharp or crushing chest pain
    • chest tightness
    • coughing up blood
    • shortness of breath
    • calf pain
    • severe stomach pain
    • sleep problems, mood changes, and other signs of depression
    • yellowing of the skin or eyes
    • unusual bleeding
    • loss of appetite
    • extreme tiredness, weakness, or lack of energy
    • fever
    • dark-colored urine
    • light-colored stool
    • rash
    Ethinyl estradiol and norelgestromin contraceptive patch may increase the risk of developing endometrial and breast cancer, gallbladder disease, liver tumors, heart attack, stroke, and blood clots. Talk to your doctor about the risks of using this medication.
    Ethinyl estradiol and norelgestromin contraceptive patch may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, remove all the patches that were applied and call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor's directions for examining your breasts; report any lumps immediately.
    Before you have any laboratory tests, tell the laboratory personnel that you use ethinyl estradiol and norelgestromin contraceptive patch, as this medication may interfere with some laboratory tests.
    Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Ortho Evra® (as a combination product containing Ethinyl Estradiol, Norelgestromin)

    Other Names

    • birth control patch

    Estradiol Transdermal

    (es tra dye' ole)

    IMPORTANT WARNING:

    Estradiol increases the risk that you will develop endometrial cancer (cancer of the lining of the uterus [womb]). The longer you use estradiol, the greater the risk that you will develop endometrial cancer. If you have not had a hysterectomy (surgery to remove the uterus), you should be given another medication called a progestin to take with transdermal estradiol. This may decrease your risk of developing endometrial cancer but may increase your risk of developing certain other health problems, including breast cancer. Before you begin using transdermal estradiol, tell your doctor if you have or have ever had cancer and if you have unusual vaginal bleeding. Call your doctor immediately if you have abnormal or unusual vaginal bleeding during your treatment with transdermal estradiol. Your doctor will watch you closely to help ensure you do not develop endometrial cancer during or after your treatment.
    In a large study, women who took estrogens (a group of medications that includes estradiol) by mouth with progestins had a higher risk of heart attacks, strokes, blood clots in the lungs or legs, breast cancer, and dementia (loss of ability to think, learn, and understand). Women who use transdermal estradiol alone or with progestins may also have a higher risk of developing these conditions. Tell your doctor if you smoke or use tobacco, if you have had a heart attack or a stroke in the past year, and if you or anyone in your family has or has ever had blood clots or breast cancer. Also tell your doctor if you have or have ever had high blood pressure, high blood levels of cholesterol or fats, diabetes, heart disease, lupus ( a condition in which the body attacks its own tissues causing damage and swelling), breast lumps, or an abnormal mammogram (x-ray of the breast used to find breast cancer).
    The following symptoms can be signs of the serious health conditions listed above. Call your doctor immediately if you experience any of the following symptoms while you are using transdermal estradiol: sudden, severe headache; sudden, severe vomiting; speech problems; dizziness or faintness; sudden complete or partial loss of vision; double vision; weakness or numbness of an arm or a leg; crushing chest pain or chest heaviness; coughing up blood; sudden shortness of breath; difficulty thinking clearly, remembering, or learning new things; breast lumps or other breast changes; discharge from nipples; or pain, tenderness, or redness in one leg.
    You can take steps to decrease the risk that you will develop a serious health problem while you are using transdermal estradiol. Do not use transdermal estradiol alone or with a progestin to prevent heart disease, heart attacks, strokes, or dementia. Use the lowest dose of transdermal estradiol that controls your symptoms and only use transdermal estradiol as long as needed. Talk to your doctor every 3 to 6 months to decide if you should use a lower dose of transdermal estradiol or should stop using the medication.
    You should examine your breasts every month and have a mammogram and a breast exam performed by a doctor every year to help detect breast cancer as early as possible. Your doctor will tell you how to properly examine your breasts and whether you should have these exams more often than once a year because of your personal or family medical history.
    Tell your doctor if you are having surgery or will be on bedrest. Your doctor may tell you to stop using transdermal estradiol 4 to 6 weeks before the surgery or bedrest to decrease the risk that you will develop blood clots.
    Talk to your doctor regularly about the risks and benefits of using transdermal estradiol.

    WHY is this medicine prescribed?

    Most brands of estradiol transdermal patches are used to treat hot flushes (hot flashes; sudden strong feelings of heat and sweating) and/or vaginal dryness, itching, and burning in women who are experiencing menopause (change of life; the end of monthly menstrual periods). Transdermal estradiol is also used to prevent osteoporosis (a condition in which the bones become thin and weak and break easily) in women who are experiencing or have experienced menopause. Women who need to use transdermal estradiol for more than one of these reasons can benefit most from the medication. Women whose only bothersome symptoms are vaginal dryness, itching, or burning may benefit more from an estrogen product that is applied topically to the vagina. Women who only need a medication to prevent osteoporosis may benefit more from a different medication that does not contain estrogen. Most brands of estradiol transdermal patches are also sometimes used as a source of estrogen in young women who do not produce enough estrogen naturally. Estradiol is in a class of medications called estrogen hormones. It works by replacing estrogen that is normally produced by the body.
    Menostar® brand patches contain less estrogen than other brands of estradiol transdermal patches. Menostar®patches are used only to prevent osteoporosis in women who are experiencing or have experienced menopause.

    HOW should this medicine be used?

    Transdermal estradiol comes as a patch to apply to the skin. Transdermal estradiol is usually applied once or twice a week, depending on the brand of patch that is used. Some women wear a patch all the time, and other women wear a patch according to a rotating schedule that alternates 3 weeks when the patch is worn followed by 1 week when the patch is not worn. Always apply your transdermal patch on the same day(s) of the week every week. There may be a calendar on the inner flap of your medication carton where you can keep track of your patch change schedule. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use transdermal estradiol exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor.
    Your doctor will start you on a low dose of transdermal estradiol and may increase your dose if your symptoms are still bothersome. If you are already taking or using an estrogen medication, your doctor will tell you how to switch from the estrogen medication you are taking or using to transdermal estradiol. Be sure you understand these instructions. Talk to your doctor about how well transdermal estradiol works for you.
    You should apply estradiol patches to clean, dry, cool skin in the lower stomach area, below your waistline. Some brands of patches may also be applied to the upper buttocks or the hips. Ask your doctor or pharmacist or read the manufacturer's information that comes with your patches to find the best place(s) to apply the brand of patches you have received. Do not apply any brand of estradiol patches to the breasts or to skin that is oily, damaged, cut, or irritated. Do not apply estradiol patches to the waistline where they may be rubbed off by tight clothing or to the lower buttocks where they may be rubbed off by sitting. Be sure that the skin in the area where you plan to apply an estradiol patch is free of lotion, powders, or creams. After you apply a patch to a particular area, wait at least 1 week before applying another patch to that spot. Some brands of patches should not be applied to an area of the skin that is exposed to sunlight. Talk to your doctor or pharmacist to find out whether your patch should be applied to an area that will not be exposed to sunlight.
    Talk to your doctor or pharmacist or read the manufacturer's information that came with your medication to find out if you need to be careful when you swim, bathe, shower, or use a sauna while wearing an estradiol transdermal patch. Some brands of patches are not likely to be affected by these activities, but some brands of patches may loosen. Some types of patches may also be pulled and loosened by your clothes or towel when you change clothes or dry your body. You may need to check that your patch is still firmly attached after these activities.
    If the patch loosens or falls off before it is time to replace it, try to press it back in place with your fingers. Be careful not to touch the sticky side of the patch with your fingers while you are doing this. If the patch cannot be pressed back on, fold it in half so it sticks to itself, throw it away in a trash can that is out of the reach of children and pets, and apply a fresh patch to a different area. Replace the fresh patch on your next scheduled patch change day.
    Each brand of estradiol transdermal patches should be applied following the specific directions given in the manufacturer's information for the patient. Read this information carefully before you start using estradiol transdermal and each time you refill your prescription. Ask your doctor or pharmacist if you have any questions. The following general directions can help you remember some important things to do when you apply any type of estradiol transdermal patch.
    1. Tear open the pouch with your fingers. Do not use scissors because they may damage the patch. Do not open the pouch until you are ready to apply the patch.
    2. Remove the patch from the pouch. There may be a silver foil sticker used to protect the patch from moisture inside the pouch. Do not remove this sticker from the pouch.
    3. Remove the protective liner from the patch and press the sticky side of the patch against your skin in the area you have chosen to wear your patch. Some patches have a liner that is made to peel off in two pieces. If your patch has that type of liner, you should peel off one part of the liner and press that side of the patch against your skin. Then fold back the patch, peel off the other part of the liner and press the second side of the patch against your skin. Always be careful not to touch the sticky side of the patch with your fingers.
    4. Press down on the patch with your fingers or palm for 10 seconds. Be sure that the patch is firmly attached to your skin, especially around its edges.
    5. Wear the patch all the time until it is time to remove it. When it is time to remove the patch, slowly peel it off of your skin. Fold the patch in half so that the sticky sides are pressed together and throw it away in a trash can that is out of reach of children and pets.
    6. Some brands of patches may leave a sticky substance on your skin. In some cases, this can be rubbed off easily. In other cases, you should wait 15 minutes and then remove the substance using an oil or lotion. Read the information that came with your patches to find out what to do if a substance is left on your skin after you remove your patch.
    Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

    Are there OTHER USES for this medicine?

    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before using transdermal estradiol,
    • tell your doctor and pharmacist if you are allergic to any brand of transdermal estradiol, any other estrogen products, any other medications, or any adhesives. Ask your doctor or pharmacist if you are not sure if a medication you are allergic to contains estrogen.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral); aprepitant (Emend); carbamazepine (Carbatrol, Epitol, Tegretol); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); dexamethasone (Decadron, Dexpak); diltiazem (Cardizem, Dilacor, Tiazac, others); erythromycin (E.E.S, Erythrocin); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); griseofulvin (Fulvicin, Grifulvin, Gris-PEG); lovastatin (Altocor, Mevacor); medications for human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) such as atazanavir (Reyataz), delaviridine (Rescriptor); efavirenz (Sustiva);indinavir (Crixivan), lopinavir (in Kaletra),nelfinavir (Viracept), nevirapine (Viramune); ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); medications for thyroid disease; nefazodone; other medications that contain estrogen; phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate); sertraline (Zoloft);troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor what herbal products you are taking, especially St. John's wort.
    • tell your doctor if you have or have ever had asthma; seizures; migraine headaches; endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body); uterine fibroids (growths in the uterus that are not cancer); yellowing of the skin or eyes, especially during pregnancy or while you were using an estrogen product; very high or very low levels of calcium in your blood; porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system)or gallbladder, thyroid, pancreas, liver or kidney disease.
    • tell your doctor if you are pregnant or plan to become pregnant, or are breast-feeding. If you become pregnant while using transdermal estradiol, call your doctor.
    • if you are using transdermal estradiol to prevent osteoporosis, talk to your doctor about additional ways to prevent the disease such as exercising and taking vitamin D and/or calcium supplements.

    What SPECIAL DIETARY instructions should I follow?

    Talk to your doctor about eating grapefruit and drinking grapefruit juice while using this medication.
    Talk to your doctor about ways to increase the amount of calcium and vitamin D in your diet.

    What should I do IF I FORGET to take a dose?

    Apply the missed patch as soon as you remember. Then apply the next patch according to your regular schedule. Do not apply extra patches to make up for a missed patch.

    What SIDE EFFECTS can this medicine cause?

    Transdermal estradiol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • headache
    • breast pain or tenderness
    • nausea
    • vomiting
    • constipation
    • gas
    • heartburn
    • weight gain or loss
    • hair loss
    • redness or irritation of the skin that was covered by the estradiol patch
    • swelling, redness, burning, irritation or itching of the vagina
    • vaginal discharge
    • painful menstrual periods
    • anxiety
    • depression
    • changes in mood
    • change in sexual desire
    • back, neck, or muscle pain
    • runny nose or congestion
    • cough
    • darkening of skin on face (may not go away even after you stop using transdermal estradiol)
    • unwanted hair growth
    • difficulty wearing contact lenses
    Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:
    • bulging eyes
    • yellowing of the skin or eyes
    • loss of appetite
    • fever
    • joint pain
    • stomach tenderness, pain, or swelling
    • movements that are difficult to control
    • itching
    • hives
    • rash, blisters on skin, or other skin changes
    • swelling, of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
    • hoarseness
    • difficulty breathing or swallowing
    Transdermal estradiol may increase your risk of developing cancer of the ovaries and gallbladder disease that may need to be treated with surgery. Talk to your doctor about the risks of using transdermal estradiol.
    Transdermal estradiol may cause growth to slow or stop early in children who use large doses for a long time. Your child's doctor will monitor her carefully during her treatment with transdermal estradiol. Talk to your child's doctor about the risks of giving this medication to your child.
    Transdermal estradiol may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep estradiol patches sealed in their original pouches and out of reach of children. Store the patches at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include:
    • nausea
    • vomiting
    • vaginal bleeding

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to transdermal estradiol.
    Before having any laboratory test, tell your doctor and the laboratory personnel that you are using transdermal estradiol.
    Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Alora®
    • Climara®
    • Estraderm®
    • Menostar®
    • Vivelle®
    • Vivelle-Dot®

    Other Names

    • Estrogen replacement therapy
    • ERT
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  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.